Be careful what you think*

“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.


Posture affects memory recall and mood

This blog has been reprinted from: Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood.  Biofeedback, 45 (2), 36-41.

When I sat collapsed looking down, negative memories flooded me and I found it difficult to shift and think of positive memories. While sitting erect, I found it easier to think of positive memories.               -Student participant

Charlie BrownThe link between posture and mood is embedded in idiomatic phrases such as walking tall, standing proud, and an upstanding citizen, versus collapsed, defeated, or in a slump–Language suggests that posture and mood/emotions are connected. Slumped posture is commonly observed in depression (Canales et al., 2010; Michalak et al., 2009) and adapting an upright posture increases positive affect, reduces fatigue, and increases energy in people with mild to moderate depression (Wilkes et al., 2017; Peper & Lin, 2012).

This blog describes in detail our research study that demonstrated  how posture affects memory recall  (Peper et al, 2017). Our findings may explain why depression is increasing the more people use cell phones. More importantly,  learning posture awareness and siting more upright  at home and in the office may be an effective somatic self-healing strategy to increase positive affect and decrease depression.

Background

Most psychotherapies tend to focus on the mind component of the body-mind relationship. On the other hand, exercise and posture focus on the body component of the mind/emotion/body relationship. Physical activity in general has been demonstrated to improve mood and exercise has been successfully used to treat depression with lower recidivism rates than pharmaceuticals such as sertraline (Zoloft) (Babyak et al., 2000). Although the role of exercise as a treatment strategy for depression has been accepted, the role of posture is not commonly included in cognitive behavior therapy (CBT) or biofeedback or neurofeedback therapy.

The link between posture, emotions and cognition to counter symptoms of depression and low energy have been suggested by Wilkes et al. (2017) and Peper and Lin (2012),  . Peper and Lin (2012) demonstrated that if people tried skipping rather than walking in a slouched posture, subjective energy after the exercise was significantly higher. Among the participants who had reported the highest level of depression during the last two years, there was a significant decrease of subjective energy when they walked in slouched position as compared to those who reported a low level of depression. Earlier, Wilson and Peper (2004) demonstrated that in a collapsed posture, students more easily accessed hopeless, powerless, defeated and other negative memories as compared to memories accessed in an upright position. More recently, Tsai, Peper, and Lin (2016) showed that when participants sat in a collapsed position, evoking positive thoughts required more “brain activation” (i.e. greater mental effort) compared to that required when walking in an upright position.

Even hormone levels also appear to change in a collapsed posture (Carney, Cuddy, & Yap, 2010). For example, two minutes of standing in a collapsed position significantly decreased testosterone and increased cortisol as compared to a ‘power posture,’ which significantly increased testosterone and decreased cortisol while standing. As  Professor Amy Cuddy pointed out in herTechnology, Entertainment and Design (TED) talk, “By changing posture, you not only present yourself differently to the world around you, you actually change your hormones” (Cuddy, 2012).  Although there appears to be controversy about the results of this study, the overall findings match mammalian behavior of dominance and submission. From my perspective, the concepts underlying Cuddy’s TED talk are correct and are reconfirmed in our research on the effect of posture.  For more detail about the controversy, see the article by Susan Dominusin in the New York Times,  “When the revolution came for Amy Cuddy,”, and Amy Cuddy’s response (Dominus, 2017;Singal and Dahl, 2016).

The purpose of our study is to expand on our observations with more than 3,000 students and workshop participants. We observed that body posture and position affects recall of emotional memory. Moreover, a history of self-described depression appears to affect the recall of either positive or negative memories.

Method

Subjects: 216 college students (65 males; 142 females; 9 undeclared), average age: 24.6 years (SD = 7.6) participated in a regularly planned classroom demonstration regarding the relationship between posture and mood. As an evaluation of a classroom activity, this report of findings was exempted from Institutional Review Board oversight.

Procedure

While sitting in a class, students filled out a short, anonymous questionnaire, which asked them to rate their history of depression over the last two years, their level of depression and energy at this moment, and how easy it was for them to change their moods and energy level (on a scale from 1–10). The students also rated the extent they became emotionally absorbed or “captured” by their positive or negative memory recall. Half of the students were asked to rate how they sat in front of their computer, tablet, or mobile device on a scale from 1 (sitting upright) to 10 (completely slouched).

Two different sitting postures were clearly defined for participants: slouched/collapsed and erect/upright as shown in Figure 1. To assume the collapsed position, they were asked to slouch and look down while slightly rounding the back. For the erect position, they were asked to sit upright with a slight arch in their back, while looking upward.

Figure 1 body positionFigure 1. Sitting in a collapsed position and upright position (photo by Jana  Asenbrennerova). Reprinted by permission from Gorter and Peper (2011).

After experiencing both postures, half the students sat in the collapsed position while the other half sat in the upright position. While in this position, they were asked to recall/evoke as many hopeless, helpless, powerless, or defeated memories as possible, one after the other, for 30 seconds.

After 30 seconds they were reminded to keep their same position and let go of thinking negative memories. They were then asked to recall/evoke only positive, optimistic, or empowering memories for 30 seconds.

They were then asked to switch positions. Those who were collapsed switched to sitting erect, and those who were erect switched to sitting collapsed. Then they were again asked to recall/evoke as many hopeless, helpless, powerless, or defeated memories as possible one after the other for 30 seconds. After 30 seconds they were reminded to keep their same position and again let go of thinking of negative memories. They were then asked to recall/evoke only positive, optimistic, or empowering memories for 30 seconds, while still retaining the second posture.

They then rated their subjective experience in recalling negative or positive memories and the degree to which they were absorbed or captured by the memories in each position, and in which position it was easier to recall positive or negative experiences.

Results

86% of the participants reported that it was easier to recall/access negative memories in the collapsed position than in the erect position, which was significantly different as determined by one-way ANOVA (F(1,430)=110.193, p < 0.01) and 87% of participants reported that it was easier to recall/access positive images in the erect position than in the collapsed position, which was significantly different as determined by one-way ANOVA (F(1,430)=173.861, p < 0.01) as shown in Figure 2.

Figure 2 emotional recallFigure 2. Percent of respondents who reported that it was easier to recall positive or negative memories in an upright or slouched posture.

The difficulty or ease of recalling negative or positive memories varied depending on position as shown in Figure 3.

Figure 3 access to memoriesFigure 3. The relative subjective rating in the ease or difficulty of recalling negative and positive memories in collapsed and upright positions.

The participants with a high level of depression over the last two years (top 23% of participants who scored 7 or higher on the scale of 1–10) reported that it was significantly more difficult to change their mood from negative to positive (t(110) = 4.08, p < 0.01) than was reported by those with a low level of depression (lowest 29% of the participants who scored 3 or less on the scale of 1–10). It was significantly easier for more depressed students to recall/evoke negative memories in the collapsed posture (t(109) = 2.55, p = 0.01) and in the upright posture (t(110) = 2.41, p ≦0.05 he) and no significant difference in recalling positive memories in either posture, as shown in Figure 4.

Figure 4 least most depressedFigure 4. Differences is in memory access for participants with a history of least or most depression.

For all participants, there was a significant correlation (r = 0.4) between subjective energy level and ease with which they could change from negative to positive mood. There were no significance differences for gender in all measures except that males reported a significantly higher energy level than females (M = 5.5, SD = 3.0 and M = 4.7, SD = 3.8, respectively; t(203) = 2.78, p < 0.01).

A subset of students also had rated their posture when sitting in front of a computer or using a digital device (tablet or cell phone) on a scale from 1 (upright) to 10 (completely slouched). The students with the highest levels of depression over the last two years reporting slouching significantly more than those with the lowest level of depression over the last two years (M = 6.4, SD = 3.5 and M = 4.6, SD = 2.6; t(46) = 3.5, p < 0.01).

There were no other order effects except of accessing fewer negative memories in the collapsed posture after accessing positive memories in the erect posture (t(159)=2.7, p < 0.01). Approximately half of the students who also rated being “captured” by their positive or negative memories were significantly more captured by the negative memories in the collapsed posture than in the erect posture (t(197) = 6.8, p < 0.01) and were significantly more captured by positive memories in the erect posture than the collapsed posture (t(197) = 7.6, p < 0.01), as shown in Figure 5.

Figure 5 Posture dependent ratingFigure 5. Subjective rating of being captured by negative and positive memories depending upon position.

Discussion

Posture significantly influenced access to negative and positive memory recall and confirms the report by Wilson and Peper (2004). The collapsed/slouched position was associated with significantly easier access to negative memories. This is a useful clinical observation because ruminating on negative memories tends to decrease subjective energy and increase depressive feelings (Michi et al., 2015). When working with clients to change their cognition, especially in the treatment of depression, the posture may affect the outcome. Thus, therapists should consider posture retraining as a clinical intervention. This would include teaching clients to change their posture in the office and at home as a strategy to optimize access to positive memories and thereby reduce access or fixation on negative memories. Thus if one is in a negative mood, then slouching could maintain this negative mood while changing body posture to an erect posture, would make it easier to shift moods.

Physiologically, an erect body posture allows participants to breathe more diaphragmatically because the diaphragm has more space for descent. It is easier for participants to learn slower breathing and increased heart rate variability while sitting erect as compared to collapsed, as shown in Figure 6 (Mason et al., 2017).

Figure 6 collapse and physiologyFigure 6. Effect of posture on respiratory breathing pattern and heart rate variability.

The collapsed position also tends to increase neck and shoulder symptoms This position is often observed in people who work at the computer or are constantly looking at their cell phone—a position sometimes labeled as the i-Neck.

Implication for therapy

In most biofeedback and neurofeedback training sessions, posture is not assessed and clients sit in a comfortable chair, which automatically causes a slouched position. Similarly, at home, most clients sit on an easy chair or couch, which lets them slouch as they watch TV or surf the web. Finally, most people slouch when looking at their cellphone, tablet, or the computer screen (Guan et al., 2016). They usually only become aware of slouching when they experience neck, shoulder, or back discomfort.

Clients and therapists are usually not aware that a slouched posture may decrease the client’s energy level and increase the prevalence of a negative mood. Thus, we recommend that therapists incorporate posture awareness and training to optimize access to positive imagery and increase energy.

References

Babyak, M., Blumenthal, J. A., Herman, S., Khatri, P., Doraiswamy, M., Moore, K., … Krishnan, K. R. (2000). Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosomatic Medicine, 62(5), 633–638. 

Canales, J. Z., Cordas, T. A., Fiquer, J. T., Cavalcante, A. F., & Moreno, R. A. (2010). Posture and body image in individuals with major depressive disorder: A controlled study. Revista brasileira de psiquiatria, 32(4), 375–380.

Carney, D. R., Cuddy, A. J., & Yap, A. J. (2010). Power posing brief nonverbal displays affect neuroendocrine levels and risk tolerance. Psychological Science, 21(10), 1363–1368.

Cuddy, A. (2012). Your body language shapes who you are. Technology, Entertainment, and Design (TED) Talk, available at:  www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are

Dominus, S. (2017, October 18). When the revolution came for Amy Cuddy. New York Times Magazine, https://www.nytimes.com/2017/10/18/magazine/when-the-revolution-came-for-amy-cuddy.html?_r=0

Gorter, R. & Peper, E. (2011). Fighting Cancer-A Non Toxic Approach to Treatment. Berkeley, CA: North Atlantic Books

Guan, X., Fan, G., Chen, Z., Zeng, Y., Zhang, H., Hu, A., … He, S. (2016). Gender difference in mobile phone use and the impact of digital device exposure on neck posture. Ergonomics59(11), 1453–1461.

Mason, L., Joy, M., Peper, E., & Harvey, R, A. (2017). Posture Matters. Poster presented at the 48th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Chicago, IL March, 2017. Abstract published in Applied Psychophysiology and Biofeedback, 42(2), 148.

Michalak, J., Troje, N. F., Fischer, J., Vollmar, P., Heidenreich, T., & Schulte, D. (2009). Embodiment of sadness and depression: Gait patterns associated with dysphoric mood. Psychosomatic Medicine, 71(5), 580–587.

Michl, L. C., McLaughlin, K. A., Shepherd, K., & Nolen-Hoeksema, S. (2013). Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: Longitudinal evidence in early adolescents and adults. Journal of Abnormal Psychology122(2), 339.

Peper, E. & Lin, I-M. (2012). Increase or decrease depression: How body postures influence your energy level. Biofeedback, 40(3), 126–130.

Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood.  Biofeedback.45 (2), 36-41.

Singal, J. and Dahl, M. (2016, Sept 30 ) Here Is Amy Cuddy’s Response to Critiques of Her Power-Posing Research. https://www.thecut.com/2016/09/read-amy-cuddys-response-to-power-posing-critiques.html

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.

Wilkes, C., Kydd, R., Sagar, M., & Broadbent, E. (2017). Upright posture improves affect and fatigue in people with depressive symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 54, 143–149.

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.

We thank Frank Andrasik for his constructive comments.

 


Increase energy*

Are you full of pep and energy, ready to do more? Or do you feel drained and exhausted? After giving at the office, is there nothing left to give at home? Do you feel as if you are on a treadmill that will never stop, that more things feel draining than energizing?

Feeling chronically drained is often a precursor for illness; conversely, feeling energized enhances productivity and encourages health. An important aspect of staying healthy is that one’s daily activities are filled more with activities that contribute to our energy than with tasks and activities that drain our energy. Similarly, Dr. John Gottman and colleagues have discovered that marriages prosper when there are many more positive appreciations communicated by each partner than negative critiques.

Energy is the subjective sense of feeling alive and vibrant.  An energy gain is an activity, task, or thought that makes you feel better and slightly more alive—those things we want to or choose to do. An energy drain is the opposite feeling—less alive and almost depressed—those things we have to or must do; often something that we do not want to do.  In almost all cases, it is not that we have to, should, or must do, it is a choice.  Remember, even though you may say, “I have to study.”  It is a choice.  You can choose not to study and choose to drop out of school. Similarly, when you say, “I have to do the dishes,” it is still a choice.  You can choose to do the dishes or let the dirty dishes pile up and just use paper plates.

Energy drains and gains are always unique to the individual; namely, what is a drain for one can be a gain for another.  Energy drains can be doing the dishes and feeling resentful that your partner or children are not doing them, or anticipating seeing a person whom you do not really want to see. An energy gain can be meeting a friend and talking or going for a walk in the woods, or finishing a work project.

When patients with cancer start exploring what they truly would like to do and start acting on their unfulfilled dreams, a few experience that their health improves as documented by Dr. Lawrence LeShan in his remarkable book, Cancer as a Turning Point. So often our lives are filled with things that we should do versus want to do.  In some cases, the lives we created are not the ones we wanted but the result of self-doubt and worry, “If I did do this, my family and friends won’t like me”, or “I am not sure I will be successful so I will do something that is safe.”  Just ask yourself the question when you woke up this morning and most mornings this week, “How did you feel?” Did you felt happy and looking forward to the day?

photo

Explore strategies to decrease the drains and increase the energy gains. Use the following exercise to increase your energy:

  1. For one week monitor your energy drains and energy gains. Monitor events, activities, thoughts, or emotions that increase or decrease energy at home and at work. For example some drains can include cleaning bathroom, cooking another meal, or talking to a family member on the phone, while gains can be taking a walk, talking to a friend, completing a work task. Be very honest, just note the events that change your energy level.
  2. After the week look over your notes and identify at least one activity that drains your energy and one activity that increases your energy
    • Develop a strategy to decrease one of the energy drains.  Be very specific how, where, when, with whom, and which situations decreasing the tasks that drain your energy.  As you think about it, anticipate obstacles that may interfere with reducing your drains and develop new ways to overcome these obstacles such as trading tasks with others (I will cook if you clean the bathroom), setting time limits, giving yourself positive reward after finishing the task (a cup of tea, a text or phone message to a close friend, watching a video in the evening).
    • Develop new ways how you can increase energy gains such as doing exercise, completing a task.
  3. Each day implement the behavior to reduce one less energy drain and increase one energy gain and observe what happens.

Initially it may seem impossible, many students and clients report that the practice made them aware, increased their energy, and they had more control over their lives than they thought.  It also encouraged them to explore the question, “What is it that you really want to do?”  So often we do energy drains because of convention, habit and fear which makes us feel powerless and suppresses our immune system thereby increasing the risk of illness.  In observing the energy drains and energy gains, it may give the person a choice.  Sometimes, the choice is not changing the tasks but how we think about it.  Many of the things we do are not MUSTs; they are choices.  I do the work at my job because I choose to benefits of earning money.

How your internal language impacts your energy**

Sit and think of something that you feel you have to do, should do, or must do. Something you slightly dread such as cleaning the dishes, doing a math assignment. While sitting say to yourself, “I have to do, should do, or must do_______________.”  Keep repeating the phrase for a minute.

Then change your internal phrase and instead say one of the following phrases, “I choose to do,”  “I look forward to doing,” or “I choose not to do _________.”  Keep repeating the phrase for a minute.

Now compare how you felt.  Almost all people feel slight less energy and more depressed when they are thinking, “I have to do,” “should do”, or must do”.  While when they shifted the phrase to, “I choose to,” “I look forward to doing,” or “I choose not to do it,” they feel lighter, more expanded and more optimistic.  When university students practice this change of language during the week, they find it was easier to start and complete their homework tasks.

Watch your thoughts; they become words. 

Watch your words; they become actions. 

Watch your actions; they become habits. 

Watch your habits; they become character.

Watch your character; it becomes your destiny.

– Frank Outlaw

 References

Gottman, J.M. & Silver, N. (2015). The Seven Principles for Making Marriage Work. New York: Harmony.

LeShan, L. (1999). Cancer as a Turning Point. New York: Plume

*Adapted from: Peper, E. (2016). Increase energy. Western Edition. April, pp4.  http://thewesternedition.com/admin/files/magazines/WE-April-2016.pdf

**Adapted from: Gorter, R. & Peper, E. (2011). Fighting Cancer-A Nontoxic Approach to Treatment.  Berkeley: North Atlantic Books, 107-200.