Posture affects memory recall and mood
Posted: November 25, 2017 Filed under: Exercise/movement, self-healing, stress management, Uncategorized | Tags: cognitive therapy, depression, empowerment, energy, helplessness, memory, mood, posture, power posture, somatics 5 CommentsThis blog has been reprinted from: Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood. Biofeedback, 45 (2), 36-41.
When I sat collapsed looking down, negative memories flooded me and I found it difficult to shift and think of positive memories. While sitting erect, I found it easier to think of positive memories. -Student participant
The link between posture and mood is embedded in idiomatic phrases such as walking tall, standing proud, and an upstanding citizen, versus collapsed, defeated, or in a slump–Language suggests that posture and mood/emotions are connected. Slumped posture is commonly observed in depression (Canales et al., 2010; Michalak et al., 2009) and adapting an upright posture increases positive affect, reduces fatigue, and increases energy in people with mild to moderate depression (Wilkes et al., 2017; Peper & Lin, 2012).
This blog describes in detail our research study that demonstrated how posture affects memory recall (Peper et al, 2017). Our findings may explain why depression is increasing the more people use cell phones. More importantly, learning posture awareness and siting more upright at home and in the office may be an effective somatic self-healing strategy to increase positive affect and decrease depression.
Background
Most psychotherapies tend to focus on the mind component of the body-mind relationship. On the other hand, exercise and posture focus on the body component of the mind/emotion/body relationship. Physical activity in general has been demonstrated to improve mood and exercise has been successfully used to treat depression with lower recidivism rates than pharmaceuticals such as sertraline (Zoloft) (Babyak et al., 2000). Although the role of exercise as a treatment strategy for depression has been accepted, the role of posture is not commonly included in cognitive behavior therapy (CBT) or biofeedback or neurofeedback therapy.
The link between posture, emotions and cognition to counter symptoms of depression and low energy have been suggested by Wilkes et al. (2017) and Peper and Lin (2012), . Peper and Lin (2012) demonstrated that if people tried skipping rather than walking in a slouched posture, subjective energy after the exercise was significantly higher. Among the participants who had reported the highest level of depression during the last two years, there was a significant decrease of subjective energy when they walked in slouched position as compared to those who reported a low level of depression. Earlier, Wilson and Peper (2004) demonstrated that in a collapsed posture, students more easily accessed hopeless, powerless, defeated and other negative memories as compared to memories accessed in an upright position. More recently, Tsai, Peper, and Lin (2016) showed that when participants sat in a collapsed position, evoking positive thoughts required more “brain activation” (i.e. greater mental effort) compared to that required when walking in an upright position.
Even hormone levels also appear to change in a collapsed posture (Carney, Cuddy, & Yap, 2010). For example, two minutes of standing in a collapsed position significantly decreased testosterone and increased cortisol as compared to a ‘power posture,’ which significantly increased testosterone and decreased cortisol while standing. As Professor Amy Cuddy pointed out in herTechnology, Entertainment and Design (TED) talk, “By changing posture, you not only present yourself differently to the world around you, you actually change your hormones” (Cuddy, 2012). Although there appears to be controversy about the results of this study, the overall findings match mammalian behavior of dominance and submission. From my perspective, the concepts underlying Cuddy’s TED talk are correct and are reconfirmed in our research on the effect of posture. For more detail about the controversy, see the article by Susan Dominusin in the New York Times, “When the revolution came for Amy Cuddy,”, and Amy Cuddy’s response (Dominus, 2017;Singal and Dahl, 2016).
The purpose of our study is to expand on our observations with more than 3,000 students and workshop participants. We observed that body posture and position affects recall of emotional memory. Moreover, a history of self-described depression appears to affect the recall of either positive or negative memories.
Method
Subjects: 216 college students (65 males; 142 females; 9 undeclared), average age: 24.6 years (SD = 7.6) participated in a regularly planned classroom demonstration regarding the relationship between posture and mood. As an evaluation of a classroom activity, this report of findings was exempted from Institutional Review Board oversight.
Procedure
While sitting in a class, students filled out a short, anonymous questionnaire, which asked them to rate their history of depression over the last two years, their level of depression and energy at this moment, and how easy it was for them to change their moods and energy level (on a scale from 1–10). The students also rated the extent they became emotionally absorbed or “captured” by their positive or negative memory recall. Half of the students were asked to rate how they sat in front of their computer, tablet, or mobile device on a scale from 1 (sitting upright) to 10 (completely slouched).
Two different sitting postures were clearly defined for participants: slouched/collapsed and erect/upright as shown in Figure 1. To assume the collapsed position, they were asked to slouch and look down while slightly rounding the back. For the erect position, they were asked to sit upright with a slight arch in their back, while looking upward.
Figure 1. Sitting in a collapsed position and upright position (photo by Jana Asenbrennerova). Reprinted by permission from Gorter and Peper (2011).
After experiencing both postures, half the students sat in the collapsed position while the other half sat in the upright position. While in this position, they were asked to recall/evoke as many hopeless, helpless, powerless, or defeated memories as possible, one after the other, for 30 seconds.
After 30 seconds they were reminded to keep their same position and let go of thinking negative memories. They were then asked to recall/evoke only positive, optimistic, or empowering memories for 30 seconds.
They were then asked to switch positions. Those who were collapsed switched to sitting erect, and those who were erect switched to sitting collapsed. Then they were again asked to recall/evoke as many hopeless, helpless, powerless, or defeated memories as possible one after the other for 30 seconds. After 30 seconds they were reminded to keep their same position and again let go of thinking of negative memories. They were then asked to recall/evoke only positive, optimistic, or empowering memories for 30 seconds, while still retaining the second posture.
They then rated their subjective experience in recalling negative or positive memories and the degree to which they were absorbed or captured by the memories in each position, and in which position it was easier to recall positive or negative experiences.
Results
86% of the participants reported that it was easier to recall/access negative memories in the collapsed position than in the erect position, which was significantly different as determined by one-way ANOVA (F(1,430)=110.193, p < 0.01) and 87% of participants reported that it was easier to recall/access positive images in the erect position than in the collapsed position, which was significantly different as determined by one-way ANOVA (F(1,430)=173.861, p < 0.01) as shown in Figure 2.
Figure 2. Percent of respondents who reported that it was easier to recall positive or negative memories in an upright or slouched posture.
The difficulty or ease of recalling negative or positive memories varied depending on position as shown in Figure 3.
Figure 3. The relative subjective rating in the ease or difficulty of recalling negative and positive memories in collapsed and upright positions.
The participants with a high level of depression over the last two years (top 23% of participants who scored 7 or higher on the scale of 1–10) reported that it was significantly more difficult to change their mood from negative to positive (t(110) = 4.08, p < 0.01) than was reported by those with a low level of depression (lowest 29% of the participants who scored 3 or less on the scale of 1–10). It was significantly easier for more depressed students to recall/evoke negative memories in the collapsed posture (t(109) = 2.55, p = 0.01) and in the upright posture (t(110) = 2.41, p ≦0.05 he) and no significant difference in recalling positive memories in either posture, as shown in Figure 4.
Figure 4. Differences is in memory access for participants with a history of least or most depression.
For all participants, there was a significant correlation (r = 0.4) between subjective energy level and ease with which they could change from negative to positive mood. There were no significance differences for gender in all measures except that males reported a significantly higher energy level than females (M = 5.5, SD = 3.0 and M = 4.7, SD = 3.8, respectively; t(203) = 2.78, p < 0.01).
A subset of students also had rated their posture when sitting in front of a computer or using a digital device (tablet or cell phone) on a scale from 1 (upright) to 10 (completely slouched). The students with the highest levels of depression over the last two years reporting slouching significantly more than those with the lowest level of depression over the last two years (M = 6.4, SD = 3.5 and M = 4.6, SD = 2.6; t(46) = 3.5, p < 0.01).
There were no other order effects except of accessing fewer negative memories in the collapsed posture after accessing positive memories in the erect posture (t(159)=2.7, p < 0.01). Approximately half of the students who also rated being “captured” by their positive or negative memories were significantly more captured by the negative memories in the collapsed posture than in the erect posture (t(197) = 6.8, p < 0.01) and were significantly more captured by positive memories in the erect posture than the collapsed posture (t(197) = 7.6, p < 0.01), as shown in Figure 5.
Figure 5. Subjective rating of being captured by negative and positive memories depending upon position.
Discussion
Posture significantly influenced access to negative and positive memory recall and confirms the report by Wilson and Peper (2004). The collapsed/slouched position was associated with significantly easier access to negative memories. This is a useful clinical observation because ruminating on negative memories tends to decrease subjective energy and increase depressive feelings (Michi et al., 2015). When working with clients to change their cognition, especially in the treatment of depression, the posture may affect the outcome. Thus, therapists should consider posture retraining as a clinical intervention. This would include teaching clients to change their posture in the office and at home as a strategy to optimize access to positive memories and thereby reduce access or fixation on negative memories. Thus if one is in a negative mood, then slouching could maintain this negative mood while changing body posture to an erect posture, would make it easier to shift moods.
Physiologically, an erect body posture allows participants to breathe more diaphragmatically because the diaphragm has more space for descent. It is easier for participants to learn slower breathing and increased heart rate variability while sitting erect as compared to collapsed, as shown in Figure 6 (Mason et al., 2017).
Figure 6. Effect of posture on respiratory breathing pattern and heart rate variability.
The collapsed position also tends to increase neck and shoulder symptoms This position is often observed in people who work at the computer or are constantly looking at their cell phone—a position sometimes labeled as the i-Neck.
Implication for therapy
In most biofeedback and neurofeedback training sessions, posture is not assessed and clients sit in a comfortable chair, which automatically causes a slouched position. Similarly, at home, most clients sit on an easy chair or couch, which lets them slouch as they watch TV or surf the web. Finally, most people slouch when looking at their cellphone, tablet, or the computer screen (Guan et al., 2016). They usually only become aware of slouching when they experience neck, shoulder, or back discomfort.
Clients and therapists are usually not aware that a slouched posture may decrease the client’s energy level and increase the prevalence of a negative mood. Thus, we recommend that therapists incorporate posture awareness and training to optimize access to positive imagery and increase energy.
References
Singal, J. and Dahl, M. (2016, Sept 30 ) Here Is Amy Cuddy’s Response to Critiques of Her Power-Posing Research. https://www.thecut.com/2016/09/read-amy-cuddys-response-to-power-posing-critiques.html
We thank Frank Andrasik for his constructive comments.
Breathing to improve well-being
Posted: November 17, 2017 Filed under: Breathing/respiration, Exercise/movement, Neck and shoulder discomfort, Pain/discomfort, self-healing, stress management, Uncategorized | Tags: anxiety, Breathing, health, mindfulness, pain, respiration, stress 9 CommentsBreathing affects all aspects of your life. This invited keynote, Breathing and posture: Mind-body interventions to improve health, reduce pain and discomfort, was presented at the Caribbean Active Aging Congress, October 14, Oranjestad, Aruba. www.caacaruba.com
The presentation includes numerous practices that can be rapidly adapted into daily life to improve health and well-being.
Are you out of control and reacting in anger? The role of food and exercise
Posted: October 6, 2017 Filed under: Uncategorized | Tags: anger, diet, emotional control, exercise, food, heart rate, Holistic health 2 Comments
Fuming in anger, exploding in rage, shaking in fear, or trembling with anxiety, what can you do? How can you control your emotions and what can you do if you are reacting to a friend or colleague who is out of control? There are many useful self-directed approaches and traditional advice such as, “Count to 10 before you speak,” ”Sleep on it before acting on the decision you have made,” “Practice stress reduction techniques such as mindfulness meditation,” “Leave the situation,” or “Wait 24 hours before clicking “send” on an angry email response.”
These suggestions aim to reduce the strong negative emotions which could cause people to lash out at or totally withdraw from the perceived threat. Under perceived threat, we may react defensively and impulsively to protect ourselves. During those times we may say the meanest things to hurt the person as a substitute for inflicting actual physical harm.
In almost most cases when angry or frightened we may react automatically. Thus having skills to recognize and interrupt the escalating cycle of negative emotions can facilitate resolving conflicts. These skills allow us to react more cool headed, rationally, and recognize how our responses would impact other people and prevent future blow back from our excessive emotional response. It could also interrupt an escalating argument. Despite our best efforts, it is often difficult to change our emotional reaction especially when we feel threatened, hungry and tired.
Emotion regulation as described by Professor James Gross, Professor of Psychology at Stanford University, consists of 1) awareness that there is a need for an unhelpful emotion to be regulated such as noticing an increase in heart rate or worry, 2) selecting a strategy to regulate the emotion such as thinking about positive memories such as a loving grandparent or practicing breathing, 3) implementing and acting on this strategy which means doing the strategy at that moment when we don’t want to and all our impulses are saying “I am right, don’t change,” and 4) constant follow-up to check if what we are doing is effective and if not, what needs to be improved (Gross, 213).
This approach can be very effective and may work even better by combining multiple strategies instead of only one technique. The more skills you have and practiced the easier it becomes to master motional regulation. Sometimes, psychological behavioral approaches may underestimate the role of biological factors such as diet, exhaustion and exercise that underlie emotional regulation.
Think of a four-year child throwing a temper tantrum. As a parent, it not useful to discuss with the child what is going on. Each suggestion may increase the tantrum. Instead the parent thinks, “My child is exhausted or hungry” (how many tantrums don’t occur when the child stays up after bed time or just before dinner?). The millennium’s phrase, “hangry,” is the combination of hunger and anger.
The knowledge that food may prevent or reduce conflict is reflected in the cultural wisdom of most countries except the USA. In the Middle East you are offered tea and sweets before buying a small rug at the bazaar; in Japan or China, you are invited to a meal before beginning a business transaction. The food and may slightly raise your blood glucose levels and encourage digestion which triggers a physiological state that is the opposite of that triggered by anger or fear. It may also evoke positives feelings associated with eating such as family gatherings and parties. As the food and drink are a gift, it may allow you to perceive the other person more positively. Thus, it is easier to be collegial and react more positively in challenging situations. The influence of rest and food has also been observed in Judicial rulings. Judges are much more likely to accept prisoners’ requests for parole at the beginning of the session–right after breakfast or lunch–than later in the session (Danzier, Levav & Avnaim-Pesso, 2011).
What can you do?
One useful mental strategy when you are out of control is to remind yourself that you are acting like a four-year-old child who is having a tantrum. Begin in the same way as you would with a four-year-old: take time out, eat some food, and get rest. Then in the clear light of the next day, after having eating a nutritious breakfast– not just a cup of coffee with a muffin–discuss and resolve what happened the day before that triggered the outburst. Similarly, when another person is out of control, do not to take it personally, he/she may be a momentary acting like four-year-old.
Keep in mind, whatever other people said or did during an outburst, they may have responded automatically because they experienced their survival being threatened. Remember, how in a past moment of anger, you have said something very hurtful? At the moment the words left your mouth, you wished you could have reeled them back in as you realized that it would be almost impossible to repair the damage.
From a biological perspective you were hijacked by the amygdala which is part of our emotional brain (Goleman, 2006). The amygdala processes information 22 milliseconds earlier than the rational brain and acts protectively before our rational brain, the neocortex, can assess the situation and respond. This reaction occurs because the information signals “we are in danger” and evokes the automatic defense reaction as shown Figure 1.
Figure 1. Triggering of a defense reaction is 22 milliseconds quicker from the amygdala than from the cortex. Thus we sometimes react without recognizing the consequences (adapted from Ropeik, 2011)
Implement the cultural wisdom of eating together first and then discussing business or challenging issues. Do not send negative messages by email or mail since that allows people to react asynchronously without having the social feedback to modulate their emotions.
Self-regulation of unhelpful emotions is challenging because negative emotions trigger the body’s defense reactions to prepare it for flight and fight. At that point, it is more and more difficult to perceive the long term consequences of our action– our only goal is to survive. Even our cognitions change and we tend to interpret any information more negatively and may assume harmful intent. The more we are captured by our emotions, the more challenging is it to implement emotional self-regulation strategies.
Once the defense reaction has been activated, it is not the time to resolve conflict. Dr. Gottman and colleagues at the Seattle Love lab, discovered that when couples argued and their heartrate went over a hundred (a possible biological marker of sympathetic activation) arguments could escalate. If the person whose heart rate went up spontaneously took a time out and did self-soothing, the couple had a lower divorce rate and higher marital happiness than those couples who continue the arguments (Gottman & Gottman, 2008).
One of the effective ways to begin emotion regulation is to leave the situation and first complete the fight/flight defense reaction. If possible, this means interrupting whatever you are doing and exercise vigorously. After you have done a vigorous workout, emotional regulation is much easier as the ruminating thoughts have decreased or stopped.
Complete the alarm reaction with exercise
When you are upset take a break. If possible, take a time out and exercise to complete the fight/flight response that was activated by the negative emotions. This is not always possible in a business or social gathering; instead, excuse yourself and go to the bathroom. In the bathroom do the following five-minute exercise that was taught by Rinpoche Tarthang Tulku of the Nyingma tradition of Tibetan Buddhism as an approach to stop ruminating thoughts as shown in Figure 2.
Stand on your toes with the heels touching each other and lifted off the floor with your knees bent. Place your
hands on your sides, breathe slowly and deeply. Do this next to wall to reach with your hand to steady you if you lose your balance. Stay in this position for as long as 5 minutes. Do not straighten up, keep squatting.
In a very short time your attention will be drawn and captured by the burning sensation in your thighs. Continue. After five minutes stop, shake your legs and relax.
After this exercise your thoughts have stopped and continue with the more cognitive approach of emotional self-regulation or return to the meeting. Warming: Do not do this if you have hip, knee or ankle difficulty.
Use heart rate biofeedback to signal you that you may be losing control.
Wear a heart rate monitor to signal you when your heart rate increases twenty to thirty beats above your personal baseline rate during a discussion or conflict. Use that feedback to stop and take time out and implement self-regulation practices such as exercise, breathing or meditation to allow your arousal to decrease. When feeling more calm, return to the meeting.
Summary
Food and exercise are powerful tools to augment emotional self-regulation and health. In our research, Lena Stampfli and I have observed that many students who miss meals, have an unhealthy diet, do not the exercise, are sometimes irritable and experience difficulty in concentration. When San Francisco State University students implemented a four-week self-healing project as part of a class experience, the students who changed their eating behavior (eating breakfast, not skipping meals, reducing caffeine and simple carbohydrates and increase proteins, fats and fresh vegetables) and implemented daily physical exercise (e.g., yoga, jogging, and dancing), reported significant improvements in their energy level, fewer emotion outbursts and improved quality of life. They report some of the following:
“I thought I did not particularly like exercising and eating healthy, but when it is over I feel like I am on cloud nine!… I started to look forward to doing my exercises.” –A.M.
“I started to eat breakfast, I started biking to work and did a few [meditation] exercises before bed… I felt happier and more have energy to get through the day.” –C.B.
“I have learned that letting go of what no longer serves me allow room for healing and opportunities for growth… I can only imagine what years of healthy living could do for my well-being.” –K.S.
*I thank Pardis Miri, PhD, for her constructive comments.
The blog was adapted from Peper, E. (2017). Emotional control through mindfulness as path to mental health? Western Edition HP Journal. October. http://thewesternedition.com/admin/files/magazines/WE-October-2017.pdf
References
Goleman, D. (2006). Emotional intelligence. New York: Bantam.
Gross, James J., ed. (2013). Handbook of emotion regulation. New York, Guilford publications.
Treat yourself to a different point of view: Malcolm Gladwell’s podcasts-Revisionist History
Posted: October 2, 2017 Filed under: Uncategorized | Tags: history, thinking Leave a comment
Each time I listen to one of Malcolm Gladwell’s podcasts, Revisionist History, I experience a veil lifting from my eyes. He reminds me that what I accept without question may not be correct. Malcolm Gladwell is an English Canadian and author of five books including The Tipping Point: How Little Things Can Make a Big Difference, Outliers: The Story of Success, and David and Goliath: Underdogs, Misfits, and the Art of Battling Giants. More recently he is the host of the podcast Revisionist History. His podcasts are goldmine of information. In every episode he re-examines something from the past or present—an event, a person, an idea, even a song—and asks whether we got it right the first time. He brings clarity to topics such as art, basketball, education, financial investment, and philanthropy. His “out of the box” perspective lead me continuously to say, This really makes sense! I wish I thought of that!
Treat yourself and listing to Malcom Gladwell’s podcasts, Revisionist History, It is a journey through the overlooked and the misunderstood. For season 1 and 2 see: http://revisionisthistory.com/about
First do no harm: Listen to Freakonomics Radio Episodes Bad Medicine
Posted: September 3, 2017 Filed under: Uncategorized | Tags: health, Medicine, pharmaceuticals, placebo, treatment 1 Comment
How come up to 250,000 people a year die of medical errors and is the third leading cause of death in the USA (Makary & Daniel, 2016)?
Why are some drugs recalled after years of use because they did more harm than good?
How come arthroscopic surgery continues to be done for osteoarthritis of the knee even though it is no more beneficial than mock surgery (Moseley et al, 2002)?
How come women have more negative side effects from Ambien and other sleep aids than men?
Is it really true that the average new cancer drug costs about $100,000 for treatment and usually only extends the life of the selected study participants by about two months (Szabo, 2017; Fojo, Mailankody, & Lo, 2014)?
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of the New England Journal of Medicine”—Dr. Marcia Angell, longtime Editor in Chief of the New England Medical Journal (Angell, 2009).
Medical discoveries have made remarkable improvements in our health. The discovery of insulin in 1921 by Canadian physician Frederick Banting and medical student Charles H. Best allowed people with Type 1 Diabetes to live healthy productive lives (Rosenfeld, 2002). Cataract lens replacement surgery is performed more than three million times per year and allows millions of people to see better even though a few patients have serious side negative side effects. And, there appears to be new hope for cancer. The FDA on August 30, 2017, approved a new individualized cancer treatment that uses genetically engineered cells from a patient’s immune system to produce remissions in 83 percent of the children and young adults who have relapsed after undergoing standard treatment for B cell acute lymphoblastic leukemia. (FDA August 30, 2017). The one-time treatment for this breakthrough cancer drug for patients who respond costs $475,000 according to the manufacturer Novartis. Yet, it will be years before we know if there are long term negative side effects.
The cost of this treatment is much more than the average cost of $100,000 for newly developed and approved cancer drugs which at best extend the life of highly selected patients on the average by two months; however, when they used with more typical Medicare patients, these drugs often offer little or no increased benefits (Szabo, 2017; Freakonomics Radio episode Bad Medicine, Part 2: (Drug) Trials and Tribulations).
As the health care industry is promising new screening, diagnostic and treatment approaches especially through direct-to-consumer advertising, they may not always be beneficial and, in some cases, may cause harm. The only way to know if a diagnostic or treatment procedure is beneficial is to do long term follow-up; namely, did the treated patients live longer, have fewer complications and better quality of life than the non-treatment randomized control patients. Just because a surrogate illness markers such as glucose level for type 2 Diabetes or blood pressure for essential hypertension decrease in response to treatment, it does not always mean that the patients will have fewer complications or live longer.
To have a better understanding of the complexity and harm that can occur from medical care, listen to the following three Freakonomics Radio episodes titled Bad Medicine.
Freakonomics Radio episode Bad Medicine, Part 1: The story of 98.6. We tend to think of medicine as a science, but for most of human history it has been scientific-ish at best. In the first episode of a three-part series, we look at the grotesque mistakes produced by centuries of trial-and-error, and ask whether the new era of evidence-based medicine is the solution. http://freakonomics.com/podcast/bad-medicine-part-1-story-98-6/
Freakonomics Radio episode Bad Medicine, Part 2: (Drug) Trials and Tribulations. How do so many ineffective and even dangerous drugs make it to market? One reason is that clinical trials are often run on “dream patients” who aren’t representative of a larger population. On the other hand, sometimes the only thing worse than being excluded from a drug trial is being included. http://freakonomics.com/podcast/bad-medicine-part-2-drug-trials-and-tribulations/
Freakonomics Radio episode, Bad Medicine, Part 3: Death by Diagnosis. By some estimates, medical error is the third-leading cause of death in the U.S. How can that be? And what’s to be done? Our third and final episode in this series offers some encouraging answers. http://freakonomics.com/podcast/bad-medicine-part-3-death-diagnosis/
References
Angell M. Drug companies and doctors: A story of corruption. January 15, 2009. The New York Review of Books 56. Available: http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/. Accessed 24, November, 2016.
FDA approval brings first gene therapy to the United States, August 30, 2017. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm574058.htm
Makary, M. A., & Daniel, M. (2016). Medical error-the third leading cause of death in the US. BMJ: British Medical Journal (Online), 353. Listen to his BMJ medical talk: https://soundcloud.com/bmjpodcasts/medical-errorthe-third-leading-cause-of-death-in-the-us
Rosenfeld, L. (2002). Insulin: discovery and controversy. Clinical chemistry, 48(12), 2270-2288. http://clinchem.aaccjnls.org/content/48/12/2270
Szabo, L. (201, February 9). Dozens of new cancer drugs do little to improve survival. Kaiser Health News. Downloaded September 3, 2017. https://www.usatoday.com/story/news/nation/2017/02/09/new-cancer-drugs-do-little-improve-survival/97712858/
Hurricane Harvey: Wake-up call for tax reform and government regulation to improve equality for all citizens
Posted: August 31, 2017 Filed under: Uncategorized | Tags: floods, Hurricane Harvey, legislation, taxes Leave a comment
Hurricane Harvey was not preventable; however, researchers have predicted this flooding scenario for years. The severe damage was partly caused by the failure of local, state and federal government regulations and planning. It was the lack of governmental oversight and absence of regulations that allowed floodplain to be transformed into corporate profit centers by building houses and industrial buildings.
In Houston two inches of rain will automatically cause flooding and somewhere in Harris County and major flooding has occurred about every two years. Despite the repeated flooding, legislators avoided implementing meaningful flood control regulations such as prohibiting building on floodplains, having more green space for water drainage, or implementing building codes that require flood proof buildings. If you live in an earthquake zone, building codes demand that the structure can resist earthquake damage. Why not have similar rules for buildings on a flood plains? To build a flood proof structure on a flood plain does not take rocket science. All you have to do is build it on on stilts so that the ground floor is free to flood without damage.
Such building code regulations would increase the cost to the developer, reduce profitability and increase taxes. Instead, developers and corporations reaped the immediate profits through legal bribery to politicians (contributions to election campaigns) to block rules and regulations. They thereby transferred the preventable flood loss to the individual home owners. Similarly, the explosion at the Arkema plant near Crosby, Texas, occurred when the plant lost its refrigeration as its backup power supply was flooded. It was a failure of planning and regulations– It is so much cheaper to put the emergency power supply on the ground floor than high enough to prevent flooding. This is similar to the 2011 Fukushima Daiichi nuclear disaster–flooding of the emergency power supply which pumped the water to cool the reactors.
Eventually, it will be the American tax payer who will pay for the Hurricane Relief Package. Already FEMA reported that 95,745 people in Texas have been approved for emergency assistance. The agency has so far disbursed about $57 million to citizens in Texas and this is only the beginning.
As in all disasters, the lower and middle economic classes will disproportionately suffer. They are already living from paycheck to paycheck and have limited resources to recover. It is the role of Government to provide help to allow recovery. Yet, this is counter to the prevailing philosophy of the Republican party as illustrated by more than 20 Texan representatives and senators, including Senator John Cornyn and Ted Cruz, who voted against the $50.5 billion 2013 Hurricane Sandy Relief Package for the victims of Superstorm Sandy that impacted New York and New Jersey. They are now trying to rewrite their scandalous voting record by claiming that they voted against the 2013 Relief Package because it was “full of pork” — A patent lie. The actual data as summarized by Linda Qui in the New York Times’ fact check article, Was 2013 Hurricane Sand Relief Package full of Pork.” points out that the Congressional Congressional Quarterly analysis said that $17 billion in the bill went toward immediate aid for Sandy victims while $33.5 billion was for “near- and long-term assistance and mitigation” of damage from future disasters. See the superb article https://www.nytimes.com/2017/08/30/us/politics/hurricane-sandy-relief-fact-check.html?hpw&rref=politics&action=click&pgtype=Homepage&module=well-region®ion=bottom-well&WT.nav=bottom-well
It is the government’s role to help all citizens regardless of race, age, gender and political preference. It is ironic that the Republican Texan legislators who all voted against the 2013 Hurricane Sandy Relief Package will now need those New York and New Jersey legislators’ support to pass an estimate $150 billion Hurricane Harvey Relief act. Part of me thinks, Senator Cruz and Cornyn, you got what you deserved. How do you dare to ask other legislators to support a Texas Hurricane Harvey Recovery Act when you previously voted against helping others. Also, you have consistently supported ways to shrink government, reduce taxes on the rich, reduced rules and regulations that were created to protect people. Luckily, not everyone is like you. The lawmakers from the New York-New Jersey region are not as callous and have already stated they will support help. As Republican Rep. Peter King of New York wrote in a tweet directed at Cruz., “I won’t abandon Texas the way Ted Cruz did New York.”
The damage caused by Hurricane Harvey reminds us that no one is an island and we all need each other’s support in time of crisis. The role of government is to help all people in need and create regulations to prevent a similar harm from reoccurring. Government rules and regulations are citizens’ only protection against corporate greed.
The upcoming tax reform debate and legislation is an opportunity to demonstrate that the well-being of all citizens is more important than increasing the wealth of the super rich and corporations who avoid paying taxes by holding their profits offshore. It means increasing the tax revenues to pay for infrastructure repair and reduce economic inequality. The tax reform bill will need to increase the taxes on affluent citizens and reduce corporate tax loopholes. Reducing taxes on the rich and corporations, the mantra of “Republican Trickle down economics,” has predominantly benefited the super affluent and reduced the prosperity of average Americans.
Hurricane Harvey disaster as a wake-up call to demand that the government is for the people and by the people and demonstrate that its role is to mitigate and prevent disasters and improve the quality of life of every citizen.
Contact your legislators and demand that they:
- Support Hurricane Harvey Relief funds
- Work on the Tax Reform Legislation that increases the taxes on the rich, reduces corporate tax loopholes
- Create legislation to protect individuals against corporate greed which means more industry regulations and infrastructure improvement.
Finally, remember the role of government is NOT to create rules and regulations to maximize immediate profits, it is to provide a future so that our great grandchildren have more equally and better productive and healthier lives. If only the government, designers and builders of the houses in Houston had acted by this creed, flooding would have been a challenge but almost all people could have ridden out the storm at home.
Enhance Yoga with Biofeedback*
Posted: August 6, 2017 Filed under: Uncategorized | Tags: asana, awareness, biofeedback, Breathing, electromyography, meditation, posture, yoga Leave a commentHow can you demonstrate that yoga practices are beneficial?
How do you know you are tightening the correct muscles or relaxing the muscle not involved in the movement when practicing asanas?
How can you know that the person is mindful and not sleepy or worrying when meditating?
How do you know the breathing pattern is correct when practicing pranayama?
The obvious answer would be to ask the instructor or check in with the participant; however, it is often very challenging for the teacher or student to know. Many participants think that they are muscularly relaxed while in fact there is ongoing covert muscle tension as measured by electromyography (EMG). Some participants after performing an asana, do not relax their muscles even though they report feeling relaxed. Similarly, some people practice specific pranayama breathing practice with the purpose of restoring the sympathetic/parasympathetic system; however, they may not be doing it correctly. Similarly, when meditating, a person may become sleepy or their attention wanders and is captured by worries, dreams, and concerns instead of being present with the mantra. These problems may be resolved by integrating bio- and neurofeedback with yoga instruction and practice. Biofeedback monitors the physiological signals produced by the body and displays them back to the person as shown in Figure 1.
Figure 1: Biofeedback is a methodology by which the participant receives ongoing feedback of the physiological changes that are occurring within the body. Reproduced with permission from Peper et al, 2008.
With the appropriate biofeedback equipment, one can easily record muscle tension, temperature, blood flow and pulse from the finger, heart rate, respiration, sweating response, posture alignment, etc.** Neurofeedback records the brainwaves (electroencephalography) and can selectively feedback certain EEG patterns. In most cases participants are unaware of subtle physiological changes that can occur. However, when the physiological signals are displayed so that the person can see or hear the changes in their physiology they learn internal awareness that is associated with these physiological changes and learn mastery and control. Biofeedback and neuro feedback is a tool to make the invisible, visible; the unfelt, felt and the undocumented, documented.
Biofeedback can be used to document that a purported yoga practice actually affects the psychophysiology. For example, in our research with the Japanese Yogi, Mr. Kawakami, who was bestowed the title “Yoga Samrat’ by the Indian Yoga Culture Federation in 1983, we measured his physiological responses while breathing at two breaths a minute as well as when he inserted non-sterilized skewers through his tongue tongue (Arambula et al, 2001; Peper et al, 2005a; Peper et al, 2005b). The physiological recordings confirmed that his Oxygen saturation stayed normal while breathing two breaths per minute and that he did not trigger any physiological arousal during the skewer piercing. The electroencephalographic recordings showed that there was no response or registration of pain. A useful approach of using biofeedback with yoga instruction is to monitor muscle activity to measure whether the person is performing the movement appropriately. Often the person tightens the wrong muscles or performs with too much effort, or does not relax after performing. An example of recording muscle tension as shown in Figure 2.
Figure 2: Recording the muscle tension with Biograph Infinity while performing an asana.
In our research it is clear that many people are unaware that they tighten muscles. For example, Mcphetridge et al, (2011) showed that when participants were asked to bend forward slowly to touch their toes and then hang relaxed in a forward fold, most participants reported that they were totally relaxed in their neck. In actuality, they were not relaxed as their neck muscles were still contracting as recorded by electromyography (EMG). After muscle biofeedback training, they all learned to let their neck muscles be totally relaxed in the hanging fold position as shown in Figure 3 & 4.
Figure 3: Initial assessment of neck SEMG while performing a toe touch. Reproduced from Harvey, E. & Peper, E. (2011).
Figure 4: Toe touch after feedback training. The neck is now relaxed; however, the form is still not optimum. . Reproduced from Harvey, E. & Peper, E. (2011).
Thus, muscle feedback is a superb tool to integrate with teaching yoga so that participants can perform asanas with least amount of inappropriate tension and also can relax totally after having tightened the muscles. Biofeedback can similarly be used to monitor body posture during meditation. Often participants become sleepy or their attention drifts and gets captured by imagery or worries. When they become sleepy, they usually begin to slouch. This change in body position can be readily be monitored with a posture feedback device. The UpRight,™ (produced by Upright Technologies, Ltd https://www.uprightpose.com/) is a small sensor that is placed on the upper or lower spine and connects with Bluetooth to the cell phone. After calibration of erect and slouched positions, the device gives vibratory feedback each time the participant slouches and reminds the participant to come back to sitting upright as shown in Figure 5.
Figure 5: UpRigh™ device placed on the upper spine to provide feedback during meditation. Each time person slouches which often occurs when they become sleepy or loose meditative focus, the device provides feedback by vibrating.
Alternatively, the brainwaves patterns (electroencephalography could be monitored with neurofeedback and whenever the person drifts into sleep or becomes excessively aroused by worry, neurofeedback could remind the person to be let go and be centered. Finally, biofeedback can be used with pranayama practice. When a person is breathing approximately six breaths per minute heart rate variability can increase. This means that during inhalation heart rate increases and during exhalation heart rate decreases. When the person breathes so that the heart rate variability increases, it optimizes sympathetic/parasympathetic activity. There are now many wearable biofeedback devices that can accurately monitor heart rate variability and display the changes in heart rate as modulated by breathing.
Conclusion: Biofeedback is a useful strategy to enhance yoga practice as it makes the invisible visible. It allows the teacher and the student to become aware of the dysfunctional patterns that may be occurring beneath awareness.
References
*Reprinted from: Peper, E. (2017). Enhancing Yoga with Biofeedback. J Yoga & Physio.2(2).*55584. DOI: 10.19080/JYP.2017.02.555584
**Biofeedback and neurofeedback takes skill and training. For information on certification, see http://www.bcia.org Two useful websites are:
Sitting disease is the new health hazard
Posted: July 29, 2017 Filed under: Uncategorized | Tags: exercise, health, posture, sitting 11 Comments
Sedentary behavior is the new norm as most jobs do not require active movement. Sitting in a car instead of walking, standing on the escalator instead of walking up the stairs, using an electric mixer instead of whipping the eggs by hand, sending a text instead of getting up and talking to a co-worker in the next cubicle, buying online instead of walking to the brick and mortar store, watching TV shows, streaming movies, or playing computer games instead of socializing with actual friends, are all examples how the technological revolution has transformed our lives. The result is sitting disease which we belief can mitigate by daily exercise.
The research data is very clear– exercise does not totally reverse the health risks of sitting. In the NIH-AARP Diet and Health Study, researchers Matthews and colleagues (Matthews et al, 2012) completed an 8.5 year follow up on 240,819 adults (aged 50–71 year) who at the beginning baseline surveys did not report any cancer, cardiovascular disease, or respiratory disease.
The 8.5 year outcome data showed that the time spent in sedentary behaviors such as sitting and watching TV was positively correlated with an increased illness and death rates as shown in Figure 1. More disturbing, moderate vigorous exercises does not totally reverse the health risks of sitting and watching television (Matthews et al, 2012).
Figure 1. The more you sit the higher the risk of mortality even if you if you attempt to mitigate the effect with moderate vigorous exercise (Matthews et al, 2012). From: https://www.washingtonpost.com/apps/g/page/national/the-health-hazards-of-sitting/750/
The harmful impact of sedentary behavior and simple ways to improve health have been superbly described and illustrated by Bonnie Berkowitz and Patterson Clark (2014), in their January 20, 2014, Washington Post article, The health hazards of sitting, Their one page poster should be posted on the office walls and given to all clients. http://www.washingtonpost.com/wp-srv/special/health/sitting/Sitting.pdf
As they point out, sitting disease increases the risk of heart disease, diabetes, colon cancer, muscle degeneration especially weaker abdominal muscles and gluteus muscles, back pain and reduced hip flexibility, poor circulation in the legs which may cause edema in the ankles and deep vein thrombosis, osteoporosis, strained neck, shoulder and back pain. The effects are not only physical. Sitting reduces subjective energy level and attention as our brain becomes more and more sleepy.
The solution is both very simple and challenging. To reduce the risks, do less sedentary behavior and sitting and do more physical movement during the day. Continuously interrupt sitting with standing and movement. After sitting at the computer for 30 minutes, get up and move. Even skipping in place for 30 seconds, significantly will increase your energy and mood (Peper and Lin, 2012). There are many ways to remind and support yourself and others to move. For example, use reminder programs on the computer such as StretchBreakTM to remind you to get up and stretch. Employees who do episode movements, report fewer symptoms and have more energy (Peper & Harvey, 2008). As one of the employees state after implementing the break program, “There is life after five.” Meaning he was no longer exhausted when he finished work.
Although challenging, wean yourself away from the addicting digital screen and being a couch potato at home. At those moments when you feel drained and all you want to do is veg out by watching another TV series, go for a walk. After walking for 20 minutes, in most cases your energy will have returned and your low mood has been transformed to see new positive option. Plan the walks with neighbors and friends who provide the motivation to pull you out of your funk and go out.
References:
Berkowitz, B. & Clark, P. (Jan 20, 2014). The health hazard of sitting. The Washington Post. Retrieved July 29, 2017.https://www.washingtonpost.com/apps/g/page/national/the-health-hazards-of-sitting/750/
Matthews, C. E., George, S. M., Moore, S. C., Bowles, H. R., Blair, A., Park, Y., … Schatzkin, A. (2012). Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. The American Journal of Clinical Nutrition, 95(2), 437–445. http://doi.org/10.3945/ajcn.111.019620
Exercise: Improve your health, mood, and cognitive function
Posted: July 22, 2017 Filed under: Uncategorized | Tags: depression, exercise, health, hypertension, mood, Sitting disease 1 CommentThrough millions of years, movement was part of our biological necessity.. Movement was necessary to hunt, to escape predators, to explore and to find a mate. Organisms developed a brain (nervous system) to coordinate movement as eloquently explain by neuroscientist Daniel Wolpert in his 2011 TED talk, The Real Reasons for Brains.
It is only recently that we limit movement by sitting, driving, taking the escalator, or controlling equipment that performs the actual physical labor. We interfere with our evolutionary developed physiology when we reduce or even eliminate movement for the sake of efficiency. Lack of movement, “sitting disease”, is a significant contributor and causal factor in illness. It also increases the stress response, negative mood and depression and reduces cognitive activity. Take charge and reduce illness when you integrate purposeful exercise (walking, running, dancing, etc.) into your life style.
Exercise is the most effective behavioral technique for self-regulation of mood in healthy people as summarized in the superb article, The Effects of Acute Exercise on Mood, Cognition, Neurophysiology, and Neurochemical Pathways: A Review, Dr. Julia C. Basso and Wendy A. Suzuki of the Center for Neural Science, New York University, New York, NY, USA. The robust research findings show that acute exercise improves mood, significantly reduces depression, tension, anger, fatigue, and confusion. In addition, acute exercise improves symptoms associated with psychological disorders such as depression, anxiety, schizophrenia, and post-traumatic stress disorder. Exercise decreases the risk of type 2 diabetes, coronary heart disease and stress-related blood pressure response by inhibiting the sympathetic nervous system response to stress. For a detailed summary, see the blogs, What is the best single thing we can do for our health and Healthy movement is the new aging.
Finally, the authors also review the relevant neurophysiological, and neurochemical processes that are affected by exercise. What is most interesting are the findings that “acute exercise primarily enhances executive functions dependent on the prefrontal cortex including attention, working memory, problem solving, cognitive flexibility, verbal fluency, decision making, and inhibitory control. These positive changes have been demonstrated to occur with very low to very high exercise intensities, with effects lasting for up to two hours after the end of the exercise bout.”
As the authors state, “We show that the three most consistent cognitive/behavioral effects of a single bout of exercise in humans are improved executive functions, enhanced mood states, and decreased stress levels.”
Even though the findings are clear that movement/exercise is a powerful “drug” to improve our health, most health professionals focus on sitting treatment and prescribing pharmaceutical agents. Possibly, a treatment session should start with fun physical exercise and followed by therapy. Remember, if you feel blah, have lower energy, feel frustrated or irritated, get up and move. Movement and exercise will change your mood. You will experience what Peper and Lin (2012), have shown that less than minute of skipping in place will significantly improve your subjective energy level and mood. Get up and skip in place, then observe how much better you feel. Then sit again read the article by Dr. Julia C. Basso and Wendy A. Suzuki, http://content.iospress.com/download/brain-plasticity/bpl160040?id=brain-plasticity%2Fbpl160040
Listen to Revisionist History-A podcast series from Malcolm Gladwell
Posted: June 22, 2017 Filed under: Uncategorized | Tags: history, Interpretation, Malcolm Gladwell 3 Comments
Each week I look forward to listening to a new episode by Malcom Gladwell’s podcast Revisionist History. Malcolm Gladwell is the author of five New York Times bestsellers — The Tipping Point, Blink, Outliers, and David and Goliath. In the podcasts he goes back in history and reinterpret something from the past. He offers a new perspective which illuminates the present. Take time to listen to the podcast on your cellphone or computer. His revisionist’s interpretation will shed a different perspective on present days’ events. It even gave me a new understanding why some people vote against their own self-interest. His podcast can be downloaded from: http://revisionisthistory.com/seasons
the peper perspective 