|Adapted from Peper, E., Covell, A., & Matzembacker, N. (2021). How a chronic headache condition became resolved with one session of breathing and posture coaching. NeuroRegulation, 8(4), 194–197. https://doi.org/10.15540/nr.8.4.194|
This blog describes the process by which a 32 year old woman student’s chronic headaches that she had since age eighteen was resolved in a single coaching session. The student suffered two or three headache per week a week which initially began when she was eighteen after using digital devices and encouraged her to slouch as she looked down. Although she describes herself as healthy, she reported having high level of anxiety and occasional depression. She self-medicated with 2 to 10 Excedrin tablets a week. It is possible that the chronic headaches could partially be triggered by caffeine withdrawal which get resolved by taking more Excedrins (Greben et al., 1980) since Excedrin contains 65 mg of caffeine as well as 250 mg of Acetaminophen which can be harmful to liver function (Bauer et al., 2021).
The behavioral coaching intervention
During the first day in class, the student approached the instructor and she shared that she had a severe headache. During their conversation, the instructor noticed that she was breathing in her chest without abdominal movement, her shoulders were held tight, her posture slightly slouched and her hands were cold. As she was unaware of her body responses, the instructor offered to guide her through some practices that may be useful to reduce her headache. The same strategies could also be useful for the other students in the class; since, headaches, anxiety, zoom fatigue, neck and shoulder tension, abdominal discomfort, and vision problems are common and have increased as people spent more time in front of screens (Charles et al., 2021; Ahmed et al., 2021; Bauer, 2021; Kuehn, 2021; Peper et al., 2021 ).
These symptoms may occur because of bad posture, neck and shoulder tension, shallow chest breathing, stress and social isolation (Elizagaray-Garcia et al., 2020; Schulman, 2002). When people become aware of their dysfunctional somatic patterns and change their posture, breathing pattern, internal language and implement stress management techniques, they often report a reduction in symptoms such as irritable bowel syndrome, acid reflux, neck and shoulder tension, or anxiety (Peper et al, 2017a; Peper et al, 2016a). Sometimes, a single coaching session can be sufficient to improve health.
Working hypothesis: The headaches were most likely tension headaches and not migraines and may be the result of chronic neck and shoulder tension which was maintained during chest breathing and the slouched head forward body posture. If she could change her posture, relax her neck and shoulders, and breathe diaphragmatically so that the lower abdomen widen during inhalation, most likely her shoulder and neck tension would decrease. Therefore, by changing posture from a slouched to upright position combined with slower diaphragmatic breathing, the muscle tension would be reduced and the headaches would decrease.
Breathing and posture changes
She was encouraged to sit upright so that the abdomen had space to expand (Peper et al., 2020). In addition, she needed to loosen the clothing around her waist to provide room for her abdomen to expand during inhalation instead of her chest lifting (MacHose & Peper, 1991). Allowing abdominal expansion can be challenging for many paticipants since they are self-conscious about their body image, as well holding their stomach in as an unconscious learned response to avoid pain after having had abdominal surgery, or as an automatic protective response to threat (Peper et al., 2015). The upright position also allowed her to sit tall and erect in which the back of head reaches upward towards the ceiling while relaxing and feeling gravity pulling her shoulders downward and at the same time relaxing her hips and legs.
With guided verbal and tactile coaching, she learned to master slower diaphragmatic breathing in which she gently and slowly exhaled by making a sound of pssssssst (exhaling through pursed lips) which tends to activate the transverse and oblique abdominal muscles and slightly tighten the pelvic floor muscles so that her lower abdomen would slightly constrict at the end of the exhalation (Peper et al., 2016). Then, by allowing the lower abdomen and pelvic floor relax so that the abdomen could expand in 360 degrees, inhalation occurred.
While practicing the slower breathing in this relaxed upright position, she was instructed to sense/imagine feeling a flow of down and through her arms and out her hands as she exhaled (as if the air could flow through straws down her arms). After a few minutes, she felt her headache decrease and noticed that her hands had warmed. After this short coaching intervention, she went back to her seat in class and continued to practice the relaxed effortless breathing while sitting upright and allowing her shoulders to melt downward.
The use of muscle feedback to demonstrate residual covert muscle tension
During class session, she volunteered to have her trapezius muscle monitored with electromyography (EMG). The EMG indicated that her muscles were slightly tense even though she reported feeling relaxed. With a few minutes of EMG biofeedback exploration, she discovered that she could relax her shoulder muscles by feeling them being heavy and melting.
Implementing home practice with a posture app
As part of the class homework, she was assigned a self-study for two weeks with the posture feedback app, Dario Desktop. The app uses the computer/laptop camera to monitor posture and provides visual feedback in a small window on the computer screen and/or an auditory signal each time she slouches as shown in Figure 1.
Figure 1. Posture feedback to signal to participant that the person is slouching.
To observe the effect of the posture breathing training, she monitored her symptoms for three days without feedback and then installed the posture feedback application on her laptop to provide feedback whenever she slouched. The posture feedback reminded her to practice better posture during the day while working on her computer and also do a few stretches or shift to standing when using the computer for an extended period of time. Each time the feedback signal indicated she slouched, she would sit up and change her posture, breathe lower and slower and relax her shoulders.
She also monitored what factors triggered the slouching. In additionally, she added daily reminders to her phone to remind her of her posture and to stretch and stand after each hour of studying. After two weeks she recorded her symptoms for three days for the post assessment without posture feedback.
The chronic headache condition which had been present for fourteen years disappeared and she has not used any medication since the first day of class. She reported after two weeks that her shoulder and back discomfort/pain, depression, anxiety and lack of motivation decreased as shown in Figure 2. At the fourteen week follow up, she continues to have no headaches and has not used any medication.
Figure 2. Changes in symptoms after implementing posture feedback for two weeks.
She used the desktop posture app every time she opened her laptop at home as often as 3-5 times per day (roughly 2-6 hours).In addition, when she felt beginning of discomfort or thought she should take medication, she would adjust her posture and breathe. While using the app, she identified numerous factors that were associated with slouching as shown in Figure 3.
Figure 3. Behaviors associated with slouching.
The decrease in depression, anxiety and increase in motivation may be the direct result of posture change; since, a slouched position tends to increase hopeless, helpless and powerless thoughts while the upright position tends to increase subjective felt energy and easier access to empowering and positive thoughts (Peper et al., 2017b; Veenstra et al., 2017; Wilson & Peper, 2004; Tsai et al., 2016). Most likely, a major factor that contributed to the elimination of her headaches was that she implemented changes in her behavior. One major factor was using posture feedback tool at home to remind her to sit tall and relax her shoulders while practicing slower diaphragmatic breathing. As she noted, “Although it was distracting to be reminded all the time about my posture, it did decrease my neck pain. With the pain reduction, I was able to sit at the computer longer and felt more motivated.”
The combination of slower lower abdominal breathing with the upright posture reversed her protective/defensive body position (tightening the muscle in the lower abdomen and pelvic floor and pressing the knees together while curling the shoulder forward for protection). The upright posture creates a position of empowerment and trust by which the lower abdomen could expand which supported health and regeneration. In addition, the upright posture allowed easier access to positive thoughts and reduced recall of hopeless, powerless, defeated memories. It is also possible that caffeine withdrawal was a co-factor in evoking headaches (Küçer, 2010). By eliminating the medication containing caffeine, she also eliminated the triggering of the caffeine withdrawal headaches.
This case example suggests that health care providers first rule out any pathology and then teach behavioral self-healing strategies that the clients can implement instead of immediately prescribing medications. These interventions could include slower and lower diaphragmatic breathing, upright posture feedback, muscle biofeedback training, hear rate variability training, stress management, cognitive behavior therapy and facilitating health promoting lifestyles modifications such as regular sleep, exercise and healthier diet. When students implement these behavioral changes as part of a five week self-healing program, many report significant decreases in symptoms such as headaches, anxiety, neck and shoulder pain, and gastrointestinal distress (Peper et al., 2016a).
Watch April Covell describe her experience with the self-healing approach to eliminate her chronic headaches.
See the following blogs for additional instructions how to breathe diaphragmatically.
Ahmed, S., Akter, R., Pokhrel, N. et al. (2021). Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study. J Public Health (Berl.) 29, 411–416. https://doi.org/10.1007/s10389-019-01139-4
Bauer, A.Z., Swan, S.H., Kriebel, D. et al. (2021). Paracetamol use during pregnancy — a call for precautionary action. Nat Rev Endocrinol . https://doi.org/10.1038/s41574-021-00553-7
Charles, N. E., Strong, S. J., Burns, L. C., Bullerjahn, M. R., & Serafine, K. M. (2021). Increased mood disorder symptoms, perceived stress, and alcohol use among college students during the COVID-19 pandemic. Psychiatry research, 296, 113706. https://doi.org/10.1016/j.psychres.2021.113706
Elizagaray-Garcia, I., Beltran-Alacreu, H., Angulo-Díaz, S., Garrigós-Pedrón, M., Gil-Martínez, A. (2020). Chronic Primary Headache Subjects Have Greater Forward Head Posture than Asymptomatic and Episodic Primary Headache Sufferers: Systematic Review and Meta-analysis. Pain Med, 21(10):2465-2480. https://doi.org/10.1093/pm/pnaa235
Greden, J.F., Victor, B.S., Fontaine, P., & Lubetsky, M. (1980). Caffeine-Withdrawal Headache: A Clinical Profile. Psychosomatics, 21(5), 411-413, 417-418. https://doi.org/10.1016/S0033-3182(80)73670-8
Küçer, N. (2010). The relationship between daily caffeine consumption and withdrawal symptoms: a questionnaire-based study. Turk J Med Sci, 40(1), 105-108. https://doi.org/10.3906/sag-0809-26
Kuehn, B.M. (2021). Increase in Myopia Reported Among Children During COVID-19 Lockdown. JAMA, 326(11),999. https://doi.org/10.1001/jama.2021.14475
MacHose, M. & Peper, E. (1991). The effect of clothing on inhalation volume. Biofeedback and Self-Regulation 16, 261–265 (1991). https://doi.org/10.1007/BF01000020
Peper, E., Booiman, A., Lin, I-M, Harvey, R., & Mitose, J. (2016). Abdominal SEMG Feedback for Diaphragmatic Breathing: A Methodological Note. Biofeedback. 44(1), 42-49. https://doi.org/10.5298/1081-5937-44.1.03
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. https://doi.org/10.5298/1081-5937-43.4.06
Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017b). How posture affects memory recall and mood. Biofeedback. 45 (2), 36-41. https://doi.org/10.5298/1081-5937-45.2.01
Peper, E., Mason, L., Harvey, R., Wolski, L, & Torres, J. (2020). Can acid reflux be reduced by breathing? Townsend Letters-The Examiner of Alternative Medicine, 445/446, 44-47. https://www.townsendletter.com/article/445-6-acid-reflux-reduced-by-breathing/
Peper, E., Mason, L., Huey, C. (2017a). Healing irritable bowel syndrome with diaphragmatic breathing. Biofeedback. (45-4). https://doi.org/10.5298/1081-5937-45.4.04
Peper, E., Miceli, B., & Harvey, R. (2016a). Educational Model for Self-healing: Eliminating a Chronic Migraine with Electromyography, Autogenic Training, Posture, and Mindfulness. Biofeedback, 44(3), 130–137. https://doi.org/10.5298/1081-5937-44.3.03
Peper, E., Wilson, V., Martin, M., Rosegard, E., & Harvey, R. (2021). Avoid Zoom fatigue, be present and learn. NeuroRegulation, 8(1), 47–56. https://doi.org/10.15540/nr.8.1.47
Schulman, E.A. (2002). Breath-holding, head pressure, and hot water: an effective treatment for migraine headache. Headache, 42(10), 1048-50. https://doi.org/10.1046/j.1526-4610.2002.02237.x
Tsai, H. Y., Peper, E., & Lin, I. M.* (2016). EEG patterns under positive/negative body postures and emotion recall tasks. NeuroRegulation, 3(1), 23-27. https://doi.org/10.15540/nr.3.1.23
Veenstra, L., Schneider, I.K., & Koole, S.L. (2017). Embodied mood regulation: the impact of body posture on mood recovery, negative thoughts, and mood-congruent recall. Cogntion and Emotion, 31(7), 1361-1376. https://doi.org/10.1080/02699931.2016.1225003
Wilson, V.E. and Peper, E. (2004). The effects of upright and slumped postures on the generation of positive and negative thoughts. Applied Psychophysiology and Biofeedback, 29(3), 189–195. https://doi.org/10.1023/b:apbi.0000039057.32963.34
It is the time of year when we once again make New Year resolutions, “I plan to exercise every day,” “I will stop drinking,” “I will eat less processed foods and more fruits and vegetables.” We use our will power and positive thoughts to begin these new activities; however, our will power often fades out and we quickly fall of the wagon. The reason vary such as, I had planned to jog today; however it is raining, I was planning to eat more vegies; however, I had dinner with a friend and ate a juicy hamburger, I had planned to meditate; however, I needed to help my son. So many other things took priority and the motivation disappeared..
Yet it is possible to be successful with starting and then maintaining new health promoting habits. The key is to increase the friction for the behaviors that you want to reduce and decrease the friction for behaviors that you want to increase. Friction is the extra work you need to do in order to do the task. For example, to eat fewer cookies, increase the friction by not having them in the house (you now have to go to the store to buy them) or by placing them somewhere where it takes greater effort to get them such as the top shelf for which that you need a small ladder to reach them. The extra effort (increased friction) brings awareness to the automatic behavior. At that point, you can interrupt your unconscious eating pattern and choose to do something else. On the other hand, to increase eating fruits, decrease the friction by having the fruit right in front of you on the table so that you can take one without thinking.
The key is to interrupt the habit chain of behavior you want to reduce and automate the habit chains of behaviors you want to increase. The more you do a behavior and the more pleasurable it is, the more likely will the new behaviore become an automatic habit. To learn how to change friction and how to be successful in creating new habits, listen to Shankar Vedantam Hidden Brain’s Podcast, Creatures of Habit.
Andrea Castillo and Erik Peper
We are what we eat. Our body is synthesized from the foods we eat. Creating the best conditions for a healthy body depends upon the foods we ingest as implied by the phrase, Let food be thy medicine, attributed to Hippocrates, the Greek founder of western medicine (Cardenas, 2013). The foods are the building blocks for growth and repair. Comparing our body to building a house, the building materials are the foods we eat, the architect’s plans are our genetic coding, the care taking of the house is our lifestyle and the weather that buffers the house is our stress reactions. If you build a house with top of the line materials and take care of it, it will last a life time or more. Although the analogy of a house to the body is not correct since a house cannot repair itself, it is a useful analogy since repair is an ongoing process to keep the house in good shape. Our body continuously repairs itself in the process of regeneration. Our health will be better when we eat organic foods that are in season since they have the most nutrients.
Organic foods have much lower levels of harmful herbicides and pesticides which are neurotoxins and harmful to our health (Baker et al., 2002; Barański, et al, 2014). Crops have been organically farmed have higher levels of vitamins and minerals which are essential for our health compared to crops that have been chemically fertilized (Peper, 2017),
Even seasonality appears to be a factor. Foods that are outdoor grown or harvested in their natural growing period for the region where it is produced, tend to have more flavor that foods that are grown out of season such as in green houses or picked prematurely thousands of miles away to allow shipping to the consumer. Compare the intense flavor of small strawberry picked in May from the plant grown in your back yard to the watery bland taste of the great looking strawberries bought in December.
The seasonality of food
It’s the middle of winter. The weather has cooled down, the days are shorter, and some nights feel particularly cozy. Maybe you crave a warm bowl of tomato soup so you go to the store, buy some beautiful organic tomatoes, and make yourself a warm meal. The soup is… good. But not great. It is a little bland even though you salted it and spiced it. You can’t quite put your finger on it, but it feels like it’s missing more tomato flavor. But why? You added plenty of tomatoes. You’re a good cook so it’s not like you messed up the recipe. It’s just—missing something.
That something could easily be seasonality. The beautiful, organic tomatoes purchased from the store in the middle of winter could not have been grown locally, outside. Tomatoes love warm weather and die when days are cooler, with temperatures dropping to the 30s and 40s. So why are there organic tomatoes in the store in the middle of cold winters? Those tomatoes could’ve been grown in a greenhouse, a human-made structure to recreate warmer environments. Or, they could’ve been grown organically somewhere in the middle of summer in the southern hemisphere and shipped up north (hello, carbon emissions!) so you can access tomatoes year-round.
That 24/7 access isn’t free and excellent flavor is often a sacrifice we pay for eating fruits and vegetables out of season. Chefs and restaurants who offer seasonal offerings, for example, won’t serve bacon, lettuce, tomato (BLT) sandwiches in winter. Not because they’re pretentious, but because it won’t taste as great as it would in summer months. Instead of winter BLTs, these restaurants will proudly whip up seasonal steamed silky sweet potatoes or roasted brussels sprouts with kimchee puree.
When we eat seasonally-available food, it’s more likely we’re eating fresher food. A spring asparagus, summer apricot, fall pear, or winter grapefruit doesn’t have to travel far to get to your plate. With fewer miles traveled, the vitamins, minerals, and secondary metabolites in organic fruits and vegetables won’t degrade as much compared to fruits and vegetables flown or shipped in from other countries. Seasonal food tastes great and it’s great for you too.
If you’re curious to eat more of what’s in season, visit your local farmers market if it’s available to you. Strike up a conversation with the people who grow your food. If farmers markets are not available, take a moment to learn what is in season where you live and try those fruits and vegetables next time to go to the store. This Seasonal Food Guide for all 50 states is a great tool to get you started.
Once you incorporate seasonal fruits and vegetables into your daily meals, your body will thank you for the health boost and your meals will gain those extra flavors. Remember, you’re not a bad cook: you just need to find the right seasonal partners so your dinners are never left without that extra little something ever again.
Sign up for Andrea Castillo’s Seasonal, a newsletter that connects you to the Bay Area food system, one fruit and vegetable at a time. Andrea is a food nerd who always wants to know the what’s, how’s, when’s, and why’s of the food she eats.
Baker, B.P., Benbrook, C.M., & Groth III, E., & Lutz, K. (2002). Pesticide residues in conventional, integrated pest management (IPM)-grown and organic foods: insights from three US data sets. Food Additives and Contaminants, 19(5) http://www.tandfonline.com/doi/abs/10.1080/02652030110113799
Barański, M., Średnicka-Tober, D., Volakakis, N., Seal, C., Sanderson, R., Stewart, G., . . . Leifert, C. (2014). Higher antioxidant and lower cadmium concentrations and lower incidence of pesticide residues in organically grown crops: A systematic literature review and meta-analyses. British Journal of Nutrition, 112(5), 794-811. https://doi.org/10.1017/S0007114514001366
Cardenas, E. (2013). Let not thy food be confused with thy medicine: The Hippocratic misquotation,e-SPEN Journal, I(6), e260-e262. https://doi.org/10.1016/j.clnme.2013.10.002
Peper, E. (2017). Yes, fresh organic food is better! the peper perspective. https://peperperspective.com/2017/10/27/yes-fresh-organic-food-is-better/
Get Well & Stay Well: Technology’s effect on our mind and body with Wayne Jonas, MD and Erik Peper, PhDPosted: December 3, 2021
Enjoy the conversations, Get Well & Stay Well, with Wayne Jonas, MD, Former Director NIH Office of Alternative Medicine, and Erik Peper, PhD of San Francisco State University (SFSU) recorded November 30, 2021. They discuss technology’s effect on our mind and body and holistic approaches to managing stress and pain from chronic illness. Have patience when you watch the video–it takes 5 seconds for the program to begin. Click on the link to watch: https://fb.watch/9Cbkw9GZw8/
For more information, see the following blogs:
Madhu Anziani and Erik Peper
In April 2009, Madhu Anziani, just one month prior to graduation from San Francisco State University with a degree in Jazz/World music performance, fell two stories and broke C5 and C7 vertebras. He became a quadriplegic (tretraplegia) and could not breathe, talk, move his arms and legs and was incontinent. He also could not remember anything about the accident because of retrograde amnesia. Even though he was paralyzed and the medical staff suggested that he focussed on how to live well as a quadriplegic, he transcended his paralysis and the prognosis and is now a well-known vocal looping arts and ceremonial song leader/composer.
His recovery against all odds provides hope that growth and healing is possible when the mind and spirit focus on possibilities and not on limitations. Alongside physical thereapy he utilized energy healing and toning/sound vibrations to recover mobility. Toning, the vocalization of an elonggated monotonous vowel sound susteained for a number of minutes tends to vibrate specific areas in the body where the chakras are located (Crowe & Scovel, 1996; Goldman, 2017). Toning compared to mindfulness meditation reduces intrusive thoughts and mind wandering. It also increases body vibration sensations and heart rate variability much more than mindfulness practice (Peper et al, 2019). The body vibrations induced by toning and music could be one of the mechanisms by which recovery can occur at an accelerated rate as it allows the person’s passive awareness and sustained attention to feel the paralyzed body and yet be relaxed in the present without judgement.
Watch Madhu’s inspirational presentation as part of the Holistic Health Lecture Series by the Institute for Holistic Health Studies, San Francisco State University. In this presentation, he describes the process of recovery and guides the viewer through toning practices to evoke quieting of mind, bliss within the heart, and a healing state of being.
For an additional discussion and guided practice in toning, see the blog, Toning quiets the mind and increases HRV more quickly than mindfulness practice.
Madu Anziani is a sound healer who endured being a tetraplegic (paralysis affecting all four
limbs) and used sound and energy healing to recover mobility. He is a SFSU graduate and most
well-known as a vocal looping artist and ceremonial song leader/composer.
Erik Peper, PhD and Monica Almendras
Our evolutionary traps with technology
Maintaining and optimizing health at the computer means re-envisioning our relationship with technology—and reclaiming health, happiness, and sanity in a plugged-in world. We have the ability to control everything from our mobile phones without needing to get up from our seat. Work, social life and online learning all involve the mobile phone or some type of smart devices.
A convenient little device that is supposed to simplify our lives has actually trapped us into a vicious cycle of relying on it for every single thing we must do. We spend most of our day being exposed to digital displays on our smartphones, computers, gaming consoles, and other digital devices, immersing ourselves in the content we are viewing. From work related emails or tasks, to spending our free time looking at the screen for texting, playing games, and updating social media sites on a play-by-play of what we are eating, wearing, and doing. We click on one hyperlink after the other and create a vicious cycle trapped for hours until we realize we need to move. We are unaware how much time has frittered away without actually doing anything productive and then, we realize we have wasted another day. Below are some recent estimates of ‘daily active user’ minutes per day that uses a screen.
- Facebook about an hour per day
- Instagram just under an hour per day
- Texting about 45 minutes per day
- Internet browsing, about 45 minutes per day
- Snapchat, about 30 minutes per day
- Twitter, about 25 minutes per day
Adolescents and college students interact with media for over 40 hours per week, or around 6 hours per day. That is a lot of hours spent on staring at the screen, which it is almost impossible not to be distracted by the digital screen. In time, we rehearse a variety of physical body postures as well as a variety of cognitive and behavioral states that impact our physical, mental, emotional, and social health. The powerful audiovisual formats override our desires to do something different, that some of us become enslaved to streaming videos, playing virtual games, or texting. We then tell ourselves that the task that needs to be done, will be finished later. That later becomes never by the end of the day, since the ongoing visual and auditory notifications from our apps interrupt and/or capture our attention. This difficulty to turn away from visual or auditory stimuli roots in our survival instincts.
Each time visual or auditory stimuli occur, we automatically check it out and see if it is a friend or foe, safety or danger. It is such an automatic response that we are unaware are reacting. The good news is that we all have experienced this compelling effect. Even when we are waiting for a response and the notifications has not arrived, we may anticipate or project that there may be new information on our social media accounts, and sometimes we become disappointed when the interval between notification is long. As one student said, “Don’t worry, they’ll respond. It’s only been 30 seconds”. Anticipating responses from the media can interrupt what we are otherwise doing. Rather than finishing our work or task, we continuously check for updates on social media, even though we probably know that there are no new important messages to which we would have to respond right away.
Unfortunately, some forms of social media interactions also lead to a form of social isolation, loneliness–sometimes called phoneliness (Christodoulou, G., Majmundar, A., Chou, C-P, & Pentz, M.A., 2020; Kardaras, 2017). Digital content requires the individual to respond to the digital stimuli, without being aware of the many verbal and nonverbal communication cues (facial expressions, gestures, tone of voice, eye contact, body language, posture, touch, etc.) that are part of social communication (Remland, 2016). It is no wonder that more and more adolescents experience anxiety, depression, loneliness, and attention deficit disorders with a constant ‘digital diet’ that some have suggested that include not only media, but junk food as well.
In my class survey of 99 college students, 85% reported experiencing anxiety, 48% neck and should tension, and 41% abdominal discomfort.
We are not saying to avoid the beneficial parts of the digital age. Instead, it should be used in moderation and to be aware of how some material and digital platforms prey upon our evolutionary survival mechanisms. Unfortunately, most people -especially children- have not evolved skills to counter the negative impacts of some types of media exposure. Parental control and societal policies may be needed to mitigate the damage and enhance the benefits of the digital age.
Zoom Fatigue- How to reduce it and configure your brain for better learning
Zoom became the preferred platform for academic teaching and learning for synchronous education during the pandemic. Thus, students and faculty have been sitting and looking at the screen for hours end. While looking at the screen, the viewers were often distracted by events in their environment, notifications from their mobile phones, social media triggers, and emails; which promoted multitasking (Solis, 2019). These digital distractions cause people to respond to twice as many devices with half of our attention- a process labeled semi-tasking’ -meaning getting twice as much done and half as well.
We now check our phones an average of 96 times a day – that is once every 10 minutes and an increase of 20% as compared to two years ago (Asurion Research, 2019). Those who do media multitasking such as texting while doing a task perform significantly worse on memory tasks than those who are not multitasking (Madore et al., 2020). Multitasking is negatively correlated with school performance (Giunchiglia et al, 2018). The best way to reduce multitasking is to turn off all notifications (e.g., email, texts, and social media) and let people know that you will look at the notifications and then respond in a predetermined time, so that you will not be interrupted while working or studying.
When students from San Francisco State University in the United States chose to implement a behavior change to monitor mobile phone and media use and reduce the addictive behavior during a five-week self-healing project, many reported a significant improvement of health and performance. For example one student reported that when she reduced her mobile phone use, her stress level equally decreased as shown in Fig 1 (Peper et al, 2021).
Figure 1. Example of student changing mobile phone use and corresponding decrease in subjective stress level. Reproduced by permission from Peper et al. (2021).
During this class project, many students observed that the continuous responding to notifications and social media affected their health and productivity. As one student reported,
The discovery of the time I wasted giving into distractions was increasing my anxiety, increasing my depression and making me feel completely inadequate. In the five-week period, I cut my cell phone usage by over half, from 32.5 hours to exactly 15 hours and used some of the time to do an early morning run in the park. Rediscovering this time makes me feel like my possibilities are endless. I can go to work full time, take online night courses reaching towards my goal of a higher degree, plus complete all my homework, take care of the house and chores, cook all my meals, and add reading a book for fun! –22-year-old College Student
Numerous students reported that it was much easier to be distracted and multitask, check social media accounts or respond to emails and texts than during face-to-face classroom sessions as illustrated by two student comments from San Francisco State University.
“Now that we are forced to stay at home, it’s hard to find time by myself, for myself, time to study, and or time to get away. It’s easy to get distracted and go a bit stir-crazy.”
“I find that online learning is more difficult for me because it’s harder for me to stay concentrated all day just looking at the screen.”
Students often reported that they had more difficulty remembering the material presented during synchronous presentations. Most likely, the passivity while watching Zoom presentations affected the encoding and consolidation of new material into retrievable long-term memory. The presented material was rapidly forgotten when the next screen image or advertisement appeared and competed with the course instructor for the student’s attention. We hypothesize that the many hours of watching TV and streaming videos have conditioned people to sit and take in information passively, while discouraging them to respond or initiate action (Mander, 1978; Mărchidan, 2019).
To reduce the deleterious impact of media use, China has placed time limits on cellphone use, gaming, and social media use for children. On February 2021 Chinese children were banned from taking their mobile phones into school, on August 2021 Children under 18 were banned from playing video games during the week and their play was restricted to just one hour on Fridays, weekends and holidays, and beginning on September 20, 2021 children under 14 who have been authenticated using their real name can access Douyin, the Chinese version of Tik Tok, for maximum of 40 minutes a day between the hours of 6:00 and 22:00.
Ways to avoid Zoom
Say goodnight to your phone
It is common for people to use their mobile phone before going to bed, and then end up having difficult falling asleep. The screen emits blue light that sends a signal to your brain that says it is daytime instead of night. This causes your body to suppress the production of the melatonin hormone, which tells your body that it is time to sleep. Reading or watching content also contributes, since it stimulates your mind and emotions and thereby promote wakefulness (Bravo, 2020). Implement sleep hygiene and stop using your phone or watching screens 30-minutes before going to bed for a better night’s sleep.
Maintaining a healthy vision
We increase near visual stress and the risk of developing myopia when we predominantly look at nearby surfaces. We do not realize that eyes muscles can only relax when looking at the far distance. For young children, the constant near vision remodels the shape of eye and the child will likely develop near sightedness. The solutions are remarkably simple. Respect your evolutionary background and allow your eyes to spontaneously alternate between looking at near and far objects while being upright (Schneider, 2016; Peper, 2021; Peper, Harvey & Faass, 2020).
Interrupt sitting disease
We sit for the majority of the day while looking at screens that is a significant risk factor for diabetes, cardiovascular disease, depression and anxiety (Matthews et al., 2012; Smith et al., 2020). Interrupt sitting by getting up every 30 minutes and do a few stretches. You will tend to feel less sleepy, less discomfort and more productive. As one of our participants reported that when he got up, moved and exercised every 30 minutes at the end of the day he felt less tired. As he stated, “There is life after five”, which meant he had energy to do other activities after working at the computer the whole day. While working time flies and it is challenging to get up every 30 minutes. Thus, install a free app on your computer that reminds you to get up and move such as StretchBreak (www.stretchbreak.com).
Use slouching as a cue to change
Posture affects thoughts and emotions as well as, vice versa. When stressed or worried (e.g., school performance, job security, family conflict, undefined symptoms, or financial insecurity), our bodies tend to respond by slightly collapsing and shifting into a protective position. When we collapse/slouch, we are more at risk to:
- Feel helpless (Riskind & Gotay, 1982).
- Feel powerless (Westfeld & Beresford, 1982; Cuddy, 2012).
- Recall and being more captured by negative memories (Peper, Lin, Harvey, & Perez, 2017; Tsai, Peper, & Lin, 2016),
- Experience cognitive difficulty (Peper, Harvey, Mason, & Lin, 2018).
When stressed, anxious or depressed, it is challenging to change. The negative feelings, thoughts and worries continue to undermine the practice of reframing the experience more positively. Our recent study found that a simple technique, that integrates posture with breathing and reframing, rapidly reduces anxiety, stress, and negative self-talk (Peper, Harvey, Hamiel, 2019). When you are captured by helpless defeated thoughts and slouch, use the thought or posture as the trigger to take change. The moment you are aware of the thoughts or slouched posture, sit up straight, look up, take a slow large diaphragmatic breath and only then think about reframing the problem positively (Peper, Harvey, Hamiel, 2019).
When we are upright and look up, we are more likely to:
- Have more energy (Peper & Lin, 2012).
- Feel stronger (Peper, Booiman, Lin, & Harvey, 2016).
- Find it easier to do cognitive activity (Peper, Harvey, Mason, & Lin, 2018).
- Feel more confident and empowered (Cuddy, 2012).
- Recall more positive autobiographical memories (Michalak, Mischnat,& Teismann, 2014).
The challenge is that we are usually unaware we have begun to slouch. A very useful solution is to use a posture feedback device to remind us, such as the UpRight Go (https://www.uprightpose.com/). This simple device and app signals you when you slouch. The device attaches to your neck and connects with blue tooth to your cellphone. After calibrating, it provides vibrational feedback on your neck each time you slouch. When participants use the vibration feedback to become aware of what is going on and interrupt their slouch by stretching and sitting up, they report a significant decrease in symptoms and an increase in productivity. As one student reported: “Having immediate feedback on my posture helped me to be more aware of my body and helped me to link my posture to my emotions. Before using the tracker, doing this was very difficult for me. It not only helped my posture but my awareness of my mental state as well.”
 Adapted from the book by Erik Peper, Richard Harvey and Nancy Faass, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, North Atlantic Press. https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/
 Correspondence should be addressed to:
Erik Peper, Ph.D., Institute for Holistic Healing Studies/Department of Recreation, Parks, Tourism and Holistic Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132 COVID-19 mailing address: 2236 Derby Street, Berkeley, CA 94705 Email: firstname.lastname@example.org web: www.biofeedbackhealth.org blog: www.peperperspective.com
In hunting and gathering cultures, alternating movement patterns was part of living and essential for health. This shift from dynamic movement to static or awkward positions is illustrated in Figure 1.
Figure 1. The shift from dynamic movement to immobility and near vision as illustrated by the Hadzabe men in Tanzania returning from a hunt to our modern immobilized work and pleasure positions (Reproduced by permission from Peper, Harvey & Faass, 2020).
Dynamic movement promotes blood and lymph circulation and reduces static pressures. At present times our work and leisure activities increase immobility and static positions as we predominantly have shifted to a sitting immobilized position. This significantly increases musculoskeletal discomfort, cardiovascular disease, diabetes etc. The importance of movement as a factor to enhance health is illustrated in the recent findings of 2110 middle aged participants who were followed up for ten years. Those who took approximately 7000 steps per day or more experienced significantly lower mortality rates compared with participants taking fewer than 7000 steps per day (Paluch et al., 2021). Just having the head forward while looking at the cellphone significantly increases the forces on the muscles holding the head up as illustrated in Figure 2.
Figure 2. The head-forward position puts as much as sixty pounds of pressure on the neck muscles and spine (reproduced by permission from Dr. Kenneth Hansaraj, 2014).
For background and recommendations on what how to reduce static positions, look at our book, TechStress-How technology is hijacking our lives, strategies for coping and pragmatic ergonomics. and the superb article, Static postures are harmful – dynamic postures at work are key to musculoskeletal health, published by the European Agency for Safety and Health at Work (EU-OSHA, Sept 16, 2021) and reproduced below.
Our bodies are built for movement – it’s a central part of maintaining a healthy musculoskeletal system and the less we move, the more chance we have of developing health issues including musculoskeletal disorders (MSDs), type 2 diabetes, cardiovascular disease, cancer and more. However, the negative effects of sedentary work can be mitigated by paying attention to the postures we adopt when we work.
Whether workers are standing or seated while working, maintaining a good ergonomic posture is essential when it comes to preventing MSDs. Poor or awkward postures put unnecessary strain on the musculoskeletal system and, over time, can cause the deterioration of muscle fibres and joints.
Poor or awkward postures include those which involve parts of the body not being in their natural position. More muscular effort is needed to maintain unnatural postures, which increases the energy used by the body and can cause fatigue, discomfort and pain. Unnatural postures also put strain on tendons, ligaments and nerves, which increases the risk of injury. For example, the risk of neck pain increases when the neck is rotated more than 45 degrees for more than 25% of the working day.
These postures, including slouching, rotation of the forearms, or prolonged periods of sitting or standing in the same spot, can cause pain in the lower back and upper limbs. The risk increases when combined with repetitive work, static muscle load, or the need to apply force or reach. And even natural or good postures maintained for any length of time become uncomfortable and eventually painful. Everyone has experienced stiffness after being in the same position for any length of time.
What do we mean by ‘good posture’?
For workers, especially those in sedentary jobs such as office work, factory work or driving, it is important to recognise and adopt good postures. A good posture should be comfortable and allow the joints to be naturally aligned. The segments of our body can be divided into three cross-sectional anatomical planes: the sagittal plane, which concerns bending forwards and backwards; the frontal plane, which concerns bending sideways; and finally the transverse plane, which refers to rotation or twisting of the body parts. A good posture is one that ensures that all three of these planes are set at neutral positions as much as possible, in that the worker is not leaning backwards, forwards or to any particular side, and their limbs and torso are not rotated or twisted. Adopting neutral postures will help to lessen the strain on the worker’s muscles, tendons and skeletal system, and reduces the risk of them causing or aggravating an MSD.
In practice, workers can consider the following checklist to ensure that they’re standing or sitting in a neutral position:
- Keep the neck vertical and the back in an upright position.
- Ensure the elbows are below the chest and avoid having to reach excessively.
- Keep the shoulders relaxed and use back and arm rests where possible and ensure that they are adjusted to the size and shape of the worker.
- Avoid rotating the forearms or excessively moving the wrists.
- Ensure that any work tools can be held comfortably, and that clothing doesn’t restrain or prevent movement.
- Allow room to comfortably move the legs and feet and avoid frequent kneeling or squatting.
- Ensure that long periods of standing or sitting in the same posture can be broken up.
Employers can assist workers in adopting good postures by communicating checklists such as this one, and by promoting physical activity where possible, encouraging the fair rotation of tasks between employees to avoid them consistently making repetitive movements, and ensuring that workers have the capacity to take regular breaks.
Why our next posture is the best posture
However, maintaining a good posture at all times is not enough to reduce the risk of MSDs, and can even be harmful. Static postures, even if ergonomic, are still a risk factor if over-used. Our body requires movement and variety, which is why the best approach is to use a variety of ergonomic postures in rotation, breaking up long periods of static working with stretching, exercise, and movement. This is known as adopting ‘dynamic positions’.
It is important not only for workers who spend much of their day seated, but also for workers who primarily stand – such as factory workers in assembly lines. In both cases, sitting and standing are not opposites. The opposite of both is movement. Changing postures between sitting and standing is not sufficient for any worker – the working environment must still offer ways of varying their postures and incorporating movement into their daily working routines. What’s more, if standing work cannot be avoided, workers do not need lots of space in order to adopt dynamic positions in a healthy way. Blood flow propulsion mechanisms can still work correctly even if the worker is only moving around in one square metre. However it is still the case that they should have a break after 30 minutes of standing.
Work should therefore not only facilitate good postures, but ensure that good, ergonomic postures are also dynamic. Switching between sitting, standing and moving while ensuring that the musculoskeletal frame is not under any unnecessary tension can help sedentary workers avoid the onset of MSDs and other health problems. For more information visit the priority area on sedentary work.
EU-OSHA. (September 16, 2021). Static postures are harmful – dynamic postures at work are key to musculoskeletal health. https://healthy-workplaces.eu/en/media-centre/news/static-postures-are-harmful-dynamic-postures-work-are-key-musculoskeletal-health?
Hansraj, K. K. (2014). Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head. Surgical Technology International, 25, 277–79. https://pubmed.ncbi.nlm.nih.gov/25393825/
Paluch, A.E., Gabriel, K.P., Fulton, J.E., et al.(2021). Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study. JAMA Netw Open, 4(9):e2124516. https://doi.org/10.1001/jamanetworkopen.2021.24516
Peper, E., Harvey, R. & Faass, N. (2020). TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. Berkeley: North Atlantic books. https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/
With good clean air circulation, the risk of transmitting or contracting airborne disease such as COVID-19 during air travel is very low (Pombal, Hosegood & Powell, 2020). Pombal, Hosegood & Powell, 2020 point out that modern airplanes maintain clean air by circulating a mix of fresh air and air recycled through HEPA filter. Air enters from overhead air inlets and flows downward toward floor level outlets at the same seat row or nearby rows. There is little airflow forward and backward between rows.
The risk of transmission or contracting airborne dieases is very high if the airplane ventilation system is not working while passengers are in the plane. For example, when a jet airliner with 54 persons aboard was delayed on the ground for three hours with an inoperative ventilation system 72 % of the passengers became ill with symptoms of cough, fever, fatigue, headache, sore throat and myalgia within 72 hours (Moser et al.,1979).
To reduce the risk of COVID and other airborne infections such as influenza, government policies need to implement strategies to reduce exposure to airborne pathogens and optimize the immune system. By improving ventilation that reduces and removes airborne pathogens, thousands, if not millions, lives will be saved from being infected or dying of COVID or influenza.
Before the COVID pandemic between 2010 and 2020 an average of 39,900 people a year died of influenza in the United States and during a severe influenza season such as that occurred in 2017-2018, 61,000 people died (CDC, 2021). Influenza, just as COVID, is caused by an airborne pathogens (viruses). Although wearing masks significantly reduces the airborne spread of the pathogens, the long term preventative solution is to implement indoor ventilation strategies so that the air is not contaminated in the same way that we expect drinking water not to cause illness. From a public health perspective, changing external environment so the virus is cannot spread is a more effective strategy than depending upon individuals’ actions to prevent the spread of the pathogens.
By improving the air filtration and fresh air circulation in rooms and buildings, COVID, influenza virus and other airborne pathogens can be significantly reduced just as that has been done in modern airplanes. This demands changes in building ventilation codes and design. It means changing the physical infrastructure and upgrading ventilation systems so that only fresh and/or filtered air circulates through the rooms. This infrastructure improvement would be analogous to what occurred in the 19th century in eventually eliminating the cholera epidemics that killed thousands of people a year.
For example in England during the 1831-1832 and 1848 cholera epidemics more than 50,000 people died each year as they became infected with the toxigenic bacterium Vibrio cholerae which was present the water or foods contaminated with feces from a a person infected with cholera bacterium. Approximately 1 in 10 people who get sick with cholera will develop severe symptoms and without treatment, death can occur within hours (CDC, 2021).
In Londong during the 1854 cholera epidemic Dr. John Snow observed that people who got cholera were drawing water from a the same water pump on Broad Street. He persuaded the authorities to remove the pump handle which eliminated the use of the contaminated water and stopped the spread of the Cholera.
The water pump in Broadwick Street.
This public health intervention provided some of the rationale in 19th century to build the infrastructure to provide clean drinking water and appropriate sewage disposal, so that cholera, typhoid as well as other waterborne diseases epidemics would not enter the drinking water supply.
We now need a similar infrastructure improvement to provide clean air in buildings to stop the spread of COVID-19 variants and influenza. How ventilation affects the spread a virus in a class room is illustrated in the outstanding graphical modeling by Nick Bartzokas et al. (February 26, 2021) in the New York Times article, Why opening windows is a key to reopening schools. The spatial guidelines need to be based upon air flow and not on the distance of separation.
In summary, to prevent future airborne illnesses, local, state and federal government need to create and implement ventilation standards so that airborne pathogens are not spread indoors by contaminated air. This is not rocket science! It is a very solvable problem and has been implemented in airplanes. When the air is HEPA filtered so that passengers do not rebreathe each other’s potentially contaminated exhaled air, airborne transmission is very low. Let’s do the same for the air circulating in buildings.
For more details to reduce virus exposure and increase immune competence, see the previoius published blogs,
CDC (2021). Disease Burden of Influenza. Center for Disease Control and Prevention. https://www.cdc.gov/flu/about/burden/index.html
Moser, M.R., Bender, T.R., Margolis, H.S., Noble, G.R., Kendal, A.P., & Ritter, D.G. (1979). An outbreak of influenza aboard a commercial airliner. Am J Epidemiol, 110(1), 1-6. https://doi.org/10.1093/oxfordjournals.aje.a112781
Pombal, R., Hosegood, I., & Powell, D. (2020). Risk of COVID-19 During Air Travel. JAMA, 324(17), 1798 https://doi.org/10.1001/jama.2020.19108
Zhang, S. (September 7, 2021). The plan to stop every respiratory virus at once. The Atlantic. Downloaded September 13. https://www.theatlantic.com/health/archive/2021/09/coronavirus-pandemic-ventilation-rethinking-air/620000/
Erik Peper, PhD and Vietta Wilson, PhD
Adapted from: Peper, E. & Wilson, V. (2021). Optimize the learning state: techniques and habits. Biofeedback, 9(2), 46-49. https://doi.org/10.5298/1081-5937-49-2-04
Long after the COVID-19 pandemic is over, online learning will continue to increase as better methodologies and strategies are developed to implement and integrate it into our lives. This post provides suggestions on how to enhance the learner’s ability to engage while online with the use of pre-performance routines or habits.
Facilitating online learning requires coordination of the teacher, technology, student, environment and the topic. Teachers can enhance engagement (Shoepe et al., 2020) online through different types of prompts: intellectual (associated with instructor interaction, academic challenge, active learning), organizational (associated with enriching academic experiences by directing students, selecting topics and summarizing or redirecting), and social (associated with supportive campus environments by encouraging social interaction, using informal language and affirming student comments).
The student can enhance the satisfaction and quality of the online experience by having a good self-regulated learning style. Learning is impacted by motivation (beliefs about themselves or the task, perceived value, etc.), and metacognition (ability to plan, set goals, monitor and regulate their behavior and evaluate their performance) (Greene & Azevedo, 2010; Mega et al., 2014). While critical for learning, it does not provide information on how students can maintain their optimized performance long term, which is increasingly necessary during the pandemic but will possibly be the model of education and therapy of the future.
Habit can enhance performance across a life span.
Habit is a behavioral tendency tied to a specific context, such as learning to brush one’s teeth while young and continuing through life (Fiorella, 2020). Habits are related to self-control processes that are associated with higher achievement (Hagger, 2019). Sport performance extensively values habit, typically called pre-performance routine, in creating an ongoing optimized state of performance (Lautenbach et al., 2015; Lidor & Mayan, 2005; Mesagno et al., 2015). Habits or pre-performance routines are formed by repeating a behavior tied to a specific context and with continued repetition, wherein the mental association between the context and the response are strengthened. This shifts from conscious awareness to subconscious behavior that is then cued by the environment. The majority of one’s daily actions and behaviors are the results of these habits.
Failure to create a self-regulated learning habit impedes long-term success of students. It does take significant time and reinforcement to create the automaticity of a real-life habit. Lally et al. (2010) tracked real world activities (physical activity, eating, drinking water) and found habit formation varied from 18-254 days with a mean of 66 days. There was wide variability in the creation of the habit and some individuals never reached the stage of automaticity. Interestingly, those who performed the behavior with greater consistency were more likely to develop a habit.
The COVID pandemic resulted in many people working at home, which interrupted many of the covert habit patterns by which they automatically performed their tasks. A number of students reported that everything is the same and that they are more easily distracted from doing the tasks. As one student reported:
After a while, it all seems the same. Sitting and looking at the screen while working, taking classes, entertaining, streaming videos and socializing. The longer I sit and watch screens, the more I tend to feel drained and passive, and the more challenging it is to be present, productive and pay attention.
By having rituals and habits trigger behavior, it is easier to initiate and perform tasks. Students can use the strategies developed for peak performance in sports to optimize their performances so that they can achieve their personal best (Wilson & Peper, 2011; Peper et al., 2021). These strategies include environmental cueing and personal cueing.
By taking charge of your environment and creating a unique environment for each task, it is possible to optimize performance specific for each task. After a while, we do not have to think to configure ourselves for the task. It is no different than the sequence before going to sleep: you brush your teeth and if you forget, it feels funny and you probably will get up to brush your teeth.
Previously, many people, without awareness, would configure and reinforce themselves for work by specific tasks such as commuting to go work, being at a specific worksite to perform the work, wearing specific clothing, etc. (Peper et al., 2021). Now there are few or no specific cues tied to working; it tends to be all the same and it is no wonder that people feel less energized and focused.
Many people forget that learning and recall are state-dependent to where the information was acquired. The Zoom environment where we work or attend class is the same environment where we socialize, game, watch videos, message, surf the net and participate in social media. For most, there has been no habit developed for the new reality of in-home learning. To do this, the environment must be set up so the habit state (focused, engaged) is consistently paired with environmental, emotional, social and kinesthetic cues. The environment needs to be reproducible in many locations, situations, and mental states as possible. As illustrated by one student’s report.
To cue myself to get ready for learning, I make my cappuccino play the same short piece of music, wear the same sweater, place my inspiring poster behind my screen, turn off all software notifications and place the cell phone out of visual range.
A similar concept is used in the treatment of insomnia by making the bedroom the only room to be associated with sleep or intimacy (Irish et al., 2017; Suni, 2021). All other activities, arguing with your partner, eating, watching television, checking email, texting, or social media are done at other locations. Given enough time, the cues in the bedroom become the conditioned triggers for sleep and pleasure.
Create different environments that are unique to each category of Zoom involvement (studying, working, socializing, entertaining).
Pre COVID, we usually wore different clothing for different events (work versus party) or visited different environments for different tasks (religious locations for worship; a bar, coffee shop, or restaurant for social gathering). The specific tasks in a specified location had conscious and subconscious cues that included people, lighting, odors, sound or even drinks and food. These stimuli become the classically conditioned cues to evoke the appropriate response associated with the task, just as Pavlov conditioned dogs to salivate when the bell sound was paired with the presentation of meat. Taking charge of the conditioning process at home may help many people to focus on their task as so many people now use their bedroom, kitchen or living room for Zoom work that is not always associated with learning or work. The following are suggestions to create working/learning environments.
- Wear task-specific clothing just as you would have done going to work or school. When you plan to study or work, put on your work shirt. In time, the moment you put on the work shirt, you are cueing yourself to focus on studying/working. When finishing with working/studying, change your clothing.
- If possible, maintain a specific location for learning/working. When attending classes or working, sit at your desk with the computer on top of the desk. For games or communication tasks, move to another location.
- If you can’t change locations, arrange task-specific backgrounds for each category of Zoom tasks. Place a different background such as a poster or wall hanging behind the computer screen—one for studying/working, and another for entertainment. When finished with the specific Zoom event, take down the poster and change the background.
- Keep the sound appropriate to the workstation area. Try to duplicate what is your best learning/working sound scape.
Learning to become aware of and in control of one’s personal self is equally or more important than setting up the environment with cues that foster attention and learning. Practicing getting the body/mind into the learning state can become a habit that will be available in many different learning situations across one’s lifespan.
- Perform a specific ritual or pre-performance routine before beginning your task to create the learning/performing state. The ritual is a choreographed sequence of actions that gets you ready to perform. For example, some people like to relax before learning and find playing a specific song or doing some stretching before the session is helpful. Others sit at the desk, turn off all notifications, take a deep breath then look up and state to themselves: “I am now looking forward to working/studying and learning,” “focus” (whatever it may be). For some, their energy level is low and doing quick arm and hand movements, slapping their thighs or face, or small fast jumps may bring them to a more optimal state. For many people smell and taste are the most powerful conditioners, and coffee improves their attention level. Test out an assortment of activities that get your body and mind at the performance level. Practice and modify as necessary.
Just as in sport, the most reliable method is to set up oneself for the learning/performance state, because a person has less control over the environment. For example, when I observed the Romanian rhythmic gymnasts team members practice their routine during the warmup before the international competition, they would act as if it was the actual competition. They stood at the mat preparing their body/mind state, then they would bow to the imaginary judge, wait for a signal to begin, and then perform their routine. On the other hand, most of the American rhythmic gymnasts would just do their practice routine. For the Romanian athletes, the competition was the same as their rehearsal practice. No wonder, the Romanian athletes were much more consistent in their performance. Additionally, ritual helps buffer against uncertainty and anxiety (Hobson et al., 2017).
- Develop awareness of the body-mind state associated with optimum performance. This can be done by creating a ritual and an environment that evoke the optimum mental and emotional state for learning. As you configure yourself and your environment, explore how you physically feel when you are most focused and engaged. Identify what your posture, muscle tension, and body position feel like during these times, and identify what you are paying attention to. If your attention wanders, observe how you bring your attention back to the task. Does it help focus you to write summary notes or doodle? Do you flag important statements in your head and then visibly nod your head when you understand the concept? Or do you repeat an important cue word? Find what you do when you are optimally functioning. Then try to reproduce that same state that can be triggered by a key word that tells you what to focus on (e.g., listen to teacher, look at slide, etc.).
In summary, by becoming aware of and controlling one’s environment and personal states that are associated with productive learning, and then practicing them until they become a routine or habit, one can maximize all learning opportunities. This blog presented a few tips, techniques and cues that may help one to maximize attention and increase performance and learning while online.
I noticed when I took the time to prepare and ready myself to be focused and be present during the class, I no longer had to actively work to resist distractions; I was focused in the moment and not worried about emails, other assignments, what to make for dinner, etc…
Findlay-Thompson, S. and Mombourquette, P. (2014). Evaluation of a Flipped Classroom in an Undergraduate Business Course. Business Education & Accreditation, v. 6 (1), 63-71.https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2331035
Fiorella, L. (2020). The science of habit and its implications for student learning and ell-being. Educational Psychology Review, 32,603–625. https://doi.org/10.1007/s10648-020-09525-1
Greene, J. A., & Azevedo, R. (2010). The measurement of learners’ self-regulated cognitive and metacognitive processes while using computer-based learning environments. Educational Psychologist, 45(4), 203–209. https://doi.org/10.1080/00461520.2010.515935
Hagger, M. S. (2019). Habit and physical activity: Theoretical advances, practical implications, and agenda. Psychology of Sport and Exercise, 42, 118–129. https://doi.org/10.1016/j.psychsport.2018.12.007
Hobson, N. M., Bonk, D., & Inzlicht, M. (2017). Rituals decrease the neural response to performance failure. PeerJ, 5, e3363. https://doi.org/10.7717/peerj.3363
Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews, 22, 23–36. https://doi.org/10.1016/j.smrv.2014.10.001
Lally, P., VanJaarsveld, C. H., Potts, H. W., & Wardle, J. (2010). How habits are formed: Modelling habit formation the real world. European Journal of Social Psychology, 40, 998–1009. https://doi.org/10.1002/ejsp.674
Lautenbach, F., Laborder, S. I., Lobinger, B. H., Mesagno, C. Achtzehn, S., & Arimond, F. (2015). Non automated pre-performance routine in tennis: An intervention study. Journal of Applied Sport Psychology, 27(2), 123-131. https://doi.org/10.1080/10413200.2014.957364
Lidor, R. & Mayan, Z. (2005). Can beginning learners benefit, from pre-performance routines when serving in volleyball? The Sport Psychologist 19(4), 243–263. https://doi.org/10.1123/tsp.19.4.343
Mega, C., Ronconi, L., & De Beni, R. (2014). What makes a good student? How emotions, self-regulated learning, and motivation contribute to academic achievement. Journal of Educational Psychology, 106(1), 121–131. https://doi.org/10.1037/a0033546
Mesagno, C., Hill, D. M., & Larkin, P. (2015). Examining the accuracy and in game performance effects between pre- and post-performance routines: A mixed methods study. Psychology of Sort and Exercise, 19, 85–94. https://doi.org/10.1016/j.psychsport.2015.03.005
Peper, E., Wilson, V., Martin, M., Rosegard, E., & Harvey, R. (2021). Avoid Zoom fatigue, be present and learn. NeuroRegulation, 7(1).
Shoepe, T. C., McManus, J. F., August, S. E., Mattos, N. L., Vollucci, T. C. & Sparks, P. R. (2020). Instructor prompts and student engagement in synchronous online nutrition classes. American Journal of Distance Education, 34, 194–210. https://doi.org/10.1080/08923647.2020.1726166
Suni, E. (2021). Sleep Hygiene. https://www.sleepfoundation.org/sleep-hygiene.
Wilson, V. E. & Peper, E. (2011). Athletes are different: factors that differentiate biofeedback/neurofeedback for sport versus clinical practice. Biofeedback, 39(1), 27–30. https://doi.org/10.5298/1081-5937-39.1.01