Quick Rescue Techniques When Stressed

Posted: February 4, 2024 | Author: erikpeper | Filed under: attention, behavior, biofeedback, Breathing/respiration, CBT, cognitive behavior therapy, education, emotions, Evolutionary perspective, Exercise/movement, health, mindfulness, Neck and shoulder discomfort, posture, relaxation, stress management, Uncategorized | Tags: alarm reaction, anxiety, box breathing, Breathing, conditioning, defense reaction, health, huming, Parasympathetic response, rumination, safety, sniff inhale, somatic practices, stress, sympathetic arousal, tactical breathing, Toning, yoga | 2 Comments

Erik Peper, PhD, Yuval Oded, PhD, and Richard Harvey, PhD

Adapted from Peper, E., Oded, Y, & Harvey, R. (2024). Quick somatic rescue techniques when stressed. Biofeedback, 52(1).

“If a problem is fixable, if a situation is such that you can do something about it, then there is no need to worry. If it’s not fixable, then there is no help in worrying. There is no benefit in worrying whatsoever.” ― Dalai Lama XIV

To implement the Dalai Lama’s quote is challenging. When caught up in an argument, being angry, extremely frustrated, or totally stressed, it is easy to ruminate, worry. It is much more challenging to remember to stay calm. When remembering the message of the Dalai Lama’s quote, it may be possible to shift perspective about the situation although a mindful attitude may not stop ruminating thoughts. The body typically continues to reacti to the torrents of thoughts that may occur when rehashing rage over injustices, fear over physical or psychological threats, or profound grief and sadness over the loss of a family member. Some people become even more agitated and less rational as illustrated in the following examples.

I had an argument with my ex and I am still pissed off. Each time I think of him or anticipate seeing them, my whole body tightened. I cannot stomach seeing him and I already see the anger in his face and voice. My thoughts kept rehashing the conflict and I am getting more and more upset.

A car cut right in front of me to squeeze into my lane. I had to slam on my brakes. What an idiot! My heart rate was racing and I wanted to punch the driver.

When threatened, we respond quickly in our thoughts and body with a defense reaction that may negatively affect those around us as well as ourselves. What can we do to interrupt negative stress reactions?

Background

Many approaches exist that allow us to become calmer and less reactive. General categories include techniques of cognitive reappraisal (seeing the situation from the other person’s point of view and labeling your own feelings and emotions) and stress management techniques. Practices that are beneficial include mindfulness meditation, benign humor (versus gallows humor), listening to music, taking a time out while implementing a variety of self-soothing practices, or incorporating slow breathing (e.g., heart rate variability and/or box breathing) throughout the day.

No technique fits all as we respond differently to our stressful life circumstances. For example, some people during stress react with a  “tend and befriend stress response” (Cohen & Lansing, 2021; Taylor et al., 2000). This response appears to be mostly mediated by the hormone oxytocin acting in ways that sooth or calm the nervous system as an analgesic. These neurophysiological mechanisms of the soothing with the calming analgesic effects of oxytocin have been characterized in detail by Xin,  et al. (2017).

The most common response is a fight/flight/freeze stress response that is mediated by excitatory hormones such as adrenalin and inhibitory neurotransmitters such as gamma amino butyric acid (GABA). There is a long history of fight/flight/freeze stress response research, which is beyond the scope of this blog with major theories and terms such as interior milleau (Bernard, 1872); homeostasis and fight/flight (Cannon, 1929); general adaptation syndrome (Selye, 1951); polyvagal theory (Porges, 1995); and, allostatic load (McEwen, 1998). A simplified way to start a discussion about stress reactions begins with the fight/flight stress response. When stressed our defense reactions are triggered. Our sympathetic nervous system becomes activated our mind and body stereotypically responds as illustrated in Figure 1.

Figure 1. An intense confrontation tends to evoke a stress response (reproduced from Peper et al., 2020). 

The flight/fight response triggers a cascade of stress hormones or neurotransmitters (e.g., hypothalamus-pituitary-adrenal cascade) and produces body changes such as the heart pounding, quicker breathing, an increase in muscle tension and sweating. Our body mobilizes itself to protect itself from danger. Our focus is on immediate survival and not what will occur in the future (Porges, 2021; Sapolsky, 2004). It is as if we are facing an angry lion—a life-threatening situation—and we feel threatened and unsafe.

Rather than sitting still, a quick effective strategy is to interrupt this fight/flight response process by completing the alarm reaction such as by moving our muscles (e.g., simulating a fight or flight behavior) before continuing with slower breathing or other self-soothing strategies. Many people have experienced their body tension is reduced and they feel calmer when they do vigorous exercise after being upset, frustrated or angry. Similarly, athletes often have reported that they experience reduced frequency and/or intensity of negative thoughts after an exhausting workout (Thayer, 2003; Liao et al., 2015; Basso & Suzuki, 2017). 

Becoming aware of the escalating cascades of physical, behavioral and psychological responses to a stressor is the first step in interrupting the escalating process. After becoming aware, reduce the body’s arousal and change the though patterns using any of the techniques described in this blog. The self-regulation skills presented in this blog are ideally over-learned and automated so that these skills can be rapidly implemented to shift from being stressed to being calm. Examples of skills that can shift from sympathetic neervous system overarousal to parasympathetic nervous system calm include techniques of autogenic traing (Schulz & Luthe, 1959), the quieting reflex developed by Charles Stroebel in 1985 or more recently rescue breathing developed by Richard Gevirtz (Stroebel, 1985; Gevirtz, 2014; Peper, Gibney & Holt, 2002; Peper & Gibney, 2003).

Concepts underlying the rescue techniques

1. Psychophysiological principle: “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” (Green et al. 1970, p. 3).
2. Posture evokes memories and feelings associated with the position. When the body posture is erect and tall while looking slightly up. It is easier to evoke empowering, positive thoughts and feelings. When looking down it is easier to evoke hopeless, helpless and powerless thoughts and feelings (Peper et al., 2017).
3. Healing occurs more easily when relaxed and feeling safe. Feeling safe and nurtured enhances the parasympathetic state and reduces the sympathetic state. Use memory recall to evoke those experiences when you felt safe (Peper, 2021).
4. Interrupting thoughts is easier with somatic movement than by redirecting attention and thinking of something else without somatic movement.
5. Focus on what you want to do not want to do. Attempting to stop thinking or ruminating about something tends to keeps it present (e.g., do not think of pink elephants. What color is the elephant? When you answer, “not pink,” you are still thinking pink). A general concept is to direct your attention (or have others guide you) to something else (Hilt & Pollak, 2012; Oded, 2018; Seo, 2023).
6. Skill mastery takes practice and role rehearsal (Lally et al., 2010; Peper & Wilson, 2021).
7. Use classical conditioning concepts to facilitate shifting states. Practice the skills and associate them with an aroma, memory, sounds or touch cues. Then when you the situation occurs, use these classical conditioned cues to facilitate the regeneration response (Peper & Wilson, 2021).

Rescue techniques

Coping When Highly Stressed and Agitated

1. Complete the alarm/defense reaction with physical activity (Be careful when you do these physical exercises if you have back, hip, knee, or ankle problems).
   • Acknowledge you have reacted and have chosen to interrupt your automatic response.
   • Check whether the situation is actually a threat. If yes, then do anything to get out of immediate danger (yell, scream, fight, run away, or dial 911).
   • If there is no actual physical threat, then leave the situation and perform vigorous physical activity to complete your alarm reaction, such as going for a run or walking quickly up and down stairs. As you do the exercise, push yourself so that the muscles in your thighs are aching, which focusses your attention on the sensations in your thighs. In our experience, an intensive run for 20 minutes quiets the brain while it often takes 40 minutes when walking somewhat quickly.
   • After recovering from the exhaustive exercise, explore new options to resolve the conflict.
2. Complete the alarm/defense reaction and evoke calmness with the S.O.S™ technique (Oded, 2023)
   • Acknowledge you have reacted and have chosen to interrupt your automatic response.
   • Squat against a wall (similar to the wall-sit many skiers practice). While tensing your arms and fists as shown in Figure 2, gaze upward because it is more difficult to engage in negative thinking while looking upwards. If you continue to ruminate, then scan the room for object of a certain color or feature to shift visual attention and be totally present on the visual object.
   • Do this set of movements for 7 to 10 seconds or until you start shaking. Than stand up and relax hands and legs. While standing, bounce up and down loosely for 10 to 15 seconds as you become aware of the vibratory sensations in your arms and shoulders, as shown in Figure 3.

Figure 2.Defense position wall-sit to tighten muscles in the protective defense posture (Oded, 2023). Figure 3. Bouncing up and down to loosen muscles ((Oded, 2023).

• Acknowledge you have reacted and have chosen to interrupt your automatic response. Swing your arms back and forth for 20 seconds. Allow the arms to swing freely as illustrated in Figure 4.

  Figure 4. Swinging the arms to loosen the body and spine (Oded, 2023).

• Rest and ground. Lie on the floor and put your calves and feet on a chair seat so that the psoas muscle can relax, as illustrated in Figure 5. Allow yourself to be totally supported by the floor and chair. Be sure there is a small pillow under your head and put your hand on your abdomen so that you can focus on abdominal breathing.

Figure 5. Lying down to allow the psoas muscle to relax and feel grounded (Oded, 2023).

• While lying down, imagine a safe place or memory and make it as real as possible. It is often helpful to listen to a guided imagery or music. The experience can be enhanced if cues are present that are associated with the safe place,  such as pictures, sounds, or smells. Continue to breathe effortlessly at about six breaths per minute. If your attention wanders, bring it back to the memory or to the breathing. Allow yourself to rest for 10 minutes.

In most cases, thoughts stop and the body’s parasympathetic activity becomes dominant as the person feels safe and calm. Usually, the hands warm and the blood volume pulse amplitude increases as an indicator of feeling safe, as shown in Figure 6.

Figure 6. Blood volume pulse increases as the person is relaxing, feels safe and calm.

Coping When You Can’t Get Away (adapted from Peper, Harvey & Faass, 2020)

In many cases, it is difficult or embarrassing to remove yourself from the situation when you are stressed out such as at work, in a business meeting or social gathering.

1. Become aware that you have reacted.
2. Excuse yourself for a moment and go to a private space, such as a restroom. Going to the bathroom is one of the only acceptable social behaviors to leave a meeting for a short time.
3. In the bathroom stall, do the 5-minute Nyingma exercise, which was taught by Tarthang Tulku Rinpoche in the tradition of Tibetan Buddhism, as a strategy for thought stopping (see Figure 7). Stand on your toes with your heels touching each other. Lift your heels off the floor while bending your knees. Place your hands at your sides and look upward. Breathe slowly and deeply (e.g., belly breathing at six breaths a minute) and imagine the air circulating through your legs and arms. Do this slow breathing and visualization next to a wall so you can steady yourself if necessary to keep balance. Stay in this position for 5 minutes or longer. Do not straighten your legs—keep squatting despite the discomfort. In a very short time, your attention is captured by the burning sensation in your thighs. Continue. After 5 minutes, stop and shake your arms and legs.

Figure 7. Stressor squat Nyingma exercise (reproduced from Peper et al., 2020).

• Follow this practice with slow abdominal breathing to enhance the parasympathetic response. Be sure that the abdomen expands as the inhalation occurs. Breathe in and out through the nose at about six breaths per minute.
• Once you feel centered and peaceful, return to the room.
• After this exercise, your racing thoughts most likely will have stopped and you will be able to continue your day with greater calm.

What to do When Ruminating, Agitated, Anxious or Depressed
(adapted from Peper, Harvey, & Hamiel, 2019).

1. Shift your position by sitting or standing erect in a power position with the back of the head reaching upward to the ceiling while slightly gazing upward. Then sniff quickly through nose, hold and again sniff quickly then very slowly exhale. Be sure as you exhale your abdomen constricts. Then sniff again as your abdomen gets bigger, hold, and sniff one more time letting the abdomen get even bigger. Then, very slow, exhale through the nose to the internal count of six (adapted from Balban et al., 2023). When you sniff or gasp, your racing thoughts will stop (Peper et al., 2016).
2. Continue with box breathing (sometimes described as tactical breathing or battle breathing) by exhaling slowly through your nose for 4 seconds, holding your breath for 4 seconds, inhaling slowly for 4 seconds through your nose, holding your breath for 4 seconds and then repeating this cycle of breathing for a few minutes (Röttger et al., 2021; Balban et al., 2023). Focusing your attention on performing the box breathing makes it almost impossible to think of anything else. After a few minutes, follow this with slow effortless diaphragmatic breathing at about six breaths per minute. While exhaling slowly through your nose, look up and when you inhale imagine the air coming from above you. Then as you exhale, imagine and feel the air flowing down and through your arms and legs and out the hands and feet.
3. While gazing upward, elicit a positive memory or a time when you felt safe, powerful, strong and/or grounded. Make the positive memory as real as possible.
4. Implement cognitive strategies such as reframing the issue, sending goodwill to the person, seeing the problem from the other person’s point of view, and ask is this problem worth dying over (Peper, Harvey, & Hamiel, 2019).

What to Do When Thoughts Keep Interrupting

Practice humming or toning. When you are humming or toning, your focus is on making the sound and the thoughts tend to stop. Generally, breathing will slow down to about six breaths per minute (Peper, Pollack et al., 2019). Explore the following:

1. Box breathing (Röttger et al., 2021; Balban et al., 2023)
2. Humming also known as bee breath (Bhramari Pranayama)  (Abishek et al., 2019; Yoga, 2023) – Allow the tongue to rest against the upper palate, sit tall and erect so that the back of the head is reaching upward to the ceiling, and inhale through your nose as the abdomen expands. Then begin humming while the air flows out through your nose, feel the vibration in the nose, face and throat. Let humming last for about 7 seconds and then allow the air to blow in through the nose and then hum again. Continue for about 5 minutes.
3. Toning – Inhale through your nose and then vocalize a single sound such as Om. As you vocalize the lower sound, feel the vibration in your throat, chest and even going down to the abdomen. Let each toning exhalation last for about 6 to 7 seconds and then inhale through your nose. Continue for about 5 minutes (Peper, al., 2019).

Many people report that after practice these skills, they become aware that they are reacting and are able to reduce their automatic reaction. As a result, they experience a significant decrease in their stress levels, fewer symptoms such as neck and holder tension and high blood pressure, and they feel an increase in tranquility and the ability to communicate effectively.

Practicing these skills does not resolve the conflicts; they allow you to stop reacting automatically. This process allows you a time out and may give you the ability to be calmer, which allows you to think more clearly. When calmer, problem solving is usually more successful. As phrased in a popular meme, “You cannot see your reflection in boiling water. Similarly, you cannot see the truth in a state of anger. When the waters calm, clarity comes” (author unknown).

Boiling water (photo modified from: https://www.facebook.com/photo/?fbid=388991500314839&set=a.377199901493999)

Below are additional resources that describe the practices. Please share these resources with friends, family and co-workers.

Stressor squat instructions

Are you out of control and reacting in anger? The role of food and exercise

Toning instructions

Healing from paralysis-Music (toning) to activate health

Diaphragmatic breathing instructions

A breath of fresh air: Breathing and posture to optimize health

Healing irritable bowel syndrome with diaphragmatic breathing*

Breathing: Informative YouTube videos and blogs

Reduce stress with posture and breathing

Reduce stress, anxiety and negative thoughts with posture, breathing and reframing

Conditioning

Relive memory to create healing imagery

Improve learning with peak performance techniques

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