Evolutionary traps: How screens, digital notifications and gaming software exploits fundamental survival mechanismsPosted: January 17, 2020
Erik Peper and Richard Harvey
Mental rehearsal has many benefits.
- Athletes use mental rehearsal to improve sports performance (Peper & Aita, 2017; Schenk & Miltenberger, 2019).
- Surgeons use mental rehearsal and actual practice to improve performance (Spiotta et al., 2018).
- Psychologists use cognitive behavioral therapy (CBT) rehearsal techniques to reduce anxiety and depression (Dobson & Dobson, 2018; Yamada et al, 2018; Cook, Mostazir, & Watkins, 2019)
- Successful business executives rehearse presentations before a staff meeting (Couch & Citrin, 2018).
- Actors and performers spend hours and days rehearsing their roles so that they portray and act it realistically during the performance .
- Students take practice exams so that they will perform better on the actual exam.
- Politicians, lawyers, and many others rehearse and practice being able to answer unexpected questions.
- Job seekers rehearse elevator pitches so that they transmit in a few words what is important
If athletes, psychologists, business executives, actors, students, politicians, job seekers and others use mental and actual rehearsal to improve their performances, would repeated watching of violent and aggressive streaming-videos, or playing hours and hours of first-shooter computer games be a form of rehearsal for aggressive behavior?
Arguably, mental and actual rehearsal is positively associated with improving health, such as preparing for an athletic competition or an academic exam and is negatively associated with health when playing aggressive, violent first-person shooter video games, or continuously watching aggressive or violent content on a variety of streaming platforms. Rehearsal–whether physical or in our imagination–impacts our health and performance in school, sports, therapy, politics, business and health. Choose to rehearse activities that improve health and well-being.
Mechanisms of rehearsal
Both mental and physical rehearsal strengthens neurochemical connections in the brain so that the rehearsed behaviors become more automated, fluid and unconscious. There is a saying in neurosciences, “Neurons that fire together wire together.” –the more you rehearse a task, the more those specific neurological pathways are strengthened, leading to automatic and efficient outcomes.
We now spend hours a day being exposed to digital displays on our phones, computers, gaming consoles and other digital devices, immersing ourselves in content reflecting life promoting, positive behavior and sometimes violent, negative behavior. Children and adults spend much of their free time looking at screens, texting, playing computer games, updating social media sites with moment by moment accounts of sometimes trivial activities, or going down the rabbit hole by following one hyperlinks after another. As we do this, we are unaware how much time has frittered away without actually doing anything productive. Below are some recent estimates of ‘daily active user’ minutes per day that uses a screen.
- Facebook about an hour per day
- Instagram just under an hour per day
- Texting about 45 minutes per day
- Internet browsing, about 45 minutes per day
- Snapchat, about 30 minutes per day
- Twitter, about 25 minutes per day
Adolescents interact with media for over 40 hours per week, or around 6 hours per day!
In spending much of our time with the screens, we rehearse a variety of physical body postures as well as a variety of cognitive and behavioral states that impact our physical, mental, emotional and social health. Many researchers have lamented the loss of some social skills that develop during physical face-to-face contact. The colloquial phrase, Use it or lose it, raises several questions about what is being lost when we spend so much of our waking time interacting with screens instead actually with other people?
It is almost impossible not to be distracted by the digital screen. The powerful audiovisual formats override our desire to do something different that some of us become enslaved to watching streaming videos, playing computer games or texting. Moreover, the ongoing visual and auditory notifications from our apps interrupts and/or capture our attention. Why is it difficult to turn away from visual or auditory stimuli? The answer has roots in our survival.
To attend to stimuli is an automatic evolutionary survival response. If we did not attend, we would not survive–Is the slight movement to the far right, just at the edge of our peripheral vision, a predator ready to attack?
Each time a stimulus occurs, we need to check it out to see if it is friend or foe, safety or danger. The response is so automatic that we are unaware that we have reacted until after we have responded. We all have experienced this. When a computer screen or cellphone screen is held by the stranger next to us, we automatically look at their screen and we may even begin to read their emails. Although we know that peering at some else’s screen is not proper, we are still feel compelled to do it!
Similarly, screens displaying computer games and other media can capture or hijack our attention by the rapid scene changes, primarily because the content is programmed so we receive intermittent rewards for our responses. For example, the sound or visual notifications from our apps, cellphone messages, or social media trigger an impulse to scan the environment for information that may be critical to our survival. Even without receiving notifications, we may anticipate or project that there may be new information on our social media accounts, and sometimes we become disappointed when the interval between notifications is long. One student talking to another might say: “Don’t worry, they’ll respond; It’s only been 30 seconds.” Anticipating responses from the media can interrupt what we are otherwise doing. For example, rather than finish our work, we check for updates on social media, even though we probably know that there are no new important messages to which we would have to respond right away.
The mechanisms that help us survive by scanning our environment for predators may now become an evolutionary trap and is exploited to capture as many eyeballs as possible to increase market share, advertising revenue, and corporate bottom line.
We usually blame the individual for lack of self-control instead of blaming the designers of the digital apps, games and displays who have exploited this biological survival mechanism. We expect that children have voluntary control as their brains are developing–but how could they not react to the stimuli that for thousands of generations, helped them to survive. It is similar to asking children to have control and say “No” to fast foods and sweets. The foods that were previously necessary for survival represented by moderate amounts of ‘salt, fat, acid, heat and sweet’ tastes are often found in excess in our modern commercial or packaged ‘fast food nation’ making it likely that people may fall into an evolutionary trap related to what they eat.
Presently, high levels of exposure to violent and aggressive streaming videos and computer games can be harmful as they provide the practice to rehearse violence, killing and aggression mentally. It would be too strong a statement to assert that everyone who plays violent video games will become delinquent, criminal or homicidal in an extreme form of aggression. According to the American Psychological Association Task Force on Video Game Violence in 2017, it may be asserted that high frequency, long duration, high intensity interactions with violent video games or similar media content is highly associated with angry and aggressive thoughts, desensitization to violence, and decreases in empathy or helping others (Calvert et al., 2017). Some forms of social media interactions also lead to a form of social isolation, loneliness (phoneliness) (Christodoulou, G., Majmundar, A., Chou, C-P, & Pentz, M.A., 2020; Kardaras, 2017). Digital content requires the individual to respond to the digital stimuli, without being aware of the many verbal and nonverbal communication cues (facial expressions, gestures, tone of voice, eye contact, body language, posture, touch, etc) that are part of social communication (Remland, 2016). It is no wonder that more and more adolescents experience anxiety, depression, loneliness, and attention deficit disorders with a constant ‘digital diet’ that some have suggested include not only media, but junk food as well .
The negative impact of watching digital media was prescient by Jerry Mander, one of the leading visionaries of the 20th century, in his 1978 book, Four Arguments for the Elimination of Television, as well as by Joseph C. Pearce, author of books on human development and child development, in his 1993 book, Evolution’s End.
More recently, two superb books detail the harm that the digital revolution has brought, along with recommended strategies for how to use modern technologies wisely and live successfully in an e-world. We are not saying to avoid the beneficial parts of the digital age. We are saying to be aware how some material and digital platforms prey upon our evolutionary survival mechanisms. Unfortunately, most people —especially children– have not evolved skills to counter the negative impacts of some types of media exposure. It may take parental control and societal policies to mitigate the damage and enhance the benefits of the digital age. We highly recommend the following two books.
Calvert, S. L., Appelbaum, M., Dodge, K. A., Graham, S., Nagayama Hall, G. C., Hamby, S., Fasig-Caldwell, L. G., Citkowicz, M., Galloway, D. P., & Hedges, L. V. (2017). The American Psychological Association Task Force assessment of violent video games: Science in the service of public interest. American Psychologist, 72(2), 126–143. https://doi.org/10.1037/a0040413
Christodoulou, G., Majmundar, A., Chou, C-P, & Pentz, M.A. (2020). Anhedonia, screen time, and substance use in early adolescents: A longitudinal mediation analysis. Journal of Adolescence, 78, 24-32.
Cook L, Mostazir M, Watkins E, (2019). Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students. J Med Internet Res, 21(5):e11349
Spiotta, A.M, Buchholz, A.L., Pierce, A. K., Dahlkoetter, J., & Armonda, R. (2018). The Neurosurgeon as a High-Performance Athlete: Parallels and Lessons Learned from Sports Psychology. World Neurosurgery, 120, e188-e193
Yamada, F., Hiramatsu, Y., Murata, T., Seki, Y., Yokoo, M., Noguchi, R., … & Shimizu, E. (2018). Exploratory study of imagery rescripting without focusing on early traumatic memories for major depressive disorder. Psychology and Psychotherapy: Theory, Research and Practice, 91(3), 345-362.
This post has been adapted from Peper, E., Harvey, R., & Hamiel, D. (2019). Transforming thoughts with postural awareness to increase therapeutic and teaching efficacy. NeuroRegulation, 6(3), 153-169. doi:10.15540/nr.6.3.1533-1
When locked into a position, options appear less available. By unlocking our body, we allow our brain to unlock and become open to new options.
Changing positions may dissolve the rigidity associated with a fixed position. When we step away from the conflict, take a walk, look up at the treetops, roof lines and clouds, or do something different, we loosen up and new ideas may occur. We may then be able see the conflict from a different point of view that allows resolution.
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).
Thoughts and emotions affect posture and posture affects thoughts and emotions. When stressed or worried (e.g., school performance, job security, family conflict, undefined symptoms, or financial insecurity), our bodies respond to the negative thoughts and emotions by slightly collapsing and shifting into a protective position. When we collapse/slouch, we are much 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 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).
Experience how posture affects memory and the feelings (adapted from Alan Alda, 2018)
Stand up and do the following:
- Think of a memory/event when you felt defeated, hurt or powerless and put your body in the posture that you associate with this feeling. Make it as real as possible . Stay with the feeling and associated body posture for 30 seconds. Let go of the memory and posture. Observe what you experienced.
- Think of a memory/event when you felt empowered, positive and happy put your body in the posture that you associate with those feelings. Make it as real as possible. Stay with the feeling and associated body posture for 30 seconds. Let go of the memory and posture. Observe what you experienced.
- Adapt the defeated posture and now recall the positive empowering memory while staying in the defeated posture. Observe what you experience.
- Adapt the empowering posture and now recall the defeated hopeless memory while staying in the empowered posture. Observe what you experience.
Almost all people report that when they adapt the body posture congruent with the emotion that it was much easier to access the memory and feel the emotion. On the other hand when they adapt the body posture that was the opposite to the emotions, then it was almost impossible to experience the emotions. For many people, when they adapted the empowering posture, they could not access the defeated hopeless memory. If they did access that memory, they were more likely be an observer and not be involved or emotionally captured by the negative memory.
Comparison of Posture with breathing and reframing to Reframing
The study investigated whether changing internal dialogue (reframing) or combining posture change and breathing with changing internal dialogue would reduce stress and negative self-talk more effectively.
The participants were 145 college students (90 women and 55 men) average age 25.0 who participated as part of a curricular practice in four different classes.
After the students completed an anonymous informational questionnaire (history of depression, anxiety, blanking out on exams, worrying, slouching), the classes were divided into two groups. They were then asked to do the following:
- Think of a stressful conflict or problem and make it as real as possible for one minute. Then let go of the stressful memory and do one of the two following practices.
- Practice A: Reframe the experience positively for 20 seconds.
- Practice B: Sit upright, look up, take a breath and reframe the experience positively for 20 seconds.
- After doing practice A or practice B, rate the extent to which your negative thoughts and anxiety/tension were reduced, from 0 (not at all) to 10 (totally).
- Now repeat this exercise except switch and do the other practice. (Namely, if you did A now you do B; if you did B now you do A).
Overwhelmingly students reported that sitting erect, breathing and reframing positively was much more effective than only reframing as shown in Figure 1 and 2.Figure 1. Percentage of students rating posture, breath and reframing practice (PBRP) as more effective than reframing practice (RP) in reducing negative thoughts, anxiety and stress. Figure 2. Self-rating of reduction of negative thoughts and anxiety/tension
Stop reading. Do the practice yourself. It is only through experience that you know whether posture with breathing and reframing is a more beneficial than simply reframing the language.
Implications for education, counseling, psychotherapy.
Our findings have implications for education, counseling and psychotherapy because students and clients usually sit in a slouched position in classrooms and therapeutic settings. By shifting the body position to an erect upright position, taking a breath and then reframing, people are much more successful in reducing their negative thoughts and anxiety/stress. They report feeling much more optimistic and better able to cope with felt stress as shown by representative comments in table 1.
|Reframing||Posture, breath and reframing|
|After changing my internal language, I still strongly felt the same thoughts.||I instantly felt better about my situation after adjusting my posture.|
|I felt a slight boost in positivity and optimism. The negative feelings (anxiety) from the negative thoughts also diminished slightly.||The effects were much stronger and it was not isolated mentally. I felt more relief in my body as well.|
|Even after changing my language, I still felt more anxious.||Before changing my posture and breathing, I felt tense and worried. After I felt more relaxed.|
|I began to lift my mood up; however, it didn’t really improve my mood. I still felt a bit bad afterwards and the thoughts still stayed.||I began to look from the floor and up towards the board. I felt more open, understanding and loving. I did not allow myself to get let down.|
|During the practice, it helped calm me down a bit, but it wasn’t enough to make me feel satisfied or content, it felt temporary.||My body felt relaxed overall, which then made me feel a lot better about the situation.|
|Difficult time changing language.||My posture and breathing helped, making it easier to change my language.|
|I felt anger and stayed in my position. My body stayed tensed and I kept thinking about the situation.||I felt anger but once I sat up straight and thought about breathing, my body felt relaxed.|
|Felt like a tug of war with my thoughts. I was able to think more positively but it took a lot more brain power to do so.||Relaxed, extended spine, clarity, blank state of mind.|
Table 1. Some representative comments of practicing reframing or posture, breath and reframing.
The results of our study in the classroom setting are not surprising. Many us know to take three breaths before answering questions, pause and reflect before responding, take time to cool down before replying in anger, or wait till the next day before you hit return on your impulsive email response.
Currently, counseling, psychotherapy, psychiatry and education tend not to incorporate body posture as a potential therapeutic or educational intervention for teaching participants to control their mood or reduce feelings of powerlessness. Instead, clients and students often sit slightly collapsed in a chair during therapy or in class. On the other hand, if individuals were encouraged to adopt an upright posture especially in the face of stressful circumstances it would help them maintain their self-esteem, reduce negative mood, and use fewer sadness words as compared to the individual in a slumped and seated posture (Nair, Sagar, Sollers, Consedine, & Broadbent, 2015).
THE VALUE OF SELF-EXPERIENCE
What makes this study valuable is that participants compare for themselves the effects of the two different interventions techniques to reduce anxiety, stress and negative thoughts. Thus, the participants have an opportunity to discover which strategy is more effective instead of being told what to do. The demonstration is even more impressive when done in groups because nearly all participants will report that changing posture with breathing and reframing is more beneficial.
This simple and quick technique can be integrated in counseling and psychotherapy by teaching clients this behavioral technique to reduce stress. In Cognitive Behavioral Therapy (CBT), sitting upright can help the individual replace a thought with a more reasonable one. In third wave CBT, it can help bypass the negative content of the original language and create a metacognitive change, such as, “I will not let this thought control me.”
It can also help in Acceptance and Commitment Therapy (ACT) since changing one’s body posture may facilitate the process of “acceptance” (Hayes, Pistorello, & Levin, 2012). Adopting an upright sitting position and taking a breath is like saying “I am here, I am present, I am not escaping or avoiding.” This change in body position represents movement from inside to outside, movement from accepting the unpleasant emotion related to the negative thoughts toward a “commitment” to moving ahead, contrary to the automatic tendency to follow the negative thought. The positive reframing during body position or posture change is not an attempt to color reality in pretty colors, but rather a change of awareness, perspective, and focus that helps the individual identify and see some new options for moving ahead toward commitment according to one’s values. This intentional change in direction is central in ACT and also in positive psychology (Stichter, 2018).
CONCLUSION AND RECOMMENDATIONS
We suggest that therapists, educators, clients and students get up out of their chairs and incorporate body movements when they feels overwhelmed and stuck. Finally, this study points out that mind and body are affected by each other. It provides another example of the psychophysiological principle enunciated by Elmer Green (1999, p 368):
“Every change in the physiological state is accompanied by an appropriate change in the mental-emotional state, conscious or unconscious; and conversely, every change in the mental-emotional state, conscious or unconscious is accompanied by an appropriate change in the physiological state.”
The findings of this study echo the ancient spiritual wisdom that is is central to the teaching of the Zen Master, Thich Nhat Hanh. He recommends that his students recite the following at any time:
Breathing in I calm my body,
Breathing out I smile,
Dwelling in the present moment,
I know it is a wonderful moment.
“I couldn’t belief it. I thought that I was strong and yet, I could not resist the downward pressure when I recalled a hopeless and helpless memory. Yet a minute later, I could easily resist the downward pressure on my arm when I thought of a positive and empower memory. I now understand how thoughts affect me.”
Thoughts/emotions affect body and body affects thoughts and emotions is the basis of the psychophysiological principle formulated by the biofeedback pioneers Elmer and Alice Green. The language we use, the thoughts we contemplate, the worries and ruminations that preoccupy us may impact our health.
Changing thoughts is the basis of cognitive behavior therapy and practitioners often teach clients to become aware of their negative thoughts and transform the internal language from hopeless, helpless, or powerless to empowered and positive. Think and visualize what you want and not what you do not want. For example, state, “I have studied and I will perform as best as I can” or “I choose to be a non-smoker instead of stating, “I hope I do not fail the exam” or “I want to stop smoking.” The more you imagine what you what in graphic detail, the more likely will it occur.
Most people rationally accept that thoughts may affect their body; however, it is abstract and not a felt experience. Also, some people have less awareness of the mind-body connection unless it causes discomfort. Our attention tends to be captured by visual and auditory stimuli that constantly bombard us so that we are d less aware of the subtle somatic changes.
This guided practice explores what happens when you recall helpless, hopeless, powerless or defeated memories as compared to recalling empowering positive memories. It allows a person to experience–instead of believing—how thoughts impact the body. 98% of participants felt significantly weaker after recalling the helpless, hopeless, powerless or defeated memories. Once the participants have experienced the effect, they realize how thoughts effect their body.
The loss of strength is metaphor of what may happen to our immune system and health. Do you want to be stronger or weaker? The challenge in transforming thoughts is that they occur automatically and we often doubt that we can change them. The key is to become aware of the onset of the thought and transform the thought. Thoughts are habit patterns and the more you practice a habit, the more it becomes automatic. Enjoy the experiential exercise, Mind-body/Bodymind-connection: Muscle testing.
*I thank Paul Godina, Jung Lee and Lena Stampfli for participating in the videos.
The practice was adapted from, Gorter, R. & Peper, E. (2011). Fighting Cancer-A Non Toxic Approach to Treatment. Berkeley: North Atlantic.
My arm did not move and yet the muscle tension from my forearm increased when I mentally rehearsed playing the piano. I did not notice anything. It really made me aware how my thoughts affect my body. –25 year old woman psychologist
Therapists and educators can demonstrate the mind/body interaction with physiological monitoring to change their clients’ illness beliefs and demonstrate how ruminating thoughts may affect mental and physical health (Peper, Shumay, Moss, & Sztembis, 2013). When clients see how their body’s physiological responses are affected by thoughts and emotions, they gain a perspective that allows them to KNOW that thoughts affect body—the objective physiological evidence is indisputable.
The concept that thoughts affect the body has been described by many researchers. For example, Whatmore and Kohli (1975) used the term “Representing efforts,” which are the efforts we bring forth within our self during thinking, remembering, anticipating, daydreaming and worrying. Similarly, Green, Green and Walters (1970, p.3) described a process of thoughts influencing human physiological reactions as the Psycho-physiological principle, where “every change in the physiological state is accompanied by an appropriate change in the mental-emotional state, conscious or unconscious, and conversely, every change in the mental-emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state.”
The mind/body connection can be demonstrated through recording physiological signals. For example, when a volunteer had her skin conductance (SC) level monitored, and then another person was asked in the group to give the volunteer a kiss, there was an increase in skin conductance response just after the instruction was given even though the person did not actually kiss the volunteer. The volunteer was responding to the instructions that a kiss might occur, as shown in Figure 1.
Figure 1. The effect on SC level of hearing the instruction that someone will give her a kiss
For educators and psychotherapists, biofeedback can be used to demonstrate the connection between positive or negative mental rehearsal, thoughts or visualization or recalling memories and physiological responses. This process can be demonstrated with surface electromyography (SEMG) recorded from muscles that become activated when the person mentally rehearses a task as illustrated in the following case example.
The participant was a 25 year old female psychologist who had practiced playing the piano for more than 16 years. Muscle activity was recorded from her right forearm extensor muscles and displayed on a large screen so that other group participants could observe. The physiological data and video recording of the volunteer were simultaneously recorded. The volunteer was asked to relax, imagine playing a musical piece, relax, and again imagine playing a musical piece and relax.
Results. Each time she imagined playing the piano, the forearm extensor muscle tension increased, even though there was no observed finger and forearm movements, as shown in Figure 2.
Figure 2. The covert SEMG increase in forearm SEMG as the participant imagined playing the piano.
After the recording, the session was replayed so she could see herself and her movements on the screen simultaneously with the SEMG signal. She reported being totally unaware that she had activated her forearm muscles and, was totally surprised when she saw the recording of the SEMG activity while her forearm appeared to stay in a relaxed position.
Discussion.The physiological monitoring demonstrated that her body responded to here thoughts and imagtes. In the case example, the arm muscle tension increased in tension when she mentally rehearsed playing the piano. This participant like most other people was unaware that her body reacted.If the thought of piano playing increased forearm tension,what would thoughts of anger, resentment, hopelessness, kindness or love do to the body. This concrete physiological demonstration illustrated that changing your thoughts changes your physiology. .
Once the person is aware how thoughts affect their body, it may motivate the person to become aware and change their cognitions. They can now understand that interrupting negative ruminations and behavior patterns and rehearsing new behavior patterns, their health can be improved. We strongly recommend that cognitive behavioral therapists, educators, psychologists, and other therapeutic practitioners include biofeedback monitoring for demonstrating the links between cognitions and physiological reactions.
After such a demonstration, the therapist may point out that what happens in the office setting is likely the identical process that occurs when a person worries, has negative cognitions, continuously reviews personal failures, or makes judgmental statements such as “I should not have done ________.”
When individuals think a negative statement such as “I should not have…………”, they are mentally rehearsing what they should not do and are unintentionally strengthening the negative behavior even more. Instead, whenever people becomes aware of the beginning of the negative cognitions, they can learn to stop and transform their negative cognitions to positive cognitions. In this way they can rehearse what they would want to do instead of what they do not want to do (Peper, Gibney, & Holt, 2002).
The more you rehearse what you want to achieve, the more likely it is to occur. This strategy is useful to change clients’ illness beliefs and motivate them to transform their cognitions from what they do not want to what they want to do. In addition, it offers cognitive behavior therapists documented evidence—the biofeedback recording provides the data which is necessary for evidence based medicine.
Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.
–Victor E. Frankle
* Adapted from: Peper, E., Nemoto, S., Lin, I-M., & Harvey, R. (2015). Seeing is believing: Biofeedback a tool to enhance motivation for cognitive therapy. Biofeedback, 43(4), 168-172. DOI: 10.5298/1081-5937-43.4.03
Green, E.E., Green, A.M., & Walters, E.D. (1970). Voluntary control of internal states: Psychological and physiological. Journal of Transpersonal Psychology, 11, 1-26.
Peper, E., Gibney, K.H., & Holt. C. (2002). Make health happen: Training yourself to create wellness. Dubuque, IA: Kendall-Hunt.
Peper, E., Shumay, D. M., Moss, D. & Sztembis, R. (2013). The Power of Words, Biofeedback, and Somatic Feedback to Impact Illness Beliefs. Somatics .XVII(1), 4-8.
Whatmore, G.B., & Kohli, D. R. (1975). The physiopathology and treatment of functional disorders: Including anxiety states and depression and the role of biofeedback training. New York: Grune and Stratton, Inc.