Fuming in anger, exploding in rage, shaking in fear, or trembling with anxiety, what can you do? How can you control your emotions and what can you do if you are reacting to a friend or colleague who is out of control? There are many useful self-directed approaches and traditional advice such as, “Count to 10 before you speak,” ”Sleep on it before acting on the decision you have made,” “Practice stress reduction techniques such as mindfulness meditation,” “Leave the situation,” or “Wait 24 hours before clicking “send” on an angry email response.”
These suggestions aim to reduce the strong negative emotions which could cause people to lash out at or totally withdraw from the perceived threat. Under perceived threat, we may react defensively and impulsively to protect ourselves. During those times we may say the meanest things to hurt the person as a substitute for inflicting actual physical harm.
In almost most cases when angry or frightened we may react automatically. Thus having skills to recognize and interrupt the escalating cycle of negative emotions can facilitate resolving conflicts. These skills allow us to react more cool headed, rationally, and recognize how our responses would impact other people and prevent future blow back from our excessive emotional response. It could also interrupt an escalating argument. Despite our best efforts, it is often difficult to change our emotional reaction especially when we feel threatened, hungry and tired.
Emotion regulation as described by Professor James Gross, Professor of Psychology at Stanford University, consists of 1) awareness that there is a need for an unhelpful emotion to be regulated such as noticing an increase in heart rate or worry, 2) selecting a strategy to regulate the emotion such as thinking about positive memories such as a loving grandparent or practicing breathing, 3) implementing and acting on this strategy which means doing the strategy at that moment when we don’t want to and all our impulses are saying “I am right, don’t change,” and 4) constant follow-up to check if what we are doing is effective and if not, what needs to be improved (Gross, 213).
This approach can be very effective and may work even better by combining multiple strategies instead of only one technique. The more skills you have and practiced the easier it becomes to master motional regulation. Sometimes, psychological behavioral approaches may underestimate the role of biological factors such as diet, exhaustion and exercise that underlie emotional regulation.
Think of a four-year child throwing a temper tantrum. As a parent, it not useful to discuss with the child what is going on. Each suggestion may increase the tantrum. Instead the parent thinks, “My child is exhausted or hungry” (how many tantrums don’t occur when the child stays up after bed time or just before dinner?). The millennium’s phrase, “hangry,” is the combination of hunger and anger.
The knowledge that food may prevent or reduce conflict is reflected in the cultural wisdom of most countries except the USA. In the Middle East you are offered tea and sweets before buying a small rug at the bazaar; in Japan or China, you are invited to a meal before beginning a business transaction. The food and may slightly raise your blood glucose levels and encourage digestion which triggers a physiological state that is the opposite of that triggered by anger or fear. It may also evoke positives feelings associated with eating such as family gatherings and parties. As the food and drink are a gift, it may allow you to perceive the other person more positively. Thus, it is easier to be collegial and react more positively in challenging situations. The influence of rest and food has also been observed in Judicial rulings. Judges are much more likely to accept prisoners’ requests for parole at the beginning of the session–right after breakfast or lunch–than later in the session (Danzier, Levav & Avnaim-Pesso, 2011).
What can you do?
One useful mental strategy when you are out of control is to remind yourself that you are acting like a four-year-old child who is having a tantrum. Begin in the same way as you would with a four-year-old: take time out, eat some food, and get rest. Then in the clear light of the next day, after having eating a nutritious breakfast– not just a cup of coffee with a muffin–discuss and resolve what happened the day before that triggered the outburst. Similarly, when another person is out of control, do not to take it personally, he/she may be a momentary acting like four-year-old.
Keep in mind, whatever other people said or did during an outburst, they may have responded automatically because they experienced their survival being threatened. Remember, how in a past moment of anger, you have said something very hurtful? At the moment the words left your mouth, you wished you could have reeled them back in as you realized that it would be almost impossible to repair the damage.
From a biological perspective you were hijacked by the amygdala which is part of our emotional brain (Goleman, 2006). The amygdala processes information 22 milliseconds earlier than the rational brain and acts protectively before our rational brain, the neocortex, can assess the situation and respond. This reaction occurs because the information signals “we are in danger” and evokes the automatic defense reaction as shown Figure 1.
Figure 1. Triggering of a defense reaction is 22 milliseconds quicker from the amygdala than from the cortex. Thus we sometimes react without recognizing the consequences (adapted from Ropeik, 2011)
Implement the cultural wisdom of eating together first and then discussing business or challenging issues. Do not send negative messages by email or mail since that allows people to react asynchronously without having the social feedback to modulate their emotions.
Self-regulation of unhelpful emotions is challenging because negative emotions trigger the body’s defense reactions to prepare it for flight and fight. At that point, it is more and more difficult to perceive the long term consequences of our action– our only goal is to survive. Even our cognitions change and we tend to interpret any information more negatively and may assume harmful intent. The more we are captured by our emotions, the more challenging is it to implement emotional self-regulation strategies.
Once the defense reaction has been activated, it is not the time to resolve conflict. Dr. Gottman and colleagues at the Seattle Love lab, discovered that when couples argued and their heartrate went over a hundred (a possible biological marker of sympathetic activation) arguments could escalate. If the person whose heart rate went up spontaneously took a time out and did self-soothing, the couple had a lower divorce rate and higher marital happiness than those couples who continue the arguments (Gottman & Gottman, 2008).
One of the effective ways to begin emotion regulation is to leave the situation and first complete the fight/flight defense reaction. If possible, this means interrupting whatever you are doing and exercise vigorously. After you have done a vigorous workout, emotional regulation is much easier as the ruminating thoughts have decreased or stopped.
Complete the alarm reaction with exercise
When you are upset take a break. If possible, take a time out and exercise to complete the fight/flight response that was activated by the negative emotions. This is not always possible in a business or social gathering; instead, excuse yourself and go to the bathroom. In the bathroom do the following five-minute exercise that was taught by Rinpoche Tarthang Tulku of the Nyingma tradition of Tibetan Buddhism as an approach to stop ruminating thoughts as shown in Figure 2.
Stand on your toes with the heels touching each other and lifted off the floor with your knees bent. Place your
hands on your sides, breathe slowly and deeply. Do this next to wall to reach with your hand to steady you if you lose your balance. Stay in this position for as long as 5 minutes. Do not straighten up, keep squatting.
In a very short time your attention will be drawn and captured by the burning sensation in your thighs. Continue. After five minutes stop, shake your legs and relax.
After this exercise your thoughts have stopped and continue with the more cognitive approach of emotional self-regulation or return to the meeting. Warming: Do not do this if you have hip, knee or ankle difficulty.
Use heart rate biofeedback to signal you that you may be losing control.
Wear a heart rate monitor to signal you when your heart rate increases twenty to thirty beats above your personal baseline rate during a discussion or conflict. Use that feedback to stop and take time out and implement self-regulation practices such as exercise, breathing or meditation to allow your arousal to decrease. When feeling more calm, return to the meeting.
Food and exercise are powerful tools to augment emotional self-regulation and health. In our research, Lena Stampfli and I have observed that many students who miss meals, have an unhealthy diet, do not the exercise, are sometimes irritable and experience difficulty in concentration. When San Francisco State University students implemented a four-week self-healing project as part of a class experience, the students who changed their eating behavior (eating breakfast, not skipping meals, reducing caffeine and simple carbohydrates and increase proteins, fats and fresh vegetables) and implemented daily physical exercise (e.g., yoga, jogging, and dancing), reported significant improvements in their energy level, fewer emotion outbursts and improved quality of life. They report some of the following:
“I thought I did not particularly like exercising and eating healthy, but when it is over I feel like I am on cloud nine!… I started to look forward to doing my exercises.” –A.M.
“I started to eat breakfast, I started biking to work and did a few [meditation] exercises before bed… I felt happier and more have energy to get through the day.” –C.B.
“I have learned that letting go of what no longer serves me allow room for healing and opportunities for growth… I can only imagine what years of healthy living could do for my well-being.” –K.S.
*I thank Pardis Miri, PhD, for her constructive comments.
The blog was adapted from Peper, E. (2017). Emotional control through mindfulness as path to mental health? Western Edition HP Journal. October. http://thewesternedition.com/admin/files/magazines/WE-October-2017.pdf
Danziger, S., Levav, J.& Avnaim-Pesso, L. (2011). Extraneous factors in judicial decisions. Proceedings of the National Academy of Sciences of the United States of Amereidcal, 108(17), 6889-6892. doi:10.1073/pnas.1018033108
Erik Peper, Lauren Mason and Cindy Huey
After having constant abdominal pain, severe cramps, and losing 15 pounds from IBS, I found myself in the hospital bed where all the doctors could offer me was morphine to reduce the pain. I searched on my smart phone for other options. I saw that abdominal breathing could help. I put my hands on my stomach and tried to expand it while I inhaled. All that happened was that my chest expanded and my stomach did not move. I practiced and practiced and finally, I could breathe lower. Within a few hours, my pain was reduced. I continued breathing this way many times. Now, two years later, I no longer have IBS and have regained 20 pounds.
– 21-year old woman who previously had severe IBS
Irritable bowel syndrome(IBS) affects between 7% to 21% of the general population and is a chronic condition. The symptoms usually include abdominal cramping, discomfort or pain, bloating, loose or frequent stools and constipation and can significantly reduce the quality of life (Chey et al, 2015). A precursor of IBS in children is called recurrent abdominal pain (RAP) which affects between 0.3 to 19% of school children (Chitkara et al, 2005). Both IBS and RAP appear to be functional illnesses, as no organic causes have been identified to explain the symptoms. In the USA, this results in more than 3.1 physician visits and 5.9 million prescriptions written annually. The total direct and indirect cost of these services exceeds $20 billion (Chey et al, 2015). Multiple factors may contribute to IBS, such as genetics, food allergies, previous treatment with antibiotics, severity of infection, psychological status and stress. More recently, changes in the intestinal and colonic microbiome resulting in small intestine bacterial overgrowth are suggested as another risk factor (Dupont, 2014).
Generally, standard medical treatments (reassurance, dietary manipulation and of pharmacological therapy) are often ineffective in reducing abdominal IBS and other abdominal symptoms (Chey et al, 2015), while complementary and alternative approaches such as relaxation and cognitive therapy are more effective than traditional medical treatment (Vlieger et, 2008). More recently, heart rate variability training to enhance sympathetic/ parasympathetic balance appears to be a successful strategy to treat functional abdominal pain (FAB) in children (Sowder et al, 2010). Sympathetic/parasympathetic balance can be enhanced by increasing heart rate variability (HRV), which occurs when a person breathes at their resonant frequency which is usually between 5-7 breaths per minute. For most people, it means breathing much slower, as slow abdominal breathing appears to be a self-control strategy to reduce symptoms of IBS, RAP and FAP.
This article describes how a young woman healed herself from IBS with slow abdominal breathing without any therapeutic coaching, reviews how slower diaphragmatic breathing (abdominal breathing) may reduce symptoms of IBS, explores the possibility that breathing is more than increasing sympathetic/parasympathetic balance, and suggests some self-care strategies to reduce the symptoms of IBS.
Healing IBS-a case report
After being diagnosed with Irritable Bowel Syndrome her Junior year of high school, doctors told Cindy her condition was incurable and could only be managed at best, although she would have it throughout her entire life. With adverse symptoms including excessive weight loss and depression, Cindy underwent monthly hospital visits and countless tests, all which resulted in doctors informing her that her physical and psychological symptoms were due to her untreatable condition known as IBS, of which no one had ever been cured. When doctors offered her what they believed to be the best option: morphine, something Cindy describes now as a “band-aid,” she was left feeling discouraged. Hopeless and alone in her hospital bed, she decided to take matters into her own hands and began to pursue other options. From her cell phone, Cindy discovered something called “diaphragmatic breathing,” a technique which involved breathing through the stomach. This strategy could help to bring warmth to the abdominal region by increasing blood flow throughout abdomen, thereby relieving discomfort of the bowel. Although suspicious of the scientific support behind this method, previous attempts at traditional western treatment had provided no benefit to recovery; therefore, she found no harm in trying. Lying back flat against the hospital bed, she relaxed her body completely, and began to breathe. Immediately, Cindy became aware that she took her breath in her chest, rather than her stomach. Pushing out all of her air, she tried again, this time gasping with inhalation. Delighted, she watched as air flooded into her stomach, causing it to rise beneath her hands, while her chest remained still. Over time, Cindy began to develop more awareness and control over her newfound strategy. While practicing, she could feel her stomach and abdomen becoming warmer. Cindy shares that for the first time in years, she felt relief from pain, causing her to cry from happiness. Later that day, she was released from the hospital, after denying any more pain medication from doctors.
Cindy continues to practice her diaphragmatic breathing as much as she can, anywhere at all, at the sign of pain or discomfort, as well as preventatively prior to what she anticipates will be a stressful situation. Since beginning her practice, Cindy says that her IBS is pretty much non-existent now. She no longer feels depressed about her situation due to her developed ability to manage her condition. Overall, she is much happier. Moreover, since this time two years ago, Cindy has gained approximately 20 pounds, which she attributes to eating a lot more. In regard to her success, she believes it was her drive, motivation, and willingness to dedicate herself fully to the breathing practice which allowed for her to develop skills and prosper. Although it was not natural for her to breathe in her stomach at first, a trait which she says she often recognizes in others, Cindy explains it was due to necessity which caused her to shift her previously-ingrained way of breathing. Upon publicly sharing her story with others for the first time, Cindy reflects on her past, revealing that she experienced shame for a long time as she felt that she had a weird condition, related to abnormal functions, which no one ever talks about. On the experience of speaking out, she affirms that it was very empowering, and hopes to encourage others coping with a situation similar to hers that there is in fact hope for the future. Cindy continues to feel empowered, confident, and happy after taking control of her own body, and acknowledges that her condition is a part of her, something of which she is proud.
Watch the in-depth interview with Cindy Huey in which she describes her experience of discovering diaphragmatic breathing and how she used this to heal herself of IBS
Video 1. Interview with Cindy Huey describing how she healed herself from IBS.
“Why should the body digest food or repair itself, when it will be someone else’s lunch” (paraphrased from Sapolsky (2004), Why zebras do not get ulcers).
From an evolutionary perspective, we were prey and needed to be on guard (vigilant) to the presence of predators. In the long forgotten past, the predators were tigers, snakes, and the carnivore for whom we were food as well as other people. Today, the same physiological response pathways are still operating, except that the pathways are now more likely to be activated by time urgency, work and family conflict, negative mental rehearsal and self-judgment. This is reflected in the common colloquial phrases: “It makes me sick to my stomach,” “I have no stomach for it,” “He is gutless,” “It makes me queasy,” “Butterflies in my stomach,” “Don’t get your bowels in uproar,” “Gut feelings’, or “Scared shitless.”
Whether conscious or unconscious, when threatened, our body reacts with a fight/flight/freeze response in which the blood flow is diverted from the abdomen to deep muscles used for propulsion. This results in peristalsis being reduced. At the same time the abdomen tends to brace to protect it from injury. In almost all cases, the breathing patterns shift to thoracic breathing with limited abdominal movement. As the breathing pattern is predominantly in the chest, the person increases the risk of hyperventilation because the body is ready to run or fight.
In our clinical observations, people with IBS, small intestine bacterial overgrowth (SIBO), abdominal discomfort, anxiety and panic, and abdominal pain tend to breathe more in their chest, and when asked to take breathe, they tend to inhale in their upper chest with little or no abdominal displacement. Almost anyone who experiences abdominal pain tends to hold the abdomen rigid as if the splinting could reduce the pain. A similar phenomenon is observed with female students experiencing menstrual cramps. They tend to curl up to protect themselves and breathe shallowly in their chest instead of slowly in their abdomen, a body pattern which triggers a defense reaction and inhibits regeneration. If instead they breathe slowly and uncurl they report a significant decrease in discomfort (Gibney & Peper, 2003).
Paradoxically, this protective stance of bracing the abdomen and breathing shallowly in the chest increases breathing rate and reduces heart rate variability. It reduces and inhibits blood and lymph flow through the abdomen as the defensive posture evokes the physiology of fight/flight/freeze. The reduction in venous blood and lymph flow occurs because the ongoing compression and expansion in the abdomen is inhibited by the thoracic breathing and, moreover, the inhibition of diaphragmatic breathing. It also inhibits peristalsis and digestion. No wonder so many of the people with IBS report that they are reactive to some foods. If the GI track has reduced blood flow and reduced peristalsis, it may be less able to digest foods which would affect the bacteria in the small intestine and colon. We wonder if a risk factor that contributes to SIBO is chronic lack of abdominal movement and bracing.
Slow diaphragmatic abdominal breathing to establish health
“Digestion and regeneration occurs when the person feels safe.”
Effortless, slow diaphragmatic breathing occurs when the diaphragm descends and pushes the abdominal content downward during inhalation, which causes the abdomen to become bigger. As the abdomen expands, the pelvic floor relaxes and descends. During exhalation, the pelvic floor muscles tighten slightly, lifting the pelvic floor and the transverse and oblique abdominal muscles contract and push the abdominal content upward against the diaphragm, allowing the diaphragm to relax and go upward, pushing the air out. The following video, 3D view of the diaphragm, from www.3D-Yoga.com by illustrates the movement of the diaphragm.
This expansion and constriction of the abdomen occurs most easily if the person is extended, whether sitting or standing erect or lying down, and the waist is not constricted. If the arches forward in a protected pattern and the spine is flexed in a c shape, it would compress the abdomen; instead, the body is long and the abdomen can move and expand during inhalation as the diaphragm descends (see figure 1). If the person holds their abdomen tight or it is constricted by clothing or a belt, it cannot expand during inhalation. Abdominal breathing occurs more easily when the person feels safe and expanded versus unsafe or fearful and collapsed or constricted.
Figure 1. Erect versus collapsed posture note that there is less space for the abdomen to expand in the protective collapsed position. Reproduced by permission from: Clinical Somatics (http://www.clinicalsomatics.ie/
When a person breathes slower and lower it encourages blood and lymph flow through the abdomen. As the person continues to practice slower, lower breathing, it reduces the arousal and vigilance. This is the opposite state of the flight, fight, freeze response so that blood flow is increased in abdomen, and peristalsis re-occurs. When the person practices slow exhalation and breathing and they slightly tighten the oblique and transverse abdominal muscles as well as the pelvic floor and allow these muscles to relax during inhalation. When they breathe in this pattern effortless they, they often will experience an increase in abdominal warmth and an initiation of abdominal sounds (stomach rumble or borborygmus) which indicates that peristalsis has begun to move food through the intestines (Peper et al., 2016). For a detailed description see https://peperperspective.com/2016/04/26/allow-natural-breathing-with-abdominal-muscle-biofeedback-1-2/
What can you do to reduce IBS
There are many factors that cause and effect IBS, some of which we have control over and some which are our out of our control, such as genetics. The purpose of proposed suggestions is to focus on those things over which you have control and reduce risk factors that negatively affect the gastrointestinal track. Generally, begin by integrating self-healing strategies that promote health which have no negative side effects before agreeing to do more aggressive pharmaceutical or even surgical interventions which could have negative side effects. Along the way, work collaboratively with your health care provider. Experiment with the following:
- Avoid food and drinks that may irritate the gastrointestinal tract. These include coffee, hot spices, dairy products, wheat and many others. If you are not sure whether you are reacting to a food or drink, keep a detailed log of what you eat and drink and how you feel. Do self-experimentation by eating or drinking the specific food by itself as the first food in the morning. Then observe how you feel in the next two hours. If possible, eat only organic foods that have not been contaminated by herbicides and pesticides (see: https://peperperspective.com/2015/01/11/are-herbicides-a-cause-for-allergies-immune-incompetence-and-adhd/).
- Identify and resolve stressors, conflicts and problems that negatively affect you and drain your energy. Keep a log to identify situations that drain or increase your subjective energy. Then do problem solving to reduce those situations that drain your energy and increase those situations that increase your energy. For a detailed description of the practice see https://peperperspective.com/2012/12/09/increase-energy-gains-decrease-energy-drains/
Often the most challenging situations that we cannot stomach are those where we feel defeated, helpless, hopeless and powerless or situations where we feel threatened– we do not feel safe. Reach out to other both friends and social services to explore how these situations can be resolved. In some cases, there is nothing that can be done except to accept what is and go on.
- Feel safe. As long as we feel unsafe, we have to be vigilant and are stressed which affects the GI track. Explore the following:
- What does safety mean for you?
- What causes you to feel unsafe from the past or the present?
- What do you need to feel safe?
- Who can offer support that you feel safe?
Reflect on these questions and then explore and implement ways by which you can create feeling more safe.
- Take breaks to regenerate. During the day, at work and at home, monitor yourself. Are you pushing yourself to complete tasks. In a 24/7 world with many ongoing responsibilities, we are unknowingly vigilant and do not allow ourselves to rest and relax to regenerate. Do not wait till you feel tired or exhausted. Stop earlier and take a short break. The break can be a short walk, a cup of tea or soup, or looking outside at a tree. During this break, think about positive events that have happened or people who love you and for whom you feel love. When you smile and think of someone who loves you, such as a grandparent, you may relax and for that moment as you feel safe which allows regeneration to begin.
- Observe how you inhale. Take a deep breath. If you feel you are moving upward and becoming a little bit taller, your breathing is wrong. Put one hand on your lower abdomen and the other on your chest and take a deep breath. If you observe your chest lifted upward and stomach did not expand, your breathing is wrong. You are not breathing diaphragmatically. Watch the following video, The correct way to breathe in, on how to observe your breathing and how to breathe diaphragmatically.
- Learn diaphragmatic breathing. Take time to practice diaphragmatic breathing. Practice while lying down and sitting or standing. Let the breathing rate slow down to about six breaths per minute. Exhale to the count of four and then let it trail off for two more counts, and inhale to the count of three and let it trail for another count. Practice this sitting and lying down (for more details on breathing see: https://peperperspective.com/2014/09/11/a-breath-of-fresh-air-improve-health-with-breathing/.
- Sitting position. Exhale by feeling your abdomen coming inward slightly for the count of four and trailing off for the count of two, then allow the lower ribs to widen, abdomen expand–the whole a trunk expands–as you inhale while the shoulders stay relaxed for a count of three. Allow it to trail off for one more count before you again begin to exhale. Be gentle, do not rush or force yourself. Practice this slower breathing for five minutes. Focus more on the exhalation and allowing the air to just flow in. Give yourself time during the transition between inhalation and exhalation.
- Lying down position. While lying on your back, place a two to five-pound weight such as a bag of rice on your stomach as shown in Figure 2.
Figure 2. Lying down and practicing breathing with two to five-pound weight on stomach (reproduced by permission from Gorter and Peper, 2011.
As you inhale push the weight upward and also feel your lower ribs widen. Then allow exhalation to occur by the weight pushing the abdominal content down which pushes the diaphragm upward. This causing the breath to flow out. As you exhale, imagine the air flowing out through your legs as if there were straws inside your legs. When your attention wanders, smile and bring it back to imagining the air flowing down your legs during exhalation. Practice this for twenty minutes. Many people report that during the practice the gurgling in their abdomen occurs which is a sign that peristalsis and healing is returning.
- Observe and change your breathing during the day. Observe your breathing pattern during the day. Each time you hold your breath, gasp or breathe in your chest, interrupt the pattern and substitute slow diaphragmatic breathing for the next five breaths. Do this the whole day long. Many people observe that when they think of stressor or are worried, they hold their breath or shallow breathe in the chest. If this occurs, acknowledge the worry and focus on changing your breathing. This does not mean that you dismiss the concern, instead for this moment you focus on breathing and then explore ways to solve the problem.
If you observed that under specific circumstance you held your breath or breathed shallowly in your chest, then whenever you anticipate that the same event will occur again, begin to breathe diaphragmatically. To do this consistently is very challenging and most people report that initially they only seem to breathe incorrectly. It takes practice, practice and practice—mindful practice– to change. Yet those who continue to practice often report a decrease in symptoms and feel more energy and improved quality of life.
Changing habitual health behaviors such as diet and breathing can be remarkably challenging; however, it is possible. Give yourself enough time, and practice it many times until it becomes automatic. It is no different from learning to play a musical instrument or mastering a sport. Initially, it feels impossible, and with lot of practice it becomes more and more automatic. We continue to be impressed that healing is possible. Among our students at San Francisco State University, who practice their self-healing skills for five weeks, approximately 80% report a significant improvement in their health (Peper et al., 2014).
Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: a clinical review. Jama, 313(9), 949-958.
Chitkara, D. K., Rawat, D. J., & Talley, N. J. (2005). The epidemiology of childhood recurrent abdominal pain in Western countries: a systematic review. American journal of Gastroenterology, 100(8), 1868-1875.
Dupont, H. L. (2014). Review article: evidence for the role of gut microbiota in irritable bowel syndrome and its potential influence on therapeutic targets. Alimentary pharmacology & therapeutics, 39(10), 1033-1042.
Gibney, H.K. & Peper, E. (2003). Taking control: Strategies to reduce hot flashes and premenstrual mood swings. Biofeedback, 31(3), 20-24.
Gorter, R. & Peper, E. (2011). Fighting Cancer-A NonToxic Approach to Treatment. Berkeley: North Atlantic.
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.
Peper, E., Lin, I-M, Harvey, R., Gilbert, M., Gubbala, P., Ratkovich, A., & Fletcher, F. (2014). Transforming chained behaviors: Case studies of overcoming smoking, eczema and hair pulling (trichotillomania). Biofeedback, 42(4), 154-160.
Sapolsky, R. (2004). Why Zebras Don’t Get Ulcers. New York: Owl Books
Sowder, E., Gevirtz, R., Shapiro, W., & Ebert, C. (2010). Restoration of vagal tone: a possible mechanism for functional abdominal pain. Applied psychophysiology and biofeedback, 35(3), 199-206.
Vlieger, A. M., Blink, M., Tromp, E., & Benninga, M. A. (2008). Use of complementary and alternative medicine by pediatric patients with functional and organic gastrointestinal diseases: results from a multicenter survey. Pediatrics, 122(2), e446-e451.
Stress, incorrect posture, poor vision and not knowing how to relax may all contribute to neck and shoulder tension. More than 30% of all adults experience neck pain and 45% of girls and 19% of boys 18 year old, report back, neck and shoulder pain (Cohen, 2015; Côté, Cassidy, & Carroll, 2003; Hakala, Rimpelä, Salminen, Virtanen, & Rimpelä, 2002). Shoulder pain affects almost a quarter of adults in the Australian community (Hill et al, 2010). Most employees working at the computer experience neck and shoulder tenderness and pain (Brandt et al, 2014), more than 33% of European workers complained of back-ache (The European Agency for Safety and Health at Work, 2004), more than 25% of Europeans experience work-related neck-shoulder pain, and 15% experience work-related arm pain (Blatter & De Kraker, 2005; Eijckelhof et al, 2013), and more than 90% of college students report some muscular discomfort at the end of the semester especially if they work on the computer (Peper & Harvey, 2008).
The stiffness in the neck and shoulders or the escalating headache at the end of the day may be the result of craning the head more and more forward or concentrating too long on the computer screen. Or, we are unaware that we unknowingly tighten muscles not necessary for the task performance—for example, hunching our shoulders or holding our breath. This misdirected effort is usually unconscious, and unfortunately, can lead to fatigue, soreness, and a buildup of additional muscle tension.
The stiffness in the neck and shoulders or the escalating headache at the end of the day may be the result of craning the head more and more forward or concentrating too long on the computer screen. Poor posture or compromised vision can contribute to discomfort; however, in many cases stress is major factor. Tightening the neck and shoulders is a protective biological response to danger. Danger that for thousands of years ago evoke a biological defense reaction so that we could run from or fight from the predator. The predator is now symbolic, a deadline to meet, having hurry up sickness with too many things to do, anticipating a conflict with your partner or co-worker, worrying how your child is doing in school, or struggling to have enough money to pay for the rent.
Mind-set also plays a role. When we’re anxious, angry, or frustrated most of us tighten the muscles at the back of the neck. We can also experience this when insecure, afraid or worrying about what will happen next. Although this is a normal pattern, anticipating the worst can make us stressed. Thus, implement self-care strategies to prevent the occurrence of discomfort.
What can you do to free up the neck and shoulder?
Become aware what factors precede the neck and shoulder tension. For a week monitor yourself, keep a log during the day and observe what situations occur that precede the neck and should discomfort. If the situation is mainly caused by:
- Immobility while sitting and being captured by the screen. Interrupt sitting every 15 to 20 minutes and move such as walking around while swinging your arms.
- Ergonomic factors such as looking down at the computer or laptop screen while working. Change your work environment to optimize the ergonomics such as using a detached keyboard and raising the laptop screen so that the top of the screen is at eyebrow level.
- Emotional factors. Learn strategies to let go of the negative emotions and do problem solving. Take a slow deep breath and as you exhale imagine the stressor to flow out and away from you. Be willing to explore and change ask yourself: “What do I have to have to lose to change?”, “Who or what is that pain in my neck?”, or “What am I protecting by being so rigid?”
Regardless of the cause, explore the following five relaxation and stretching exercises to free up the neck and shoulders. Be gentle, do not force and stop if your discomfort increases. When moving, continue to breathe.
1. WIGGLE. Wiggle and shake your body many times during the day. The movements can be done surreptitiously such as, moving your feet back and forth in circles or tapping feet to the beat of your favorite music, slightly arching or curling your spine, sifting the weight on your buttock from one to the other, dropping your hands along your side while moving and rotating your fingers and wrists, rotating your head and neck in small unpredictable circles, or gently bouncing your shoulders up and down as if you are giggling. Every ten minutes, wiggle to facilitate blood flow and muscle relaxation.
2. SHAKE AND BOUNCE. Stand up, bend your knees slightly, and let your arms hang along your trunk. Gently bounce your body up and down by bending and straightening your knees. Allow the whole body to shake and move for about one minute like a raggedy Ann doll. Then stop bouncing and alternately reach up with your hand and arm to the ceiling and then let the arm drop. Be sure to continue to breathe.
3. ROTATION MOVEMENT (Adapted from the work by Sue Wilson and reproduced by permission from: Gorter, R. & Peper, E. (2011). Fighting Cancer- A Nontoxic Approach to Treatment).
Pre-assessment: Stand up and give yourself enough space, so that when you lift your arms to shoulder level and rotate, you don’t touch anything. Continue to stand in the same spot during the exercise as shown in figures 1a and 1b.
Lift your arms and hold them out, so that they are at shoulder level, positioned like airplane wings. Gently rotate your arms to the left as far as you can without discomfort. Look along your left arm to your fingertips and beyond to a spot on the wall and remember that spot. Rotate back to center and drop your arms to your sides and relax.
Figures 1a and 1b. Rotating the arms as far as is comfortable (photos by Jana Asenbrennerova)
Movement practice. Again, lift your arms to the side so that they are like airplane wings pointing to the left and right. Gently rotate your trunk, keeping your arms fixed at a right angle to your body. Rotate your arms to the right and turn your head to the left. Then reverse the direction and rotate your arms in a fixed position to the left and turn your head to the right. Do not try to stretch or push yourself. Repeat the sequence three times in each direction and then drop your arms to your sides and relax.
With your arms at your sides, lift your shoulders toward your ears while you keep your neck relaxed. Feel the tension in your shoulders, and hold your shoulder up for five seconds. Let your shoulders drop and relax. Then relax even more. Stay relaxed for ten seconds.
Repeat this sequence, lifting, dropping, and relaxing your shoulders two more times. Remember to keep breathing; and each time you drop your shoulders, relax even more after they have dropped.
Repeat the same sequence, but this time, very slowly lift your shoulders so that it takes five seconds to raise them to your ears while you continue to breathe. Keep relaxing your neck and feel the tension just in your shoulders. Then hold the tension for a count of three. Now relax your shoulders very slowly so that it takes five seconds to lower them. Once they are lowered, relax them even more and stay relaxed for five seconds. Repeat this sequence two more times.
Now raise your shoulders quickly toward your ears, feel the tension in your upper shoulders, and hold it for the count of five. Let the tension go and relax. Just let your shoulders drop. Relax, and then relax even more.
Post-assessment. Lift your arms up to the side so that they are at shoulder level and are positioned like airplane wings. Gently rotate without discomfort to the left as far as you can while you look along your left arm to your fingers and beyond to a spot on the wall.
Almost everyone reports that when they rotate the last time, they rotated significantly further than the first time. The increased flexibility is the result of loosening your shoulder muscles.
4. TAPPING FEET (adapted from the work of Servaas Mes)
Diagonal movements underlie human coordination and if your coordination is in sync, this will happen as a reflex without thought. There are many examples of these basic reflexes, all based on diagonal coordination such as arm and leg movement while walking. To restore this coordination, we use exercises that emphasize diagonal movements. This will help you reverse unnecessary tension and use your body more efficiently and thereby reducing “sensory motor amnesia” and dysponesis (Hanna, 2004). Remember to do the practices without straining, with a sense of freedom, while you continue relaxed breathing. If you feel pain, you have gone too far, and you’ll want to ease up a bit. This practice offers brief, simple practices to avoid and reverse dysfunctional patterns of bracing and tension and reduce discomfort. Practicing healthy patterns of movement can reestablish normal tone and reduce tension and pain. This is a light series of movements that involve tapping your feet and turning your head. You’ll be able to do the entire exercise in less than twenty seconds.
Pre-assessment. Sit erect at the edge of the chair with your hands on your lap and your feet shoulders’ width apart, with your heels beneath your knees.
First, notice your flexibility by gently rotating your head to the right as far as you can. Now look at a spot on the wall as a measure of how far you can comfortably turn your head and remember that spot. Then rotate back to the center.
Practicing rotating feet and head. Become familiar with the feet movement, lift the balls of your feet so your feet are resting on your heels. Lightly pivot the balls of your feet to the right, tap the floor, and then stop and relax your feet for just a second. Now lift the balls of your feet, pivot your feet to the left, tap, relax, and pivot back to the right.
Just let your knees follow the movement naturally. This is a series of ten light, quick, relaxed pivoting movements—each pivot and tap takes only about one or two seconds.
Add head rotation. Turn your head in the opposite direction of your feet. This series of movements provides effortless stretches that you can do in less than half a minute as shown in figures 2a and 2b.
Figures 2a and 2b. Rotating the feet and head in opposite directions (photos by Gary Palmer)
When you’re facing right, move your feet to the left and lightly tap. Then face left and move your feet to the right and tap.
- Continue the tapping movement, but each time pivot your head in the opposite direction. Don’t try to stretch or force the movement.
- Do this sequence ten times. Now stop, face straight head, relax your legs, and just keep breathing.
Post assessment. Rotate your head to the right as far as you can see and look at a spot on the wall. Notice how much more flexibility/rotation you have achieved.
Almost everyone reports being able to rotate significantly farther after the exercise than before. They also report that they have less stiffness in their neck and shoulders.
5. SHOULDER AWARENESS PRACTICE. Sit comfortably with your hands on your lap. Allow your jaw to hang loose and breathe diaphragmatically. Continue to breathe slowly as you do the following:
- Shrug, raising your shoulders towards your ears to 70% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
- Let your shoulders drop and relax for 10 to 20 seconds
- Shrug, raising your shoulders towards your ears to 50% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
- Let your shoulders drop and relax for 10 to 20 seconds
- Shrug, raising your shoulders towards your ears to 25% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
- Let your shoulders drop and relax for 10 to 20 seconds
- Shrug, raising your shoulders towards ears to 5% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
- Let your shoulders drop and relax for 10 to 20 seconds
- Pull your shoulders down to 25% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
- Allow your shoulders to come back up and relax for 10 to 20 seconds
Remember to relax your shoulders completely after each incremental tightening. If you tend to hold your breath while raising your shoulders, gently exhale and continue to breathe. When you return to work, check in occasionally with your shoulders and ask yourself if you can feel any of the sensations of tension. If so, drop your shoulders and relax for a few seconds before resuming your tasks.
In summary, when employees and students change their environment and integrate many movements during the day, they report a significant decrease in neck and shoulder discomfort and an increase in energy and health. As one employee reported, after taking many short movement breaks while working at the computer, that he no longer felt tired at the end of the day, “Now, there is life after five”.
To explore how prevent and reverse the automatic somatic stress reactions, read Thomas Hanna‘s book, Somatics: Reawakening The Mind’s Control of Movement, Flexibility, and Health. For easy to do neck and shoulder guided instructions stretches, see the following ebsite: http://greatist.com/move/stretches-for-tight-shoulders
Brandt, M., Sundstrup, E., Jakobsen, M. D., Jay, K., Colado, J. C., Wang, Y., … & Andersen, L. L. (2014). Association between neck/shoulder pain and trapezius muscle tenderness in office workers. Pain research and treatment, 2014.
Côté, P., Cassidy, J. D., & Carroll, L. (2003). The epidemiology of neck pain: what we have learned from our population-based studies. The Journal of the Canadian Chiropractic Association, 47(4), 284. http://www.pain-initiative-un.org/doc-
Eijckelhof, B. H. W., Huysmans, M. A., Garza, J. B., Blatter, B. M., Van Dieën, J. H., Dennerlein, J. T., & Van Der Beek, A. J. (2013). The effects of workplace stressors on muscle activity in the neck-shoulder and forearm muscles during computer work: A systematic review and meta-analysis. European Journal of Applied Physiology, 113(12), 2897-2912.
Hill, C. L., Gill, T. K., Shanahan, E. M., & Taylor, A. W. (2010). Prevalence and correlates of shoulder pain and stiffness in a population‐based study: the North West Adelaide Health Study. International journal of rheumatic diseases, 13(3), 215-222.
Paoli, P., Merllié, D., & Fundação Europeia para a Melhoria das Condições de Vida e de Trabalho. (2001). Troisième enquête européenne sur les conditions de travail, 2000.
*I thank Sue Wilson and Servaas Mes for teaching me these somatic practices.
It was late in the afternoon and I was tired. A knock on my office door. One of my students came in and started to read to me from a card. “I want to thank you for all your help in my self-healing project…I didn’t know the improvements were possible for me in a span of 5 weeks…. I thank you so much for encouraging and supporting me…. I have taken back control of myself and continue to make new discoveries about my identity and find my own happiness and fulfillment… Thank you so much.”
I was deeply touched and my eyes started to fill with tears. At that moment, I felt so appreciated. We hugged. My tiredness disappeared and I felt at peace.
In a world where we are constantly bombarded by negative, fearful stories and images, we forget that our response to these stories impacts our health. When people watch fear eliciting videos, their heart rate increases and their whole body responds with a defense reaction as if they are personally being threatened (Kreibig, Wilhelm, Roth, & Gross, 2007). Afterwards, we may continue to interpret and react to new stimuli as if they are the same as what happened in the video. For example, while watching a horror movie, we may hold our breath, perspire and feel our heart racing; however, when we leave the theatre and walk down the street by ourselves, we continue to be afraid and react to stimuli as if what happened in video will now happen to us.
When we feel threatened, our body responds to defend itself. It reduces the blood flow to the gastrointestinal tract where digestion is taking place and sends it to large muscles so that we can run and fight. When threatened, most of our resources shifted to the processes that promote survival while withdrawing it from processes that do not lead to immediate survival such as digestion or regeneration (Sapolsky, 2004). From an evolutionary perspective, why spent resources to heal yourself, enhance your immune system or digest your food when you will become someone else’s lunch!
The more we feel threatened, the more we will interpret the events around us negatively. We become more stressed, defensive, and pessimistic. If this response occurs frequently, it contributes to increased morbidity and mortality. We may not be in control of external or personal event; however, we may be able to learn how to change our reactions to these events. It is our reactions and interpretations of the event that contributes to our ongoing stress responses. The stressor can be labeled as crisis or opportunity.
Mobilize your own healing when you take charge. When 92 students as part of a class at San Francisco State University practiced self-healing skill, most reported significant improvements in their health as shown in Figure 1.
Figure 1. Average self-reported improvement after practicing self-healing skills for at least four weeks. (Reproduced with permission from Tseng, Abili, Peper, & Harvey, 2016).
A strategy that many students used was to interrupt their cascading automatic negative reactions. The moment they became aware of their negative thought and body slumping, they interrupted the process and practiced a very short relaxation or meditation technique.
Implement what the students have done by taking charge of your stress responses and depressive thoughts by 1) beginning the day with a relaxation technique, Relax Body-Mind, 2) interrupting the automatic response to stressors with a rapid stress reduction technique, Breathe and be a Tree, and 3) increasing vitality by the practice, Share Gratitude (Gorter & Peper, 2011).
Relax Body-Mind to start the day*
- Lie down or sit and close your eyes. During the practice if your attention wanders, just bring it back to that part of the body you are asked to tighten or let go.
- Wrinkle your face for ten seconds while continuing to breathe. Let go and relax for ten seconds.
- Bring your hands to your face with the fingers touching the forehead while continuing to breathe. While exhaling, pull your fingers down your face so that you feel your jaw being pulled down and relaxing. Drop your hands to your lap. Feel the sensations in your face and your fingers for ten seconds.
- Make a fist with your hands and lift them slightly up from your lap while continuing to breathe. Feel the sensations of tension in your hands, arms and shoulders for ten seconds. Let go and relax by allowing the arms to drop to your lap and relax. Feel the sensations change in your hands, arms and shoulders for ten seconds.
- Tighten your buttocks and flex your ankles so that the toes are reaching upwards to your knees. Hold for ten seconds while continuing to breathe. Let go and relax for ten seconds.
- Take a big breath while slightly arching your back away from the bed ore chair and expand your stomach while keeping your arms, neck, buttocks and legs relaxed. Hold the breath for twenty seconds. Exhale and let your back relax while allowing the breathing to continue evenly while sensing your body’s contact with the bed or chair for twenty seconds. Repeat three times.
- Gently shake your arms and legs for ten seconds while continuing to breathe. Let go and relax. Feel the tingling sensations in your arms and legs for 20 seconds.
- Evoke a past positive memory where you felt at peace and nurtured.
- Stretch and get up. Know you have done the first self-healing step of the day.
*Be gentle to yourself and stop the tightening or breath holding if it feels uncomfortable.
Breathe and be a Tree to dissipate stress and focus on growth
- Look at a tall tree and realize that you are like a tree that is rooted in the ground and reaching upward to the light. It continues to grow even though it has been buffeted by storms.
- When you become aware of being stressed, exhale slowly and inhale so that your stomach expands, the while slowly exhaling, look upward to the top of a real or imagined tree, admire the upper branches and leaves that are reaching towards the light and smile.
- Remember that even though you started to respond to a stressor, the stressor will pass just like storms battering the tree. By breathing and looking upward, accept what happened and know you are growing just like the tree.
- Think of someone who did something for you that impacted your life in a positive direction and whom you never properly thanked. This could be a neighbor, teacher, friend, parent, or other family members.
- Write a 300-word testimonial describing specifically what the person did and how it positively impacted you and changed the course of your life.
- Arrange an actual face-to-face meeting with the person. Tell them you would like to see him/her. If they are far away, arrange a Skype call where you can actually see and hear him/her. Do not do it by email or texting.
- Meet with the person and read the testimonial to her/him.
- It may seem awkward to read the testimonial, after you have done it, you will feel closer and more deeply connected to the person. Moreover, the person to whom you read the testimonial, will usually feel deeply touched. Both your hearts will open.
Gorter, R. & Peper, E. (2011). Fighting cancer: A nontoxic approach to treatment. Berkeley, CA: North Atlantic Books, 205-207.
Kreibig, S. D., Wilhelm, F. H., Roth, W. T., & Gross, J. J. (2007). Cardiovascular, electrodermal, and respiratory response patterns to fear‐and sadness‐inducing films. Psychophysiology, 44(5), 787-806.Kreibig, Sylvia D., Frank H. Wilhelm, Walton T. Roth, and James J. Gross. “Cardiovascular, electrodermal, and respiratory response patterns to fear‐and sadness‐inducing films.” Psychophysiology 44, no. 5 (2007): 787-806.
Sapolsky, R. (2004). Why Zebras Don’t Get Ulcers. New York: Owl Books
Seligman, M. (2014). The new era of positive psychology. Ted Talk. Retrieved, December 10, 2016. https://www.ted.com/talks/martin_seligman_on_the_state_of_psychology
Tseng, C., Abili, R., Peper, E., & Harvey, R. (2016). Reducing Acne-Stress and an integrated self-healing approach. Appl Psychophysiol Biofeedback, 4(4), 445.)
“I have had headaches for six years, at first occurring almost every day. When I got put on an antidepressant, they slowed to about 3 times a week (sometimes more) and continued this way until I learned relaxation techniques. I am 20 years old and now headache free. Everyone should have this educational opportunity to heal themselves.” -Melinda, a 20 year old student
Health and wellness is a basic right for all people. When students learn stress management skills which include awareness of stress, progressive muscle relaxation, Autogenic phrases, slower breathing, posture change, transforming internal language, self-healing imagery, the role of diet, exercise embedded within an evolutionary perspective as part of a college class their health often improves. When students systematically applied these self-awareness techniques to address a self-selected illness or health behavior (e.g., eczema, diet, exercise, insomnia, or migraine headaches), 80% reported significant improvement in their health during that semester (Peper et al., 2014b; Tseng, et al., 2016). The semester long program is based upon the practices described in the book, Make Health Happen, (Peper, Gibney, & Holt, 2002).
The benefits often last beyond the semester. Numerous students reported remarkable outcomes at follow-up many months after the class had ended because they had mastered the self-regulation skills and continued to implement these skills into their daily lives. The educational model utilized in holistic health courses is often different from the clinical/treatment model.
Educational approach: I am a student and I have an illness (most of me is healthy and only part of me is sick).
Clinical treatment approach: I am a patient and I am sick (all of me is sick)
Some of the concepts underlying the differences between the educational and the clinical approach are shown in Table 1.
|Educational approach||Clinic/treatment approach|
|Focuses on growth and learning||Focuses on remediation|
|Focuses on what is right||Focuses on what is wrong|
|Focuses on what people can do for themselves||Focuses on how the therapist can help patients|
|Assumes students as being competent||Implies patients are damaged and incompetent|
|Students defined as being competent to master the skills||Patients defined as requiring others to help them|
|Encourages active participation in the healing process||Assumes passive participation in the healing process|
|Students keep logs and write integrative and reflective papers, which encourage insight and awareness||Patients usually do not keep logs nor are asked to reflect at the end of treatment to see which factors contributed to success|
|Students meet in small groups, develop social support and perspective||Patients meet only with practitioners and stay isolated|
|Students experience an increased sense of mastery and empowerment||Patients experience no change or possibly a decrease in sense of mastery|
|Students develop skills and become equal or better than the instructor||Patients are healed, but therapist is always seen as more competent than patient|
|Students can become colleagues and friends with their teachers||Patients cannot become friends of the therapist and thus are always distanced|
Table 1. Comparison of an educational versus clinical/treatment approach
The educational approach focuses on mastering skills and empowerment. As part of the course work, students become more mindful of their health behavior patterns and gradually better able to transform their previously covert harm promoting patterns. This educational approach is illustrated in a case report which describes how a student reduced her chronic migraines.
Case Example: Elimination of Chronic Migraines
Melinda, a 20-year-old female student, experienced four to five chronic migraines per week since age 14. A neurologist had prescribed several medications including Imitrex (used to treat migraines) and Topamax (used to prevent seizures as well as migraine headaches), although they were ineffective in treating her migraines. Nortriptyline (a tricyclic antidepressant) and Excedrin Migraine (which contains caffeine, aspirin, and acetaminophen) reduced the frequency of symptoms to three times per week.
She was enrolled in a university biofeedback class that focused on learning self-regulation and biofeedback skills. All these students were taught the fundamentals of biofeedback and practiced Autogenic Training (AT) every day during the semester (Luthe, 1979; Luthe & Schultz, 1969; Peper & Williams, 1980).
In the class, students practiced with surface electromyography (SEMG) feedback to identify the presence of shoulder muscle overexertion (dysponesis), as well as awareness of minimum muscle tension. Additional practices included hand warming, awareness of thoracic and diaphragmatic breathing, and other biofeedback or somatic awareness approaches. In parallel with awareness of physical sensations, students practiced behavioral awareness such as alternating between a slouching body posture (associated with feeling self-critical and powerless) and an upright body posture (associated with feeling powerful and in control). Psychological awareness was focused on transforming negative thoughts and self-judgments to positive empowering thoughts (Harvey and Peper, 2011; Peper et al., 2014a; Peper et al, 2015). Taken together, students systematically increased awareness of physical, behavioral, and psychological aspects of their reactions to stress.
The major determinant for success is to generalize training at school, home and at work. Each time Melinda felt her shoulders tightening, she learned to relax and release the tension in her shoulders, practiced Autogenic Training with the phrase “my neck and shoulders are heavy.” In addition, whenever she felt her body beginning to slouch or noticed a negative self-critical thought arising in her mind, she shifted her body to an upright empowered posture, and substituted positive thoughts to reduce her cortisol level and increase access to positive thoughts (Carney & Cuddy, 2010; Cuddy, 2012; Tsai, et al., 2016). Postural feedback was also informally given by Melinda’s instructor. Every time the instructor noticed her slouching in class or the hallway, he visually changed his own posture to remind her to be erect.
Melinda’s headaches reduced from between three and five per week before enrolling in the class to zero following the course, as shown in Figure 2. She has learned to shift her posture from slouching to upright and relaxed. In addition, she reported feeling empowered, mentally clear, and her acne cleared up. All medications were eliminated. At a two year follow-up, she reported that since she took the class, she had only few headaches which were triggered by excessive stress.
Figure 2. Frequency of migraine and the implementation of self-practices.
The major factors that contributed to success were:
- Becoming aware of muscle tension through the SEMG feedback. Melinda realized that she had tension when she thought she was relaxed.
- Keeping detailed logs and developing a third person perspective by analyzing her own data and writing a report. A process that encouraged acceptance of self, thereby becoming less judgmental.
- Acquiring a new belief that she could learn to overcome her headaches, facilitated by class lecture and verbal feedback from the instructor.
- Taking active control by becoming aware of the initial negative thoughts or sensations and interrupting the escalating chain of negative thoughts and sensations by shifting the attention to positive empowering thoughts and sensations–a process that integrated mindfulness, acceptance and action. Thus, transforming judgmental thoughts into accepting and positive thoughts.
- Becoming more aware throughout the day, at school and at home, of initial triggers related to body collapse and muscle tension, then changing her body posture and relaxing her shoulders. This awareness was initially developed because the instructor continuously gave feedback whenever she started to slouch in class or when he saw her slouching in the hallways.
- Practicing many, many times during the day. Namely, increasing her ongoing mindfulness of posture, neck, and shoulder tension, and of negative internal dialogue without judgment.
The benefits of this educational approach is captured by Melinda’s summary, “The combined Autogenic biofeedback awareness and skill with the changes in posture helped me remarkably. It improved my self-esteem, empowerment, reduced my stress, and even improved the quality of my skin. It proves the concept that health is a whole system between mind, body, and spirit. When I listen carefully and act on it, my overall well-being is exceptionally improved.”
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: http://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are
Harvey, E. & Peper, E. (2011). I thought I was relaxed: The use of SEMG biofeedback for training awareness and control (pp. 144-159). In W. A. Edmonds, & G. Tenenbaum (Eds.), Case studies in applied psychophysiology: Neurofeedback and biofeedback treatments for advances in human performance. West Sussex, UK: Wiley-Blackwell.
Luthe, W. (1979). About the methods of autogenic therapy (pp. 167-186). In E. Peper, S. Ancoli, & M. Quinn, Mind/body integration. New York: Springer.
Luthe, W., & Schultz, J.H. (1969). Autogenic therapy (Vols. 1-6). New York, NY: Grune and Stratton.
Peper, E., Booiman, A., Lin, I-M., & Shaffer, F. (2014a). Making the unaware aware-Surface electromyography to unmask tension and teach awareness. Biofeedback. 42(1), 16-23.
Peper, E., Gibney, K.H. & Holt. C. (2002). Make health happen: Training yourself to create wellness. Dubuque, IA: Kendall-Hunt. ISBN-13: 978-0787293314
Peper, E., Lin, I-M, Harvey, R., Gilbert, M., Gubbala, P., Ratkovich, A., & Fletcher, F. (2014b). Transforming chained behaviors: Case studies of overcoming smoking, eczema and hair pulling (trichotillomania). Biofeedback, 42(4), 154-160.
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
Peper, E. & Williams, E.A. (1980). Autogenic therapy (pp. 131-137). In: A. C. Hastings, J. Fadiman, & J. S. Gordon (Eds.). Health for the whole person. Boulder: Westview Press.
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.
Tseng, C., Abili, R., Peper, E., & Harvey, R. (2016). Reducing acne-stress and an integrated self-healing approach. Poster presented at the 47th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Seattle WA, March 9-12, 2016.
 Adapted from: Peper, E., Miceli, B., & Harvey, R. (2016). Educational Model for Self-healing: Eliminating a Chronic Migraine with Electromyography, Autogenic Training, Posture, and Mindfulness. Biofeedback, 44(3), 130–137. https://biofeedbackhealth.files.wordpress.com/2011/01/a-educational-model-for-self-healing-biofeedback.pdf
Sweating, finger temperature, muscle tension, breathing, heart rate, posture and other body signals covertly and overtly display your emotional state. The feedback from these signals can facilitate awareness and control to promote your health. Watch my presentation, The skin you’re in and other signals “Tells” of emotional state, presented at the TransTech-Transformative Technology Conference, Sofia University, Palo Alto, CA, Oct 14, 2016.
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?
Explore strategies to decrease the drains and increase the energy gains. Use the following exercise to increase your energy:
- 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.
- 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.
- 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
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.