There is Hope! Interrupt Chained Behavior

“I was able to self-heal myself. I didn’t need anyone else to do it for me.”

“I was surprised that I actually succeeded and had some really great results.”

“How much control I really had over being able to change several of my habits, when I previously thought that it was impossible.”

“That I actually have control.”

                                    Students who have practiced stress management at SFSU

This blog summarizes our recent published article that describes a teaching healing approach that can be used by many clients to mobilize their health.  The process is illustrated by a case report student who had suffered from psoriasis for more than five years totally cleared his skin in six weeks and has continued to this benefit (Klein & Peper, 2013).  At the recent one year follow-up his skin is still clear.

Low energy, being tired and depressed,  having pain, insomnia, itching skin, psoriasis, nervously pulling out hair, hypertension and other are symptoms that affects our lives. In many cases there is no identifiable biological cause. Currently, 74% of patients who visit their health care providers have undiagnosed medical conditions. Most of the symptoms are a culmination of stress, anxiety, and depression.  In many cases, health care professionals treat these patients ineffectively with medications instead of offering stress management options. For example, if patients with insomnia visits their physicians, they are most likely prescribed a sleep inducing medication (hypnotics). Patients who take sleeping medication nightly have a fourfold increase in mortality (Kripke et al., 2012).  If on the other hand if the healthcare professional takes time to talk to the patient and explores the factors that contribute to the insomnia and teach sleep hygiene methods, 50s% fewer prescriptions are written. Obviously, you may not be able to sleep if you are worried about money, job security, struggles with your partner or problems with your children; however, medication do  not solve these problems. Learning problem solving and stress management techniques often does!

When students begin to learn these stress management and self-healing skills as part of a semester long Holistic Health Class at San Francisco State University, 82% reported improvement in achieving benefits such as increasing physical fitness, healthier diets, reducing depression, anxiety, pain and eliminating eczema or reducing hair pulling (one student with Trichotillomania reduced her hair pulling from 855 to 19 minutes per week) (Peper et al., 2003; Bier et al., 2005; Ratkovich et al., 2012). The major factors that contributed to the students’ improvement are:

  • Daily monitoring of subjective and objective experiences to facilitates awareness and identify cues that trigger or aggravate the symptoms.
  • Ongoing practicing during the day and during activities of the stress management skills as adapted from the book, Make Health Happen (Peper et al, 2003)
  • Sharing subjective experiences in small groups which reduces social isolation, normalizes experiences, and encourages hope. Usually, a few students will report rapid benefits such as aborting a headache, falling asleep rapidly, or reducing menstrual cramps, which helps motivate other students to continue their practices.
  • Writing an integrative summary paper, which provides a structure to see how emotions, daily practices and change in symptoms are related.

The first step is usually Identifying the trigger that initiates the illness producing patterns. Once identified, the next step is to interrupt the pattern and do something different.  This can include transforming internal dialogue, practicing relaxation or modifying body posture. The mental/emotional and physical practices interrupts and diverts the cascading steps that develop the symptoms (Peper et al., 2003).

Interrupting and transforming the chained behavior is illustrated in our article “There Is Hope: Autogenic Biofeedback Training for the Treatment of Psoriasis” published in the recent issue of Biofeedback. We report on the process by which a 23-year-student totally cleared his skin after having had psoriasis for the last five years. Psoriasis causes red, flaky skin and is currently the most common autoimmune disease affecting approximately 2% of the US population. Many people afflicted with this disease use steroids, topical creams, special shampoos, and prescription medication. Unfortunately, the disease can only be suppressed, not cured.  Thus many people with psoriasis feel damaged and have a difficult time socially. Stress is often one of the triggers that makes psoriasis worse. In this case study, the 23-year-old student learned how to train his mind/body to transform his feelings of stress, anxiety, self-doubt, and urge to scratch his skin into a positive self-healing process.

Initially, the student was trained in stress management and biofeedback techniques that included relaxation, stress reduction, and desensitization. He learned how to increase his confidence by changing his body posture while sitting and standing. He also took time to stop and refocus his energy when he felt the need to fall back into old habits. What did he really do?

The moment he became aware of skin sensations, he would:

  1. Stop, take a deep breath into his abdomen and slowly exhale
  2. Assess how he was thinking-having negative and hopeless thoughts
  3. Change the negative thoughts into positive affirmative thoughts
  4. Breathe deeply
  5. Imagine as he exhaled feeling heaviness and warmth in his arms and feet
  6. Talk to his body by saying, “My skin is cool, clear, and regenerative.” “I am worthy.”

To become aware of his automatic negative behavior was very challenging. He had to stop focusing on the task in front of him and to put all of his energy into regaining his composure. This is very difficult because people are normally captured by whatever they are doing at that moment. As he stated: “Breaking this chain behavior was by far the hardest things I’ve ever done. It didn’t matter what situation I found myself in, my practice took precedence. The level of self- control I had to maintain was far beyond my norm. I remember taking an exam. I was struggling to recall the answer to the last essay question. All I wanted to do was finish the exam and go home. I knew that I knew it, it was coming to me, I began to write… Yet in that same moment I felt my right elbow start to tingle (the location of one of the psoriasis plagues) and my left hand started to drift towards it. Immediately I had to switch my focus. Despite my desire to finish I dropped my pen. I paused to breathe and focused upon my positive thoughts. Moments like this happened daily, my normal functions were routinely interrupted by urges to scratch. Sometimes I would spend significantly more time doing the practices than the task at hand.

Similarly, whenever he observed his body posture “collapsing” and “hiding” — thus falling into a more powerless posture — he would interrupt the collapse and shift to a power position by expanding and being more erect.  He did this while standing, sitting, and talking to other students. As he stated: “I hadn’t realized how my collapsing posture was effecting my self-image until I began practicing a more powerful posture. In class I made myself sit with my butt pushed back against the back of the chair instead of letting myself slide forwarding into a slouch. Just like the urge to itch I had to stay conscious of my posture constantly.  At work, at school, even at home on the couch I practiced expanding body posture. The more I was aware of my posture the better my posture became, and the more time I spent in power pose the more natural it began to feel. The more natural it felt the more powerful I felt.”

After three weeks, his skin had cleared and has continued to stay this way for the last year as shown in Figure 1.

Figure 2 elbow and knee croppedFigure 1. Pre and post photos of the elbow and knee showing the improvement of the skin.

There are many diseases and ailments that require the use of medication for appropriate treatment, but when stress is a factor in any diagnosis, or when a diagnosis cannot be found, it is important for stress management to be offered as a viable option for patients to consider. As shown by the student with psoriasis, learning stress management skills and then actually practicing them during the day can play a major factor in improving the health of an individual. The same process is applicable for numerous symptoms. There is hope=-Just do it.


Bier, M., Peper, E., & Burke, A. (2005). Integrated stress management with ‘Make Health Happen: Measuring the impact through a 5-month follow-up. Presented at the 36th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract published in: Applied Psychophysiology and Biofeedback, 30(4), 400.

Klein, A. & Peper, W. (2013). There is Hope: Autogenic Biofeedback Training for the Treatment of Psoriasis. Biofeedback, 41(4), 194–201.

Kripke, D.F., Langer, R.D., Kline. L.E. (2012). Hypnotics’association with mortality or cancer: a matched cohort study. BMJOpen, 2:e000850. doi:10.1136/bmjopen-2012-000850

Peper, E., Gibney, K.H. & Holt. C. (2002).  Make Health Happen: Training Yourself to Create Wellness.  Dubuque, IA: Kendall-Hunt.

Peper, E., Sato-Perry, K & Gibney, K. H. (2003). Achieving health: A 14-session structured stress management program—Eczema as a case illustration. 34rd Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract in: Applied Psychophysiology and Biofeedback, 28(4), 308.

Ratkovich, A., Fletcher, L., Peper, E., & Harvey, R. (2012). Improving College Students’ Health-Including Stopping Smoking and Healing Eczema. Presented at the 43st Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Baltimore, MD.