Freeing the neck and shoulders*

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.

 

Figure 1Figures 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.

Figure 2Figures 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

References:

Blatter, B. M., & Kraker, H. D. (2005). Prevalentiecijfers van RSI-klachten en het vóórkomen van risicofactoren in 15 Europese landen. Tijdschrift voor gezondheidswetenschappen, 1, 83, 8-15.  

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.

Cohen, S. P. (2015, February). Epidemiology, diagnosis, and treatment of neck pain. In Mayo Clinic Proceedings (Vol. 90, No. 2, pp. 284-299). Elsevier. 

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 Association47(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.

European Agency for Safety and Health at Work (2004). http://europa.eu.int/comm/employment_social/news/2004/nov/musculoskeletaldisorders_en.html

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

Hakala, P., Rimpelä, A., Salminen, J. J., Virtanen, S. M., & Rimpelä, M. (2002). Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. Bmj325(7367), 743.

Hanna, T. (2004). Somatics-Reawakening The Mind’s Control Of Movement, Flexibility, And Health Boston: Da Capo Press.

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 diseases13(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.

Peper, E. & Harvey, R. (2008). From technostress to technohealth.  Japanese Journal of Biofeedback Research, 35(2), 107-114.

*I thank Sue Wilson and Servaas Mes for teaching me these somatic practices.


How to stay safe when pulled over by the police

An officer and suspect interaction is fraught with danger especially if the police anticipate DANGER. The interaction may trigger an evolutionary based defense reaction that may mean that our analytical reflective thinking fades out and we focus only on immediate survival.  You may interpret any cues as potentially dangerous and that your life could be in danger. At that point the information is not processed rationally; since, it reaches the  amygdala 22 milliseconds faster than to the cortex where thinking would take place.  You react instead of act!

amygdala cortex.jpg

Adapted from: Ropeik, D. (2011). How Risky  Is It, Really? Why our fears don’t always match the facts. New York: McGraw Hill

We all have experienced this automatic response.  Remember when you were pissed off and angry at a close family member or friend? In the heat of the argument (or was it the battle for survival?), you said something that was cruel and painful–a real zinger.  As the words left your mouth, you realized that you should not have said what you said. You wished you could reel the words back. Immediately you know that this would be very difficult to repair. At that moment, you reacted in self-defense from the amygdala before the cortex was aware.

Similarly, an officer and you may react automatically without thinking when they perceive personal danger. How you behave and move could automatically signal DANGER or SAFETY to the officer .  To deescalate the situation when stopped by the police, behave in a way that signals to the officers that you are NOT a danger to them.

I highly recommend the short YouTube video by country singer, Coffey Anderson, Stop the Violence Safety Video for when you get pulled over by the Police. They share, what to do actually when you get pulled over by the police? It offers strategies to help diffuse tension at traffic stop, it gives solid steps into ways of staying safe, and getting home. SHARE this. It’s a must for all to see. If you have the opportunity, role-play the situation with your friends so that it becomes your new automatic response.

The video is on YouYube: https://www.youtube.com/watch?v=MnoLAtu0Wjk

 

 

 

 


Triumph and failure of medicine: When Breath Becomes Air by Paul Kalanithi

When Breath Becomes a remarkable first-person memoir by neurosurgeon Paul Kalanithi that follows his transformation from being an outstanding neurosurgeon and scientist to being a patient diagnosed with stage lV lung cancer. It shares in detail the challenges of the patient doctor relationship and the eventuality of facing death. It is a must book to read to understand the intense training that physicians undergo to reach the top of their profession. It also explores in detail the challenges facing patients and all of us when death stares us in the face.

When Breath becomes air

Dr. Kalanithi’s drive was to be the preeminent neurosurgeon and scientist.  When diagnosed with stage IV cancer, he receives the best scientific treatment at Stanford University Medical Center. His stellar treatment also illustrates medicine’s disregard of the healing process and how  the patient may contribute to his own healing process.  Even though the initial diagnosis appeared hopeless; nevertheless, he responded well to the cancer treatment. It is at this point the superb scientific Western medical approach  failed him. The failure was the medical culture of the hospital, his oncologists, and most importantly his own lack of somatic awareness. He did not listen to his own body crying out: “I am exhausted.”

When reading the book, I was shocked to realize how little he appeared to appreciate factors that suppressed the immune system.  He continued to be stressed to the extreme through working, working and working. After the initial recovery, he went back to the same pattern which had preceded the initial illness instead of respecting the biological regeneration process so that he could support the recovery of his immune system. He totally focused on performing surgery without listen to the needs of his own body.

When he initially  recovered from the cancer after the disease had regressed, he decided, “I would push myself to return to the OR (operating room). Why? Because I could.” After a month, he was again operating at nearly a full load. As he stated almost every evening he ended his days “exhausted beyond measure, muscle on fire, Coming home each night, I would scarf down a handful of pain pills, then crawl into bed.”

He was dedicated to his career and patient care. However, he did not listen to his own exhaustion. When reading this part in the book, I sadly predicted that his cancer would return with vengeance and that he would die. Although there are many causes of cancer and many treatments, in the end one component that may facilitate surviving cancer is the patient supporting his own functional immune system

Why was this brilliant neurosurgeon, his colleagues, and his physicians, so disconnected from common sense? After trauma ,the body needs time to regenerate and recover. Having meaningful work and relationships is important; however, pushing yourself to exhaustion in pursuit of professional is a prescription for illness.

Whatever happened to the well documented knowledge that ongoing excessive stress without time to regenerate is a predictable risk factor for illness and even death? High stress is associated with poorer survival in patients with cancer. (Chida et al, 2008; Denaro et, 2014). How come the medical staff was unaware of the concept of “Karoshi” a Japanese word invented in 1978 which means death from overwork (International Labor Organization, 2013).

Possibly, this disconnect from common sense is embedded in medical training in which residents and interns work 24 hours or longer shifts. With the drive and pride to perform at any time, medical staff are trained to disregard the signals of their own body.  One cannot burn the midnight oil indefinitely with incurring consequences. Do we really want our doctors, those to whom we entrust our very lives, living and working on the knife-edge of exhaustion?

Possible medicine need to encourage and support common sense such as a regular life style, exercise, healthy diet, and social support (see the book Fighting Cancer by Robert Gorter and Erik Peper, 2011).  I hope that by reading Dr. Kalanithi’s remarkable book, it will encourage you to listen to yourself and nurture the self-healing potential of the body. Hopefully, the future medical prescription, instead of offering  high technology and pharmaceutical solutions, will also respect and support the intrinsic self-healing processes of the body. Possibly the future prescription will read: have 8 hours sleep, take time to regenerate, learn relaxation skills, have regular meals, and nurture social connections.

References:

Case Study: Karoshi: Death from overwork (2013). International Labour Organization. http://www.ilo.org/safework/info/publications/WCMS_211571/lang–en/index.htm

Chida, Y., Hamer, M., Wardle, J., & Steptoe, A. (2008). Do stress-related psychosocial factors contribute to cancer incidence and survival?. Nature clinical practice Oncology, 5(8), 466-475.

Denaro, N., Tomasello, L., & Russi, E. G. (2014). Cancer and stress: what’s matter? from epidemiology: the psychologist and oncologist point of view. journal of cancer therapeutics and research, 3(1), 6.

Gorter, R. & Peper, E. (2011). Fighting Cancer-A None Toxic Approach to Treatment. Berkeley: North Atlantic. ISBN: 978-1583942482

Kalanithi, P. (2016). When Breath Becomes Air. New York: Random House http://www.amazon.com/When-Breath-Becomes-Paul-Kalanithi/dp/081298840X/ref=sr_1_1?s=books&ie=UTF8&qid=1462475949&sr=1-1&keywords=when+breath+becomes+air

 


Do medications work as promised? Ask questions!

Medications can be beneficial and safe lives; however, some may not work as well as promised. In some cases,  they may do more harm than good as illustrated by the following examples.

  • There is weak or no evidence of effectiveness for the long term use of any opiod (morphine, fentanyl, oxycodone, methadone and hydrocodone) in the treatment of chronic pain (Perlin, 2015). As the Center for Disease Control and Prevention reports, “Since 1999, the amount of prescription painkillers prescribed and sold in the U.S. has nearly quadrupled, yet there has not been an overall change in the amount of pain that Americans report. Over prescribing leads to more abuse and more overdose deaths.” More than 16,000 people a year die from prescription drug overdose (CDC, 2016). For a superb discussion of the treatment of chronic pain, see the recently published book by Cindy Perlin, The truth about chronic pain treatments.
  • Selective serotonin re-uptake inhibitor such as Paxil and Prozac (SSRI) are much less effective than promised by pharmaceutical companies. When independent researchers (not funded by pharmaceutical companies) re-analyzed the data from published and unpublished the studies, they found that the medication was no more effective than the placebo for the treatment of mild and moderate depression (Ioannidis, 2008; Le Noury et al, 2015). In addition, the SSRIs (paroxetine and Imipramine) in treatment of unipolar major depression in adolescence may cause significant harm which outweigh any possible benefits (Le Le Noury et al., 2015). On the other had, exercise appears as effective as antidepressants for reducing symptoms of mild to moderate depression (Cooney et al., 2013). Despite the questionable benefits of SSRI medications,  pharmaceutic industry to posted $11.9 billion dollars in 2011 global sales (Perlin, 2015).

When medications are recommended, ask your provider the following questions (Robin, 1984; Gorter & Peper, 2011).

  • Why are you prescribing the medication?
  • What are the risks and negative side effects?
  • Do the benefits outweigh the risks?
  • How do I know when the medication is working?
  • What will you do if the medication does not work?
  • How many patients do you need to treat before one patient benefits?
  • Can you recommend non-pharmaceutical options?

The important questions to ask are:

  • How many patients need to be treated with the medication before one patient benefits?
  • How many will experience negative side effects?

The data can be discouraging. As Daniel Levitin, neuroscientist at McGill University in Montreal and Dean at Minerva Schools in San Francisco, points out, it takes 300 people to take statins for one year before one heart attack, stroke or other serious event is prevented. However, 5% of all the people taken statins (the of drug of choice to lower cholesterol) will experience debilitating adverse effects such as severe muscle pain and gastrointestinal disorders. This means that you are 15 times more likely to suffer serious side effect than being helped by the drug. Nevertheless, the CDC reported that during 2011–2012, more than one-quarter (27.9%) of adults aged 40 and over used a prescription cholesterol-lowering medication (statins) (Gu, 2014).

Before making any medical decision when stressed, watch the superb 2015 TED London presentation by neuroscientist Daniel Levitin, How to think about making a decision under stress.

Reference:

CDC Center for Disease Control and Prevention (2016). Injury prevention & control: Prescription drug overdose. http://www.cdc.gov/drugoverdose/

Cooney, G.M., Dwan, K., Greig, C.A., Lawlor, D.A, Rimer, J., Waugh, F.R., McMurdo, M., & Mead, G. E.(2013). Exercise for depression. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub6.The Cochrane Library. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004366.pub6/epdf

Goter, R. & Peper, E. (2011). Fighting cancer: A nontoxic approach to treatment. Berkeley, CA: Noreth Atlantic Books.http://www.amazon.com/Fighting-Cancer-Nontoxic-Approach-Treatment/dp/1583942483/ref=sr_1_2_twi_pap_2?ie=UTF8&qid=1452715134&sr=8-2&keywords=gorter+and+peper

Gu, Q., Paulose-Ram, R., Burt, V.L., & Kit, B.K. (2014).Prescription Cholesterol-Lowering Medication Use in Adults Aged 40 and Over: United States, 2003–2012. NCHS Data Brief No. 177. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Health Statistics.http://www.cdc.gov/nchs/data/databriefs/db177.pdf

Ioannidis, J. P. (2008). Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?. Philosophy, Ethics, and Humanities in Medicine, 3(1), 14. http://peh-med.biomedcentral.com/articles/10.1186/1747-5341-3-14

Le Noury, J., Nardo, J. M., Healy, D., Jureidini, J., Raven, M., Tufanaru, C., & Abi-Jaoude, E. (2015). Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. http://www.bmj.com/content/351/bmj.h4320.full

Levitin, D. (2015). How to stay calm when you know you’ be stressed. TEDGlobal London Talk http://www.ted.com/talks/daniel_levitin_how_to_stay_calm_when_you_know_you_ll_be_stressed

Perlin, C. (2015). The truth about chronic pain treatments. Delmar, NY: Morning Light Books, LLC. http://www.amazon.com/gp/product/B0160UEQB2/ref=dp-kindle-redirect?ie=UTF8&btkr=1

Robin, E.D. (1984). Matters of life & death: Risks vs. benefits of medical care. New York: W.H. Freeman and Company. http://www.amazon.com/Matters-Life-Death-Benefits-Medical/dp/071671681X/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=

 

 

 


Porges and Peper Propose Physiological Basis for Paralysis as Reaction to Date Rape

Paralysis Can Be a Natural Reaction to Date rape

This is the press release for my recently published article in the journal, Biofeedback, coauthored with Stephen Porges,

Stigma is often associated with inaction during a crisis. Those who freeze in the face of a life-threatening situation often experience feelings of shame and guilt, and they often feel that they are constantly being judged for their inaction. While others may confidently assert that they would have been more “heroic” in that situation, there is a far greater chance that their bodies would have reacted in exactly the same way, freezing as an innate part of self-preservation.

Stephen Porges and Erik Peper describe how immobilization is a natural neurobiological response to being attacked as can occur during date rape.in the article titled “When Not Saying NO Does Not Mean Yes: Psychophysiological Factors Involved in Date Rape,” published in the journal Biofeedback .

The article explains the immobilization response in light of the polyvagal theory, which Porges introduced about 20 years ago. According to this theory, the brain reacts to various risk situations in three ways: The situation is safe, the situation is dangerous, or the situation is life-threatening. After our brain identifies risk, our body reacts either with a fight-or-flight response or, especially in dire situations, can become completely immobilized. The likelihood of an immobilization response increases when the person is physically restrained or is in a confined environment. Immobilization is also often accompanied by a higher pain threshold and a tendency to disassociate.

In the case of rape, it is often assumed that the victim should simply have said No, should have fought back, or should have made it clear that the sexual attention was unwanted. However, the more we learn about the brain’s response to extreme threats, the more we realize that it may be difficult to recruit the neural circuits necessary to verbally express oneself or to fight or flee, especially when drugs or alcohol are involved. Instead, it is a natural response for victims to freeze, to feel so physically threatened that their own body will not allow them to fight or flee.

Porges and Peper note that polyvagal theory supports a law passed in California in September 2014. The new law requires the governing boards of the state’s colleges and universities to adopt policies and procedures that require students who engage in sexual activity to obtain “affirmative, unambiguous, and conscious decision by each participant.” In other words, simply not saying No will no longer be tolerated as an excuse for rape.

The article conclude that victims of date rape should not feel shame or guilt if they froze in that situation. The body’s natural defense reactions are not just flight or fight; sometimes it is complete immobilization.

The authors hope that recognizing this will help people deal with trauma and help those around them understand their experiences. After a lecture, one of the authors, Peper, had a profound experience when a student came up to him with tears in her eyes. She explained that the same immobilization process happened to her two weeks before when she was robbed and she had felt so guilty.` Just listening to her made the efforts of writing the article worthwhile.”

Full text of the article, “When Not Saying NO Does Not Mean Yes: Psychophysiological Factors Involved in Date Rape,” Biofeedback, Vol. 43, No. 1, 2015, is available at https://biofeedbackhealth.files.wordpress.com/2011/01/porges-and-peper-date-rape.pdf

About the journal Biofeedback

Biofeedback is published four times per year and distributed by the Association for Applied Psychophysiology and Biofeedback. The chief editor of Biofeedback is Donald Moss, Dean of Saybrook University’s School of Mind-Body Medicine. AAPB’s mission is to advance the development, dissemination, and utilization of knowledge about applied psychophysiology and biofeedback to improve health and the quality of life through research, education, and practice.

Media Contact:

Bridget Lamb
Allen Press, Inc.
800/627-0326 ext. 248
blamb@allenpress.com


What do numbers mean? How much does Walmart’s wage raise affect profits?

cartoonWalmart created  news when it announced that it will be paying its 500,000 employees more than the minimum wage. The largest increase would be an increase of the entry-level wage from the US minimum  $7.25 to $9 an hour; howver, the overall increase in minimal. As Jody Knauss and Mary Bottari point out, The company forecasts the average hourly wage for full-time workers to rise 15 cents an hour, from $12.85 to $13.00, while the average for part-timers will bump up from $9.48 to $10.00 per hour. This will still still leave most of its workers beneath the poverty level and relying on food stamps to make ends meet.

The actual cost of this wage raise for Walmart is one billion dollars.  This seems impressive; however, this number is not meaningful without knowing the financial state of the company. The company’s estimated profit for 2014 was  $16.36 billion on annual sales of $485 Billion.  For more details see the Walmart’s financial summary.

The one billion dollars to increase the salaries is an impressive sound bite, but it only a 6.1% decreases the company’s profits.  It will still leave more than 15 billion dollar in profit and more than 150 billion dollar wealth for its owners.  Given the profits and wealth, Walmart should be ashamed to keep its employees in poverty. It should offer its employees an actually living wage of at least $15 per hour.

 

 


Reduce hot flashes and premenstrual symptoms with breathing

After the first week to my astonishment, I have fewer hot flashes and they bother me less. Each time I feel the warmth coming, I breathe out slowly and gently. To my surprise they are less intense and are much less frequent. I keep breathing slowly throughout the day. This is quite a surprise because I was referred for biofeedback training because of headaches that occurred after getting a large electrical shock. After 5 sessions my headaches have decreased and I can control them, and my hot flashes have decreased from 3-4 per day to 1-2 per week.                           -50 year old client

After students in my Holistic Health class at San Francisco State University practiced slower diaphragmatic breathing and begun to change their dysfunctional shallow breathing, gasping, sighing, and breath holding to diaphragmatic breathing. A number of the older female students students reported that their hot flashes decreased.  Some of  the younger female students reported  that their  menstrual cramps and discomfort were reduced by 80 to 90%  when they laid down and breathed slower and lower into their abdomen.

HF slidesThe recent  study in JAMA reported that many women continue to experience menopausal triggered hot flashes for up to  14 years. Although the article described the frequency and possible factors that were associated with the prolonged hot flashes, it did not offer helpful solutions.

Yet, there is hope besides hormone replacement therapy (HRT) for women who suffer from hot flashes during menopause. The general accepted hypothesis that the drop in estrogen triggers hot flashes is incomplete.  If lowering of estrogen was the main culprit then all older post-menopausal women should have more and more hot flashes–they do not!  And, all women going through menopause should suffer; however, 20% of women go through menopause without much discomfort and very few hot flashes.

Another understanding of the dynamics of hot flashes is that the decrease in estrogen  accentuates the sympathetic/ parasympathetic imbalances that probably already existed.  Then any increase in sympathetic activation can trigger a hot flash. In many cases the triggers are events and thoughts that trigger a stress response, emotional responses such as anger, anxiety, or worry, increase caffeine intake and especially shallow chest breathing punctuated with sighs. Approximately 80% of American women tend to breathe thoracically  often punctuated with sighs and these women are more likely to experience hot flashes.  On the other hand, the 20% of women who habitually breathe diaphragmatically tend to have fewer and less intense hot flashes and often go through menopause without any discomfort.  In the superb study Drs. Freedman and Woodward (1992), taught women  who experience hot flashes to breathe  slowly and diaphragmatically which increased their heart rate variability as an indicator of sympathetic/parasympathetic balance and most importantly it reduced the the frequency and intensity of hot flashes by 50%.

Test  the breathing connection if you experience hot flashes

Take a breath into your chest and rapidly exhale with a sigh. Repeat this quickly five times.  In most cases, one minute later you will experience the beginning sensations of a hot flash.   Similarly, when you practice slow diaphragmatic breathing throughout the day and interrupt every gasp, breath holding moment, sigh or shallow chest breathing with slower diaphragmatic breathing, you will experience a significant reduction in hot flashes.

Although this breathing approach has been well documented, many people are unaware of this simple behavioral approach unlike the common recommendation for the hormone replacement therapies (HRT) to ameliorate menopausal symptoms. This is not surprising since pharmaceutical companies spent  nearly five billion dollars per year  in direct to consumer advertising for drugs and very little money is spent on advertising behavioral treatments. There is no profit for pharmaceutical companies teaching effortless diaphragmatic breathing unlike prescribing HRTs. In addition, teaching and practicing diaphragmatic breathing takes skill training and practice time–time which is not reimbursable by third party payers.

For more information, research data and breathing skills to reduce hot flash intensity,  see our article which is reprinted below.

Gibney, H.K. & Peper, E. (2003). Taking control: Strategies to reduce hot flashes and premenstrual mood swings. Biofeedback, 31(3), 20-24.

Taking control: Strategies to reduce hot flashes and premenstrual mood swings*

Erik Peper, Ph.D**., and Katherine H. Gibney

San Francisco State University

After the first week to my astonishment, I have fewer hot flashes and they bother me less. Each time I feel the warmth coming, I breathe out slowly and gently. To my surprise they are less intense and are much less frequent. I keep breathing slowly throughout the day. This is quite a surprise because I was referred for biofeedback training because of headaches that occurred after getting a large electrical shock. After 5 sessions my headaches have decreased and I can control them, and my hot flashes have decreased from 3-4 per day to 1-2 per week.    -50 year old client

For the first time in years, I experienced control over my premenstrual mood swings. Each time I could feel myself reacting, I relaxed, did my autogenic training and breathing. I exhaled. It brought me back to center and calmness.    -26 year old student

Abstract

Women have been troubled by hot flashes and premenstrual syndrome for ages. Hormone replacement therapy, historically the most common treatment for hot flashes, and other pharmacological approaches for pre-menstrual syndrome (PMS) appear now to be harmful and may not produce significant benefits. This paper reports on a model treatment approach based upon the early research of Freedman & Woodward to reduce hot flashes and PMS using biofeedback training of diaphragmatic breathing, relaxation, and respiratory sinus arrhythmia. Successful symptom reduction is contingent upon lowering sympathetic arousal utilizing slow breathing in response to stressors and somatic changes. We strongly recommend that effortless diaphragmatic breathing be taught as the first step to reduce hot flashes and PMS symptoms.

A long and uncomfortable history

Women have been troubled by hot flashes and premenstrual syndrome for ages. Hot flashes often result in red faces, sweating bodies, and noticeable and embarrassing discomfort. They come in the middle of meetings, in the middle of the night, and in the middle of romantic interludes. Premenstrual syndrome also arrives without notice, bringing such symptoms as severe mood swings, anger, crying, and depression.

Hormone replacement therapy (HRT) was the most common treatment for hot flashes for decades. However, recent randomized controlled trials show that the benefits of HRT are less than previously thought and the risks—especially of invasive breast cancer, coronary artery disease, dementia, stroke and venous thromboembolism—are greater (Humphries & Gill, 2003; Shumaker, et al, 2003; Wassertheil-Smoller, et al, 2003). In addition, there is no evidence of increased quality of life improvements (general health, vitality, mental health, depressive symptoms, or sexual satisfaction) as claimed for HRT (Hays et al, 2003).

“As a result of recent studies, we know that hormone therapy should not be used to prevent heart disease. These studies also report an increased risk of heart attack, stroke, breast cancer, blood clots, and dementia…”  -Wyeth Pharmaceuticals (2003)

Because of the increased long-term risk and lack of benefit, many physicians are weaning women off HRT at a time when the largest population of maturing women in history (‘baby boomers’) is entering menopausal years. The desire to find a reliable remedy for hot flashes is on the front burner of many researchers’ minds, not to mention the minds of women suffering from these ‘uncontrollable’ power surges. Yet, many women are becoming increasingly leery of the view that menopause is an illness. There is a rising demand to find a natural remedy for this natural stage in women’s health and development.

For younger women a similar dilemma occurs when they seek treatment of discomfort associated with their menstrual cycle. Is premenstrual syndrome (PMS) just a natural variation in energy and mood levels? Or, are women expected to adapt to a masculine based environment that requires them to override the natural tendency to perform in rhythm with their own psychophysiological states? Instead of perceiving menstruation as a natural occurrence in which one has different moods and/or energy levels, women in our society are required to perform at the status quo, which may contribute to PMS. The feelings and mood changes are quickly labeled as pathology that can only be treated with medication.

Traditionally, premenstrual syndrome is treated with pharmaceuticals, such as birth control pills or Danazol. Although medications may alleviate some symptoms, many women experience unpleasant side effects, such as bloating or acne, and still experience a variety of PMS symptoms. Many cannot tolerate the medications. Thus, millions of women (and families) suffer monthly bouts of ‘uncontrollable’ PMS symptoms

For both hot flashes and PMS the biomedical model tends to frame the symptoms as a “structural biological problem.” Namely, the pathology occurs because the body is either lacking in, or has an excess of, some hormone. All that needs to be done is either augment or suppress hormones/symptoms with some form of drug. Recently, for example, medicine has turned to antidepressant medications to address menopausal hot flashes (Stearns, Beebe, Iyengar, & Dube, 2003).

The biomedical model, however, is only one perspective. The opposite perspective is that the dysfunction occurs because of how we use ourselves. Use in this sense means our thoughts, emotions and body patterns. As we use ourselves, we change our physiology and, thereby, may affect and slowly change the predisposing and maintaining factors that contribute to our dysfunction. By changing our use, we may reduce the constraints that limit the expression of the self-healing potential that is intrinsic in each person.

The intrinsic power of self-healing is easily observed when we cut our finger. Without the individual having to do anything, the small cut bleeds, clotting begin and tissue healing is activated. Obviously, we can interfere with the healing process, such as when we scrape the scab, rub dirt in the wound, reduce blood flow to the tissue or feel anxious or afraid. Conversely, cleaning the wound, increasing blood flow to the area, and feeling “safe” and relaxed can promote healing. Healing is a dynamic process in which both structure and use continuously affect each other. It is highly likely that menopausal hot flashes and PMS mood swings are equally an interaction of the biological structure (hormone levels) and the use factor (sympathetic/parasympathetic activation).

Uncontrollable or overly aroused?

Are the hot flashes and PMS mood swings really ‘uncontrollable?’ From a physiological perspective, hot flashes are increased by sympathetic arousal. When the sympathetic system is activated, whether by medication or by emotions, hot flashes increase and similarly, when sympathetic activity decreases hot flashes decrease. Equally, PMS, with its strong mood swings, is aggravated by sympathetic arousal. There are many self-management approaches that can be mastered to change and reduce sympathetic arousal, such as breathing, meditation, behavioral cognitive therapy, and relaxation.

Breathing patterns are closely associated with hot flashes. During sleep, a sigh generally occurs one minute before a hot flash as reported by Freedman and Woodward (1992). Women who habitually breathe thoracically (in the chest) report much more discomfort and hot flashes than women who habitually breathe diaphragmatically. Freedman, Woodward, Brown, Javaid, and Pandey (1995) and Freedman and Woodward (1992) found that hot flash rates during menopause decreased in women who practiced slower breathing for two weeks. In their studies, the control groups received alpha electroencephalographic feedback and did not benefit from a reduction of hot flashes. Those who received training in paced breathing reduced the frequency of their hot flashes by 50% when they practiced slower breathing. This data suggest that the slower breathing has a significant effect on the sympathetic and parasympathetic balance.

Women with PMS appear similarly able to reduce their discomfort. An early study utilizing Autogenic Training (AT) combined with an emphasis on warming the lower abdomen resulted in women noting improvement in dysfunctional bleeding (Luthe & Schultz, 1969, pp. 144-148). Using a similar approach, Mathew, Claghorn, Largen, and Dobbins (1979) and Dewit (1981) found that biofeedback temperature training was helpful in reducing PMS symptoms.. A later study by Goodale, Domar, and Benson (1990) found that women with severe PMS symptoms who practiced the relaxation response reported a 58% improvement in overall symptomatology as compared to a 27.2% improvement for the reading control group and a 17.0% improvement for the charting group.

Teaching control and achieving results

Teaching women to breathe effortlessly can lead to positive results and an enhanced sense of control. By effortless breathing, the authors refer to their approach to breath training, which involves a slow, comfortable respiration, larger volume of air exchange, and a reliance upon action of the muscles of the diaphragm rather than the chest (Peper, 1990). For more instructions see  the recent blog, A breath of fresh air: Improve health with breathing.

Slowing breathing helps to limit the sighs common to rapid thoracic breathing—sighs that often precede menopausal hot flashes. Effortless breathing is associated with stress reduction—stress and mood swings are common concerns of women suffering from PMS. In a pilot study Bier, Kazarian, Peper, and Gibney (2003) at San Francisco State University (SFSU) observed that when the subject practiced diaphragmatic breathing throughout the month, combined with Autogenic Training, her premenstrual psychological symptoms (anger, depressed mood, crying) and premenstrual responses to stressors were significantly reduced as shown in Figure 1.

Presentation1

Figure 1. Student’s Individual Subjective Rating in Response to PMS Symptoms.

In another pilot study at SFSU, Frobish, Peper, and Gibney (2003) trained a volunteer who suffered from frequent hot flashes to breathe diaphragmatically. The training goals included modifying breathing patterns, producing a Respiratory Sinus Arrhythmia (RSA), and peripheral hand warming. RSA refers to a pattern of slow, regular breathing during which variations in heart rate enter into a synchrony with the respiration. Each inspiration is accompanied by an increase in heart rate, and each expiration is accompanied by a decrease in heart rate (with some phase differences depending on the rate of breathing). The presence of the RSA pattern is an indication of optimal balance between sympathetic and parasympathetic nervous activity.

During the 11-day study period, the subject charted the occurrence of hot flashes and noted a significant decrease by day 5. However, on the evening of day 7 she sprained her ankle and experienced a dramatic increase in hot flashes on day 8. Once the subject recognized her stress response, she focused more on breathing and was able to reduce the flashes as shown in Figure 2. Presentation2

Figure 2. Subjective rating of intensity, frequency and bothersomeness of hot flashes. The increase in hot flashes coincided with increased frustration about an ankle injury.

Our clinical experience confirms the SFSU pilot studies and the previously referenced research by Freedman and Woodward (1992) and Freedman et al. (1995). When arousal is lowered and breathing is effortless, women are better able to cope with stress and report a reduction in symptoms. Habitual rapid thoracic breathing tends to increase arousal while slower breathing, especially slower exhalation, tends to relax and reduce arousal.   Learning and then applying effortless breathing reduces excessive sympathetic arousal. It also interrupts the cycle of cognitive activation, anxiety, and somatic arousal. The anticipation and frustration at having hot flashes becomes the cue to shift attention and “breathe slower and lower.” This process stops the cognitively mediated self-activation.

Successful self-regulation and the return to health begin with cognitive reframing: We are not only a genetic biological fixed (deficient) structure but also a dynamic changing system in which all parts (thoughts, emotions, behavior, diet, stress, and physiology) affect and are effected by each other. Within this dynamic changing system, there is an opportunity to implement and practice behaviors and life patterns that promote health.

Learning Diaphragmatic Breathing with and without Biofeedback

Although there are many strategies to modify respiration, biofeedback monitoring combined with respiration training is very useful as it provides real-time feedback. Chest and abdominal movement are recorded with strain gauges and heart rate can be monitored either by an electrocardiogram (EKG) or by a photoplethysmograph sensor on a finger or thumb. Peripheral temperature and electrodermal activity (EDA) biofeedback are also helpful in training. The training focuses on teaching effortless diaphragmatic breathing and encouraging the participant to practice many times during the day, especially when becoming aware of the first sensations of discomfort.

Learning and integrating effortless diaphragmatic breathing into daily life is one of the biofeedback strategies that has been successfully used as a primary or adjunctive/complementary tool for the reversal of disorders such as hypertension, migraine headaches, repetitive strain injury, pain, asthma and anxiety (Schwartz & Andrasik, 2003), as well as hot flashes and PMS.

The biofeedback monitoring provides the trainer with a valuable tool to:

  1. Observe & identify: Dysfunctional rapid thoracic breathing patterns, especially in response to stressors, are clearly displayed in real-time feedback.
  2. Demonstrate & train: The physiological feedback display helps the person see that she is breathing rapidly and shallowly in her chest with episodic sighs. Coaching with feedback helps her to change her breathing pattern to one that promotes a more balanced homeostasis.
  3. Motivate, persuade and change beliefs: The person observes her breathing patterns change concurrently with a felt shift in physiology, such as a decrease in irritability, or an increase in peripheral temperature, or a reduction in the incidence of hot flushes. Thus, she has a confirmation of the importance of breathing diaphragmatically.

In addition, we suggest exercises that integrate verbal and kinesthetic instructions, such as the following: “Exhale gently,” and “Breathe down your leg with a partner.”

Exhale Gently:

Imagine that you are holding a baby. Now with your shoulders relaxed, inhale gently so that your abdomen widens. Then as you exhale, purse your lips and very gently and softly blow over the baby’s hair. Allow your abdomen to narrow when exhaling. Blow so softly that the baby’s hair barely moves. At the same time, imagine that you can allow your breath to flow down and through your legs. Continue imagining that you are gently blowing on the baby’s hair while feeling your breath flowing down your legs. Keep blowing very softly and continuously.

Practice exhaling like this the moment that you feel any sensation associated with hot flashes or PMS symptoms. Smile sweetly as you exhale.

Breathe Down Your Legs with a Partner

Sit or lie comfortably with your feet a shoulder width apart. As you exhale softly whisper the sound “Haaaaa….” Or, very gently press your tongue to your pallet and exhale while making a very soft hissing sound.

Have your partner touch the side of your thighs. As you exhale have your partner stroke down your thighs to your feet and beyond, stroking in rhythm with your exhalation. Do not rush. Apply gentle pressure with the stroking. Do this for four or five breaths.

Now, continue breathing as you imagine your breath flowing through your legs and out your feet.

During the day remember the feeling of your breath flowing downward through your legs and out your feet as you exhale.

Learning Strategies in Biofeedback Assisted Breath Training

Common learning strategies that are associated with the more successful amelioration of hot flashes and PMS include:

  1. Master effortless diaphragmatic breathing, and concurrently increase respiratory sinus arrhythmia (RSA). Instead of breathing rapidly, such as at 18 breaths per minute, the person learns to breathe effortlessly and slowly (about 6 to 8 breaths per minute). This slower breathing and increased RSA is an indication of sympathetic-parasympathetic balance as shown in Figure 3.
  2. Practice slow effortless diaphragmatic breathing many times during the day and, especially in response to stressors.
  3. Use the physical or emotional sensations of a hot flash or mood alteration as the cue to exhale, let go of anxiety, breathe diaphragmatically and relax.
  4. Reframe thoughts by accepting the physiological processes of menstruation or menopause, and refocus the mind on positive thoughts, and breathing rhythmically.
  5. Change one’s lifestyle and allow personal schedules to flow in better balance with individual, dynamic energy levels. Presentation3Figure 3. Physiological Recordings of a Participant with PMS. This subject learned effortless diaphragmatic breathing by the fifth session and experienced a significant decrease in symptoms.

Generalizing skills and interrupting the pattern

The limits of self-regulation are unknown, often held back only by the practitioner’s and participant’s beliefs. Biofeedback is a powerful self-regulation tool for individuals to observe and modify their covert physiological reactions. Other skills that augment diaphragmatic breathing are Quieting Reflex (Stroebel, 1982), Autogenic Training (Schultz & Luthe, 1969), and mindfulness training (Kabat-Zinn, 1990). In all skill learning, generalization is a fundamental factor underlying successful training. Integrating the learned psychophysiological skills into daily life can significantly improve health—especially in anticipation of and response to stress. The anticipated stress can be a physical, cognitive or social trigger, or merely the felt onset of a symptom.

As the person learns and applies effortless breathing to daily activities, she becomes more aware of factors that affect her breathing. She also experiences an increased sense of control: She can now take action (a slow effortless breath) in moments when she previously felt powerless. The biofeedback-mastered skill interrupts the evoked frustrations and irritations associated with an embarrassing history of hot flashes or mood swings. Instead of continuing with the automatic self-talk, such as “Damn, I am getting hot, why doesn’t it just stop?” (language fueling sympathetic arousal), she can take a relaxing breath in response to the internal sensations, stop the escalating negative self-talk and allows more acceptance—a process reducing sympathetic arousal.

In summary, effortless breathing appears to be a non-invasive behavioral strategy to reduce hot flashes and PMS symptoms. Practicing effortless diaphragmatic breathing contributes to a sense of control, supports a healthier homeostasis, reduces symptoms, and avoids the negative drug side effects. We strongly recommend that effortless diaphragmatic breathing be taught as the first step to reduce hot flashes and PMS symptoms.

 I feel so much cooler. I can’t believe that my hand temperature went up. I actually feel calmer and can’t even feel the threat of a hot flash. Maybe this breathing does work!  –Menopausal patient after initial training in diaphragmatic breathing

 References

Bier, M., Kazarian, D., Peper, E., & Gibney, K. (2003). Reducing the severity of PMS symptoms with diaphragmatic breathing, autogenic training and biofeedback. Unpublished report.

Freedman, R.R., & Woodward, S. (1992). Behavioral treatment of menopausal hot flushes: Evaluation by ambulatory monitoring. American Journal of Obstetrics and Gynecology, 167 (2), 436-439.

Freedman, R.R., Woodward, S., Brown, B., Javaid, J.I., & Pandey, G.N. (1995). Biochemical and thermoregulatory effects of behavioral treatment for menopausal hot flashes. Menopause: The Journal of the North American Menopause Society, 2 (4), 211-218.

Frobish,C., Peper, E. & Gibney, K. H. (2003). Menopausal Hot Flashes: A Self-Regulation Case Study. Poster presentation at the 35th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract in: Applied Psychophysiology and Biofeedback. 29 (4), 302.

Goodale, I.L., Domar, A.D., & Benson, H. (1990). Alleviation of Premenstrual Syndrome symptoms with the relaxation response. Obstetrics and Gynecological Journal, 75 (5), 649-55.

Hays, J., Ockene, J.K., Brunner, R.L., Kotchen, J.M., Manson, J.E., Patterson, R.E., Aragaki, A.K., Shumaker, S.A., Brzyski, R.G., LaCroix, A.Z., Granek, I.A, & Valanis, B.G., Women’s Health Initiative Investigators. (2003). Effects of estrogen plus progestin on health-related quality of life. New England Journal of Medicine, 348, 1839-1854.

Humphries, K.H.., & Gill, s. (2003). Risks and benefits of hormone replacement therapy: the evidence speaks. Canadian Medical Association Journal, 168(8), 1001-10.

Kabat-Zinn, J. (1990). Full catastrophe living. New York: Dela­corte Press.

Luthe, W. & Schultz, J.H. (1969). Autogenic therapy: Vol II: Medical applications. New York: Grune & Stratton.

Mathew, R.J.; Claghorn, J.L.; Largen, J.W.; & Dobbins, K. (1979). Skin Temperature control for premenstrual tension syndrome:A pilot study. American Journal of Clinical Biofeedback, 2 (1), 7-10.

Peper, E. (1990). Breathing for health. Montreal: Thought Tech­nology Ltd.

Schultz, J.H., & Luthe, W. (1969). Autogenic therapy: Vol 1. Autogenic methods. New York: Grune and Stratton.

Schwartz, M.S. & Andrasik, F.(2003). Biofeedback: A practitioner’s guide, 3nd edition. New York: Guilford Press.

Shumaker, S.A., Legault, C., Thal, L., Wallace, R.B., Ockene, J., Hendrix, S., Jones III, B., Assaf, A.R., Jackson, R. D., Morley Kotchen, J., Wassertheil-Smoller, S.; & Wactawski-Wende, J. (2003). Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in post menopausal women: The Women’s Health Initiative memory study: A randomized controlled trial. Journal of the American Medical Association, 289 (20), 2651-2662.

Stearns, V., Beebe, K. L., Iyengar, M., & Dube, E. (2003). Paroxetine controlled release in the treatment of menopausal hot flashes. Journal of the American Medical Association, 289 (21), 2827-2834.

Stroebel, C. F. (1982). QR, the quieting reflex. New York: G. P. Putnam’s Sons.

van Dixhoorn, J.J. (1998). Ontspanningsinstructie Principes en Oefeningen (Respiration instructions: Principles and exercises). Maarssen, Netherlands: Elsevier/Bunge.

Wassertheil-Smoller, S., Hendrix, S., Limacher, M., Heiss, G., Kooperberg, C., Baird, A., Kotchen, T., Curb, Dv., Black, H., Rossouw, J.E., Aragaki, A., Safford, M., Stein, E., Laowattana, S., & Mysiw, W.J. (2003). Effect of estrogen plus progestin on stroke in postmenopausal women: The Women’s Health Initiative: A randomized trial. Journal of the American Medical Association, 289 (20), 2673-2684.

Wyeth Pharmaceuticals (2003, June 4). A message from Wyeth: Recent reports on hormone therapy and where we stand today. San Francisco Chronicle, A11.

*We thank Candy Frobish, Mary Bier and Dalainya Kazarian for their helpful contributions to this research.

**For communications contact: Erik Peper, Ph.D., Institute for Holistic Healing Studies, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132; Tel: (415) 338 7683; Email: epeper@sfsu.edu; website: http://www.biofeedbackhealth.org; blog: http://www.peperperspective.come