Healing from the Inside Out: How Your Mind–Body Shapes Pain

Posted: June 9, 2025 | Author: | Filed under: attention, behavior, Breathing/respiration, CBT, emotions, healing, health, mindfulness, Pain/discomfort, placebo, self-healing, Uncategorized | Tags: , , , , , | 2 Comments

Adapted from Peper, E., Booiman, A. C., & Harvey, R. (2025). Pain-There is Hope. Biofeedback, 53(1), 1-9. http://doi.org/10.5298/1081-5937-53.01.16

Pain is more than a physical sensation—it’s shaped by our breath, thoughts, emotions, and beliefs. A striking example: a four-year-old received a vaccination with no pain, revealing the disconnect between what science knows about pain relief and what’s practiced.
The article highlights five key ways to reduce pain:

  1. Exhale during the painful moment – This activates the parasympathetic nervous system, calming the body. A yogi famously demonstrated this by pushing skewers through his tongue without bleeding or feeling pain.
  2. Create a sense of safety – Feeling secure can lessen pain and speed healing. Sufi mystics have shown this by pushing knives through their chest muscles without long-term damage, often healing rapidly.
  3. Distract the mind – Shifting focus can ease discomfort.
  4. Reduce anticipation – Fear of pain often amplifies it.
  5. Explore the personal meaning of pain – Understanding what pain symbolizes can shift how we experience it.

The blog also explores how the body regulates pain through mechanisms which influence inflammation and pain signals. In the end, hope, trust, and acceptance, along with mindful breathing, healing imagery, and meaningful engagement, emerge as powerful tools not just to reduce pain—but to promote true healing.

Listen to the AI generated podcast created from this article by Google NotebookLM

I took my four-year-old daughter to the pediatrician for a vaccination. As the nurse prepared to administer the shot in her upper arm. I instructed my daughter to exhale while breathing, understanding that this technique could influence her perception of pain. Despite my efforts, my daughter did not follow my instructions. At that point, the nurse interjected and said, “Please sit in front of your daughter.” Then turned to my daughter and said, “Do you see your father’s curly hair? Do you think you could blow the curls to move them back and forth?” My daughter thought this playful game was fun! As she blew at my hair, the curls moved back and forth while the nurse administered the injection. My daughter was unaware that she had received the shot and felt no pain.

My experience as a father and as a biofeedback practitioner was enlightening–it demonstrated the difference between theoretical knowledge of breathing techniques associated with pain perception and practical applications of clinical skills used by a pediatric nurse practitioner while administering an injection with children. An obvious question raised is: What processes are involved in the perception of pain?

There are many factors influencing pain perception, such as physical/physiological, behavioral and psychological/emotional factors related to the injection as described by St Clair-Jones et al., (2020). Physical and physiological considerations include device type such as needle gauge size as well as formulation volume and ingredients (e.g., adjuvants, pH, buffers), fluid viscosity, temperature, as well as possible sensitivity to coincidental exposures associated with an injection (e.g., sensitivity to latex exam gloves or some other irritant in the injection room).

There are overlapping physical and behavioral-related moderators that include weight and body fat composition, proclivity towards movements (e.g., activity level or ‘squirminess’), as well as co-morbid factors such as whether the person has body sensitization due to rheumatoid arthritis and/or fibromyalgia, for example. Other behavioral factors include a clinician selecting the injection site, along with the angle, speed or duration of injection. Psychological influences center around patient expectations including injection-anxiety or needle phobia, pain catastrophizing, as well as any nocebo effects such as white-coat hypertension.

Although the physical, behavioral and psychological categories allow for considering many physical and physiological factors (e.g., product-related factors), behavioral factors (e.g., injection-related behaviors) and psychological factors (e.g., person-related psychological attitudes, beliefs, cognitions and emotions), this article focuses on a figurative recipe for success associated with benefits of simple breathing to reduce pain perceptions.

Of the many categories of consideration related to pain perceptions, following are five key ‘recipe ingredients’ that contributed to a relatively painless experience:

  1. Exhaling During Painful Stimuli: Exhaling during a painful stimulus can activate parts of the parasympathetic nervous system leading to promotion of self-healing.
  2. Creating a Sense of Safety: Ensuring that the child feels safe and secure is crucial in managing pain. My lack of worry and concern and the nurse’s gentle and engaging approach created a comforting environment for my daughter.
  3. Using Distraction: Distraction techniques, such as focusing on the movement of the curls of the hair served to redirect my daughter’s attention away from the anticipated pain.
  4. Reducing Anticipation of Pain: My daughter’s previous visits were always enjoyable and as a parent, I was not anxious and was looking forward to the pediatrician visit and their helpful advice.
  5. Understanding the Personal Meaning of Pain: The approach taken by the nurse allowed the injection to be perceived as a non-event, thereby minimizing the psychological impact of the pain.

Exhaling During Painful Stimuli

Exhaling during painful stimuli facilitates a reduction in discomfort through several physiological mechanisms. During exhalation the parasympathetic nervous system is activated, which slows the heart rate and promotes relaxation, regeneration, reduces anxiety, and may counteract the effects of pain (Magnon et al., 2021). Breathing moderation of discomfort is observable through heart rate variability associated with slow, resonant breathing patterns, where heart rate increases with inhalation and decreases with exhalation (Lehrer & Gevirtz, 2014; Steffen et al., 2017). Physiological studies show that slow, resonant breathing at approximately six breaths per minute for adults, and a little faster for young children, causes the heart rate to increase during inhalation and decrease during exhalation, as illustrated in Figure 1.

Figure 1. Changes in heart rate as modulated by slower breathing at about six breaths per minute

One can experience how breathing affects discomfort when taking a cold shower under two conditions: As the cold water hits your skin: (1) gasping and holding your breath versus (2) exhaling slowly as the cold water hits you. Most people will report that slowly exhaling feels less uncomfortable, though they may still prefer a warm shower.

An Exercise for Use During Medical Procedures: Paring the procedure with inhalation and exhalation

A simple breathing technique can be used to reduce the experience of pain during a procedure or treatment, or during uncomfortable movement post-injury or post-surgery. Physiologically, inhalation tends to increase heart rate and sympathetic activation while exhalation reduces heart rate and increases parasympathetic activity. Often inhalation increases tension in the body, while during exhalation, one tends to relax and let go. The goal is to have the patient practice longer and slower breathing so that a procedure that might be uncomfortable is initiated during the exhalation phase. Applications of long, slow breathing techniques include having blood drawn, insertion of acupuncture needles in tender points, or movement that causes discomfort or pain. Slowly breathing is helpful in reducing many kinds of discomfort and pain perceptions (Joseph et al., 2022; Jafari et al., 2020).

Implementing the technique of exhaling during painful experiences can be deceptively simple yet challenging. When initially practicing this technique, the participants often try too hard by quickly inhaling and exhaling as the pain stimulus occurs. The effective technique involves allowing the abdomen to expand while inhaling, then allowing exhaled air to flow out while simultaneously relaxing the body and smiling slightly, and initiating the painful procedure only after about 25 percent of the air is exhaled.

Some physiological mechanisms that explain how slow breathing influences on pain perceptions have focused on baroreceptors that are mechanically sensitive to pressure and breathing dynamics. According to Suarez-Roca et al. (2021, p 29): “Several physiological factors moderate the magnitude and the direction of baroreceptor modulation of pain perception, including: (a) resting systolic and diastolic AP, (b) pain modality and dimension, (c) type of activated vagal afferent, and (d) the presence of a chronic pain condition It supports the parasympathetic activity that exert an anti-inflammatory influence, whereas the sympathetic activity is mostly pro-inflammatory. Although there are complex physiological interactions between cardiorespiratory systems, arterial pressure and baroreceptor sensitivity that influence pain perceptions, this report focuses on simpler reminders, such as creating a sense of safety for people as a result of better breathing techniques.

Creating a Sense of Safety

My young daughter did not know what to expect and totally trusted me and I was relaxed because the purpose was to enhance my daughter’s future health by giving her a vaccination to prevent being sick at a future time. Often, a parent’s anxiety is contagious to the child since expectations and emotional states influence the experience of medical procedures and pain (Sullivan et al., 2021). For my daughter, the nurse’s calm and confident demeanor contributed to a safe and reassuring environment. As a result, she was more engaged in a playful distraction, blowing at my hair, rather than focusing on the impending shot. This observation underscores an important psychological principle: when individuals do not anticipate pain and feel safe, they are more likely to experience surprise rather than distress. Conversely, anticipation of pain can amplify the perception of discomfort.

For instance, many people have experienced heightened anxiety at the dentist, where they may feel the pain of the needle before it is inserted. Anticipation evocates a past memory of pain that triggers a defensive reaction, increasing sympathetic arousal and sharpening awareness of potential danger. By providing the experience of feeling of safety, parents, caretakers, and medical professionals can play a crucial role in reducing the perceived pain of medical interventions.

Using Distraction

It is inherently difficult to attend to two tasks simultaneously; thus, focusing one’s attention on one task often diminishes awareness of pain and other stimuli (Rischer et al., 2020). For instance, when the nurse asked my daughter to see if she could blow hard enough to make the curls move back and forth, this task captured her attention in a fun and multisensory way. She was engaged visually by the movement of the curls, audibly by the sound of the rushing air, physically by the act of exhalation, and cognitively by following the instructions. Additionally, her success in moving the curls reinforced the activity as a positive and enjoyable experience.

In contrast, it is challenging to allow oneself to be distracted when anticipating discomfort, as numerous cues can continuously refocus attention on the procedure that may induce pain. This experience is akin to attempting to tickle oneself, which typically fails to elicit laughter due to the predictability and lack of external stimulation. Most of us have experienced how challenging it is to be self-directive and not focus on the sensations during dental procedures as discussed in the overview of music therapy for use in dentistry by Bradt and Teague (2018). The challenges are illustrated by my own experience during a dental cleaning

During a dental cleaning, I often attempt to distract myself by mentally visualizing the sensation of breathing down my legs while repeating an internal mantra or evoking joyful memories. Despite these efforts, I frequently find myself attending to the sound of the ultrasonic probe and the sensations in my mouth. To manage this distraction more effectively, I have found that external interventions such as listening to music or an engaging audio story through earphones is more beneficial.

From this perspective, we wished that the dentist could implement an external intervention by collaborating with a massage therapist to provide a simultaneous foot massage during the teeth cleaning. This dual stimulation would offer enough competing sensations to divert attention from the dental procedure to the comfort of the foot massage.

Reducing Anticipation of Pain

A crucial factor in the experience of pain is the anticipation and expectation of discomfort, which is often shaped by previous experiences (Henderson et al., 2020; Reicherts et al., 2017). When encountering a novel experience, we might interpret the sensations as novel rather than painful. Similar phenomena can be observed in young children when they fall or get hurt on the playground. They may initially react with surprise or shock and may look for their caretaker. Depending the reaction of their caregiver, they may begin to cry or they might cry briefly, stop and resume playing.

Conversely, the anticipation of pain can heighten sensitivity to any stimuli, causing them to be automatically perceived as painful. Anticipatory responses function as a form of mental rehearsal, where the body responds in a manner similar to the actual experience of pain. For example, Peper, et al. (2015) showed that when a pianist imagined playing the piano, her forearm flexor and extensor muscles exhibited slight contractions, even though there was no observable movement in her arm and the pianist was unaware of these contractions (see Figure 2).

Figure 2. The covert SEMG increase in forearm SEMG as the participant imagined playing the piano (reproduced by permission from Peper et al., 2015).

These kind of muscle reactions are also visible in sportsmen. For example, while mentally racing a lap on a motorbike, the arm muscles act like as if the person is racing in the dust of the circuit (Booiman 2018). The blood flow (BVP) and blood vessels are reacting even quicker than muscle tension on thoughts and expected (negative) experiences.

These findings underscore how anticipatory responses can mirror actual physical experiences, providing insights into how anticipation and expectancy can modify pain perception (Henderson et al., 2020). Understanding these mechanisms allows for the development of interventions aimed at managing pain through the modification of expectations and the introduction of distraction techniques.

The Personal Meaning of Pain (adapted from Peper, 2015)

The personal meaning of pain is a complex construct that varies significantly based on context and individual perception. For example, consider the case of a heart attack. Initially, the person might experience chest pain and dismiss it, which can be attributed to societal norms where people are conditioned to ignore pain. However, once the pain is assumed or diagnosed to be a heart attack, the same pain may become terrifying as it may signify the potential for life-threatening consequences. Following bypass surgery, the pain might actually be worse, but it is now reframed positively as a sign of the surgery’s success and a symbol of hope for survival. Thus, the meaning of pain evolves from one of fear to one of reassurance and recovery.

This notion that pain is defined by the context in which it occurs is crucial (Carlino et al., 2014). For instance, childbirth, despite being intensely painful, is understood within the context of a natural and temporary process that leads to the birth of a child. This perception is often reinforced nonverbally by a supportive midwife or doula. It may be helpful if the midwife or doula has given birth herself. Without words she communicates, “This is an experience that you can transcend, just as I did.” Psychologically/emotionally, the pain serves a higher purpose, to deliver a child into the world, which may also make the pain more bearable. There is a reward, namely the child. In addition, women who have had training and information about the process of childbirth have a significant faster delivery (about 2 hours faster).

Piercing the body without reporting pain or bleeding

To further illustrate this concept, Peper et al. (2006) and Kakigi et al. (2005) physiologically monitored the experiences of a Japanese Yogi Master, Mitsumasa Kawakami,who performed voluntary body piercing with unsterilized skewers, as depicted in Figure 3 (Peper, 2015).

Figure 3. Demonstration Japanese Yogi Master, Mitsumasa Kawakami, voluntary piercing the tongue and neck with unsterilized skewers while experiencing no pain, bleeding or infection (reproduced by permission from Peper et al., 2006).

See the video recording of tongue piercing study recorded November 11, 2000, at the annual Biofeedback Society Meeting of California, Monterey, CA, https://youtu.be/f7hafkUuoU4 (Peper & Gunkelman, 2007).

Despite the visual discomfort of seeing this procedure, physiological data from pulse, EEG and breathing patterns revealed that the yogi did not experience pain. During the piercing, his heart rate was elevated, his electrodermal activity was low and unresponsive, and his EEG showed predominant alpha waves, indicating a state of focused meditation rather than pain. This study suggests that conscious self-regulation, rather than dissociation, can be employed to control attention and responsiveness to painful stimuli and possibly benefit individuals with chronic pain (Peper et al., 2005).

A similar phenomenon was observed among a spiritual gathering of Kasnazani Sufi initiates in Amman, Jordan and physiologically monitored during demonstrations as part of a scientific meeting. The Kasnazani order is a branch of Sufism that has gained widespread popularity in Iraq and Iran, particularly among the Kurdish population. What sets the Kasnazani order apart is its inclusive approach—it welcomes both Sunni and Shia Muslims, making no distinction between them. During spiritual gatherings, some followers perform acts that might seem extreme to outsiders: piercing their bodies. These acts are seen as expressions of deep spiritual devotion and are performed in a state believed to be beyond normal physical sensation. With the permission of their Sheikh Mohammed Abdul Kareem Kasnazani, they pierced their face, neck arms, or chest and reported no pain or bleeding and heal quickly, as shown in Figure 4.

Figure 4. Voluntary piercing and with unsterilized skewers by Sufi initiates and subsequent tissue healing after 14 hours.

See the video recording of the actual piercing study organized by Erik Peper and Howard Hall with Thomas Collura recording the QEEG at the 2013 Annual Scientific Meeting of the Association for Applied Psychophysiology and Biofeedback, Portland, OR (Peper & Hall, 2013; Collura et al., 2014), https://www.youtube.com/watch?v=56nLZyG87oc

What Factors Decrease the Experience of Pain and Promote Rapid Healing with the Absence of Bleeding?

In the case of the Kasnazani Sufis, they framed their experience as a normal, spiritual phenomenon that occurs in a setting of religious faith and total trust in their spiritual leader (Hall, 2011). The Sufis reported that they had permission and support from their master, Sheikh Mohammed Abdul Kareem Kasnazani. Thus, they felt totally safe and protected—they had no doubt they could experience the piercing with reasonable composure and that their bodies would totally heal. Even if pain occurred, it was not to be feared but part of the process. The experience may be modulated by the psychological context of the group, the drumming, and the chanting. The phenomenon was not simply a matter of belief; they knew that healing would occur because they had seen it many times in the past. The knowledge that healing would occur rapidly was transmitted as a felt sense in the group that this is possible and following the expected normal pattern.

The most impressive finding was that the physiology markers (heart rate, skin conductance, and breathing) were normal and there was no notable change (Booiman et al., 2015; Peper & Hall, 2013) and the QEEG indicated the inhibition of pain (Collura et al., 2014).

Clinical implications

These observations underscore that the context of pain—whether through personal meaning, spiritual belief, or communal support—can significantly alter its perception and management. This concept is also reflected in clinical settings, where a lack of diagnosis or acknowledgment of pain can exacerbate suffering. An isolated individual, alone at night with the physical sensation of pain, may find the pain tremendously stressful, which tends to intensify the experience. In this situation, there are concerns about the future: “It may get worse, it will not go away, I’m going to die from this, maybe I’ll die alone,” and the worry continues.

If one can let go of these thoughts, breathe through the pain, relax the muscles and experience a feeling of hope, the pain is often reduced. On the other hand, focusing on the pain may intensify it. On the other hand, the meaning of pain implies survival or hope as sometimes is observed in injured soldiers. In context of the hospital setting: “I have survived and I am safe.”
What are the implications of these experiences in clinical settings in which the patient is in constant pain and yet has not received an accurate diagnosis? Or, in cases in which the patient has a diagnosis, such as fibromyalgia, but treatment has not reduced the pain significantly? Experiencing pain or illness that goes undiagnosed, and/or that is not acknowledged, may increase the level of stress and tension, which can contribute to more pain and discomfort. As long as we are resentful/angry/resigned to the pain or especially to the event that we believe has caused the pain, the pain often increases. Another way to phrase this is that chronic sympathetic arousal increases the sensitivity to pain and reduces healing potential (Kyle & McNeil, 2014).

Acknowledgement means having an accurate diagnosis, validating that the pain experience is legitimate and that it is not psychosomatic (imagined), because that simply makes the experience of pain worse. Once the patient has a more accurate diagnosis, treatment may be possible.

When one has constant, chronic, or unrelenting pain, this evokes hopelessness and the patient is more likely to get depressed (Sheng et al., 2017; Meda et al., 2022). The question is, What can be done? The first step for the patients is to acknowledge to themselves that it does not mean that the situation is unsolvable. It is important to focus on other options for diagnosis and treatment and take one’s own lead in the healing/recovery process. We have observed that a creative activity that uses the signals of pain to evoke images and thoughts to promote healing may reduce pain (Peper et al., 2022). Pain awareness may be reduced when the person initiates actions that contribute to improving the well-being of others.

Overall, pain appears to decrease when a person accepts without resignation what has happened or is happening. A useful practice that may change the pain experience is to do an appreciation practice. Namely, appreciate what that part of the body has done for you and how so often in the past you may have abused it. For example, if you experience hip pain, each time you are aware of the pain, thank the hip for all the work it has done for you in the past and how often you may have neglected it. Keep thanking it for how it has supported you.

Pain often increases when the person is resentful or wished that what has happened had not happened (Burns et al., 2011). If the person can accept where they are and focus on the new opportunities and new goals can achieve, pain may still occur; however, the quality is different. Focus on what you can do and not on what you cannot do. See Janine Shepherd’s 2012 empowering TED talk, “A broken body isn’t a broken person.”

Conclusion

The primary lessons from studying the yogi and the Sufis are the concepts that a sense of safety, acceptance, and purpose can transform the experience of pain. Expressing confidence in a patient’s recovery prospects places the focus on their ability to recover. Incorporating these elements into clinical care may offer new avenues for addressing chronic pain and improving patient outcomes (Booiman & Peper, 2021).

We propose the first step is to create an atmosphere of hope, trust and safety and to emphasize the improvements made (even small ones). Then master effortless breathing to increase slow diaphragmatic breathing and teach clients somato-cognitive techniques to refocus their attention during painful stimuli (mindfulness) (Pelletier & Peper, 1977; Peper et al., 2022). Using the slow breathing as the overlearned response would facilitate the recovery and regeneration following the painful situation. To develop mastery and be able to apply it under stressful situations requires training and over-learning. Yoga masters overlearned these skills with many years of meditation. With mastery, patients may learn to abort the escalating cycle of pain, worry, exhaustion, more pain, and hopelessness by shifting their attention and psychophysiological responses. In clinical practice, strategies such as hypnotic induction, multisensory distraction, self-healing visualizations, and mindfulness techniques can be employed to manage pain. A foundational principle is that healing is promoted when the participant feels safe and accepted, experiences suffering without blame, and looks forward to life with meaning and purpose.

Acknowledgement

We thank Mitsumasa Kawakami, Sheikh Mohammed Abdul Kareem Kasnazani, and Safaa Saleh for their generous participation in this research and I thank our research collegues Thomas Collura, Howard Hall and Jay Gunkelman for their support and collaboration.

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Quick Rescue Techniques When Stressed

Posted: February 4, 2024 | Author: | Filed under: attention, behavior, biofeedback, Breathing/respiration, CBT, cognitive behavior therapy, education, emotions, Evolutionary perspective, Exercise/movement, health, mindfulness, Neck and shoulder discomfort, posture, relaxation, stress management, Uncategorized | Tags: , , , , , , , , , , , , , , , , , | 9 Comments

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

Adapted from Peper, E., Oded, Y, & Harvey, R. (2024). Quick somatic rescue techniques when stressed. Biofeedback, 52(1), 18–26. https://doi.org/10.5298/982312

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

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

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

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

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

Background

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

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

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

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

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

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

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

Concepts underlying the rescue techniques

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

Rescue techniques

Coping When Highly Stressed and Agitated

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What to Do When Thoughts Keep Interrupting

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

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

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

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

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

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

Stressor squat instructions

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

Toning instructions

Healing from paralysis-Music (toning) to activate health

Diaphragmatic breathing instructions

A breath of fresh air: Breathing and posture to optimize health
Healing irritable bowel syndrome with diaphragmatic breathing*
Breathing: Informative YouTube videos and blogs

Reduce stress with posture and breathing

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

Conditioning

Relive memory to create healing imagery
Improve learning with peak performance techniques

References

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Balban, M. Y., Neri, E., Kogon, M. M., Weed, L., Nouriani, B., Jo, B., Holl, G., Zeitzer, J. M., Spiegel, D., Huberman, A. D. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 10089. https://doi.org/10.1016/j.xcrm.2022.100895

Basso, J. C. & Suzuki, W. A. (2017). The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: A review. Brain Plast, 2(2), 127–152. https://doi.org/10.3233/BPL-160040

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Gevirtz, R. (2014). HRV Training and its Importance – Richard Gevirtz, Ph.D., Pioneer in HRV Research & Training. Thought Technology. Accessed December 29, 2023. https://www.youtube.com/watch?v=9nwFUKuJSE0

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Oded, Y. (2023). Personal communication. S.O.S 1™ technique is part of the Sense Of Safety™ method. www.senseofsafety.co

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Peper, E., Lin, I-M, Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood. Biofeedback, 45(2), 36–41. https://doi.org/10.5298/1081-5937-45.2.01

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Is mindfulness training old wine in new bottles?

Posted: January 11, 2024 | Author: | Filed under: attention, behavior, biofeedback, Breathing/respiration, CBT, cognitive behavior therapy, healing, health, meditation, self-healing, stress management | Tags: , , , , , , , , , , , | 2 Comments

Adapted from: Peper, E., Harvey, R., & Lin, I-M. (2019).  Mindfulness training has themes common to other technique. Biofeedback. 47(3), 50-57.  https://doi.org/10.5298/1081-5937-47.3.02

This extensive blog discusses the benefits of mindfulness-based meditation (MM) techniques and explores how similar beneficial outcomes occur with other mind-centered practices such as transcendental meditation, and body-centered practices such as progressive muscle relaxation (PMR), autogenic training (AT), and yoga. For example, many standardized mind-body techniques such as mindfulness-based stress reduction and mindfulness-based cognitive therapy (a) are associated with a reduction in symptoms of symptoms such as anxiety, pain and depression. This article explores the efficacy of mindfulness based techniques to that of other self-regulation techniques and identifies components shared between mindfulness based techniques and several previous self-regulation techniques, including PMR, AT, and transcendental meditation. The authors conclude that most of the commonly used self-regulation strategies have comparable efficacy and share many elements.

Mindfulness-based strategies are based in ancient Buddhist practices and have found acceptance as one of the major contemporary behavioral medicine techniques (Hilton et al, 2016; Khazan, 2013).  Throughout this blog the term mindfulness will refer broadly to a mental state of paying total attention to the present moment, with a non-judgmental awareness of the inner and/ or outer experiences (Baer et al., 2004; Kabat-Zinn, 1994).

In 1979, Jon Kabat-Zinn introduced a manual for a standardized Mindfulness-Based Stress Reduction (MBSR) program at the University of Massachusetts Medical Center (Kabat-Zinn, 1994, 2003).  The eight-week program combined mindfulness as a form of insight meditation with specific types of yoga breathing and movements exercises designed to focus on awareness of the mind and body, as well as thoughts, feelings, and behaviors. 

There is a substantial body of evidence that mindfulness-based cognitive therapy (MBCT); Teasdale et al., 1995) and mindfulness-based stress reduction (MBSR) (Kabat-Zinn, 1994, 2003) have combined with skills of cognitive therapy for ameliorating stress symptoms such as negative thinking, anxiety and depression.  For example, MBSR and MBCT has been confirmed to be clinical beneficial in alleviating a variety of mental and physical conditions, for people dealing with anxiety, depression, cancer-related pain and anxiety, pain disorder, or high blood pressure (The following are only a few of the hundred studies published: Andersen et al., 2013; Carlson et al., 2003; Fjorback et al., 2011; Greeson, & Eisenlohr-Moul, 2014; Hoffman et al., 2012; Marchand, 2012; Baer, 2015; Demarzo et al., 2015; Khoury et al, 2013; Khoury et al, 2015; Chapin et al., 2014; Witek Janusek et al., 2019).  Currently, MBSR and MBCT techniques that are more standardized are widely applied in schools, hospitals, companies, prisons, and other environments. 

The Relationship Between Mindfulness and Other Self-Regulation Techniques

This section addresses two questions: First, how do mindfulness-based interventions compare in efficacy to older self-regulation techniques? Second, and perhaps more basically, how new and different are mindfulness-based therapies from other self-regulation-oriented practices and therapies?

Is mindfulness more effective than other mind/body body/mind approaches?

Although mindfulness-based meditation (MM) techniques are effective, it does not mean that is is more effective than other traditional meditation or self-regulation approaches.  To be able to conclude that MM is superior, it needs to be compared to equivalent well-coached control groups where the participants were taught other approaches such as progressive relaxation, autogenic training, transcendental meditation, or biofeedback training. In these control groups, the participants would be taught by practitioners who were self-experienced and had mastered the skills and not merely received training from a short audio or video clip (Cherkin et al, 2016). The most recent assessment by the National Centere for Complementary and Integrative Health, National Institutes of Health (NCCIH-NIH, 2024) concluded that generally “the effects of mindfulness meditation approaches were no different than those of evidence-based treatments such as cognitive behavioral therapy and exercise especially when they include how to generalize the skills during the day” (NCCIH, 2024). Generalizing the learned skills into daily life contributes to the  successful outcome of Autogenic Training, Progressive Relaxation, integrated biofeedback stress management training, or the Quieting Response (Luthe, 1979; Davis et al., 2019; Wilson et al., 2023; Stroebel, 1982).

Unfortunately, there are few studies that compare the effective of mindfulness meditation to other sitting mental techniques such as Autogenic Training, Transcendental Meditation or similar meditative practices that are used therapeutically.  When the few randomized control studies of MBSR versus autogenic training (AT) was done, no conclusions could be drawn as to the superior stress reduction technique among German medical students (Kuhlmann et al., 2016).

Interestingly, Tanner, et al (2009) in a waitlist study of students in Washington, D.C. area universities practicing TM used the concept of mindfulness, as measured by the Kentucky Inventory of Mindfulness Skills (KIM) (Baer et al, 2004)  as a dependent variable, where TM practice resulted in greater degrees of ‘mindfulness.’ More direct comparisons of MM with body-focused techniques, such as progressive relaxation, or Autogenic training mindfulness-based approaches, have not found superior benefit.  For example, Agee et al (2009) compared the stress management effects of a five-week Mindfulness Meditation (MM) to a five-week Progressive Muscle Relaxation (PMR) course and found no meaningful reports of superiority of one over the other program; both MM and PMR were effective in reducing symptoms of stress. 

In a persuasive meta-analysis comparing MBSR with other similar stress management techniques used among military service members, Crawford, et al (2013) described various multimodal programs for addressing post-traumatic stress disorder (PTSD) and other military or combat-related stress reactions.  Of note, Crawford, et al (2013) suggest that all of the multi-modal approaches that include Autogenic Training, Progressive Muscle Relaxation, movement practices including Yoga and Tai Chi, as well as Mindfulness Meditation, and various types of imagery, visualization and prayer-based contemplative practices ALL provide some benefit to service members experiencing PTSD. 

An important observation by Crawford et al (2013) pointed out that when military service members had more physical symptoms of stress, the meditative techniques appeared to work best, and when the chief complaints were about cognitive ruminations, the body techniques such as Yoga or Tai Chi worked best to reduce symptoms.  Whereas it may not be possible to say that mindfulness meditation practices are clearly superior to other mind-body techniques, it may be possible to raise questions about mechanisms that unite the mind-body approaches used in therapeutic settings.

Could there be negative side effects?

Another point to consider is the limited discussion of the possible absence of benefit or even harms that may be associated with mind-body therapies. For example, for some people, meditation does not promote prosocial behavior (Kreplin et al, 2018). For other people, meditation can evoke negative physical and/or psychological outcomes (Lindahl et al, 2017; Britton et al., 2021).  There are other struggles with mind-body techniques when people only find benefit in the presence of a skilled clinician, practitioner, or guru, suggesting a type of psychological dependency or transference, rather than the ability to generalize the benefits outside of a set of conditions (e.g. four to eight weeks of one to four hour trainings) or a particular setting (e.g. in a natural and/or quiet space). 

Whereas the detailed instructions for many mindfulness meditation trainings, along with many other types of mind-body practices (e.g. Transcendental Meditation, Autogenic Training, Progressive Muscle Relaxation, Yoga, Tai Chi…)  create conditions that are laudable because they are standardized, a question is raised as to ‘critical ingredients’, using the metaphor of baking.  The difference between a chocolate and a vanilla cake is not ingredients such as flour, or sugar, etc., which are common to all cakes, but rather the essential or critical ingredient of the chocolate or vanilla flavoring.  So what are the essential or critical ingredients in mind-body techniques?  Extending the metaphor, Crawford, et al (2013, p. 20) might say the critical ingredient common to the mind-body techniques they studied was that people “can change the way their body and mind react to stress by changing their thoughts, emotions, and behaviors…” with techniques that, relatively speaking, “involve minimal cost and training time.”

The skeptical view suggested here is that MM techniques share similar strategies with other mind-body approaches that encouraging learners to ‘pay attention and shift intention.’ This strategy is part of the instructions when learning Progressive Relaxation, Autogenic Training, Transcendental Meditation, movement meditation of Yoga and Tai Chi and, with instrumented self-regulation techniques such as bio/neurofeedback.  In this sense, MM training repackages techniques that have been available for millennia and thus becomes ‘old wine sold in new bottles.’

We wonder if a control group for compassionate mindfulness training would report more benefits if they were asked not only to meditate on compassionate acts, but actually performed compassionate tasks such as taking care of person in pain, helping a homeless person, or actually writing and delivering a letter of gratitude to a person who has helped them in the past?  The suggestion is to titrate the effects of MM techniques, moving from a more basic level of benefit to a more fully actualized level of benefit, generalizing their skill beyond a training setting, as measured by the Baer et al (2004) Kentucky Inventory of Mindfulness Skills.

Each generation of clinicians and educators rediscover principles without always recognizing that the similar principles were part of the previous clinical interventions. The analogies and language has changed; however, the underlying concepts may be the same.   Mindfulness interventions are now the new, current and popular approach. Some of the underlying ‘mindfulness’ concepts that are shared in common with successfully other mind-body and self-regulation approaches include: 

The practitioner must be self-experienced in mindfulness practice. This means that the practitioners do not merely believe the practice is effective; they know it is effective from self-experience.  Inner confidence conveyed to clients and patients enhances the healing/placebo effect. It is similar to having sympathy or empathy for clients and patients that occurs from have similar life experiences, such as when a clinician speaks to a patient.  For example, a male physician speaking to a female patient who has had a mastectomy may be compassionate; however, empathy occurs more easily when another mastectomy patient (who may also be a physician) shares how she struggled overcame her doubts and can still be loved by her partner.   

There may also be a continuum of strengthening beliefs about the benefits of mindfulness techniques that leads to increase benefits for the approach.  Knowing there are some kinds of benefits from initiating a practice of mindfulness increases empathy/compassion for others as they learn.  Proving that mindfulness techniques are causing benefits after systematically comparing their effectiveness with other approaches strengthens the belief in the mindfulness approaches.  Note that a similar process of strengthening one’s belief in an approach occurs gradually, over time as clients and patients progress through beginner, intermediate and advanced levels of mind-body practices.

Observing thoughts without being captured. Being a witness to the thoughts, emotions, and external events results in a type of covert global desensitization and skill mastery of NOT being captured by those thoughts and emotions. This same process of non-attachment and being a witness is one of the underpinnings of techniques that tacitly and sometime covertly support learning ways of controlling attention, such as with Autogenic Training; namely how to passively attend to a specific body part without judgment and, report on the subjective experience without comparison or judgment.

Ongoing daily practice. Participants take an active role in their own healing process as they learn to control and focus their attention. Participants are often asked to practice up to one hour a day and apply the practices during the day as mini-practices or awareness cues to interrupt the dysfunctional behavior.  For example in Autogenic training, trainees are taught to practice partial formula (such my “neck and shoulders are heavy”) during the day to bring the body/mind back to balance. While with Progressive Relaxation, the trainee learns to identify when they tighten inappropriate muscles (dysponesis) and then inhibit this observed tension.

Peer support by being in a group. Peer support is a major factor for success as people can share their challenges and successes.  Peer support tends to promote acceptance of self-and others and provides role modeling how to cope with stressors.  It is possible  that some peer support groups may counter the benefits of a mind-body technique, especially when the peers do not provide support or may in fact impede progress when they complain of the obstacles or difficulties in their process.

These concepts are not unique to Mindfulness Meditation (MM) training. Similar instructions have been part of the successful/educational intervention of Progressive Relaxation, Autogenic Training, Yogic practices, and Transcendental Meditation. These approaches have been most successful when the originators, and their initial students, taught their new and evolving techniques to clients and patients; however, they became less successful as later followers and practitioners used these approaches without learning an in-depth skill mastery. For example, Progressive relaxation as taught by Edmund Jacobson consisted of advanced skill mastery by developing subtle awareness of different muscle tension that was taught over 100 sessions (Mackereth & Tomlinson, 2010).  It was not simply listening once to a 20-minute audio recording about tightening and relaxing muscles.  Similarly, Autogenic training is very specific and teaches passive attention over a three to six-month time-period while the participant practices multiple times daily.  Stating the obvious, learning Autogenic Training, Mindfulness, Progressive Relaxation, Bio/Neurofeedback or any other mind-body technique is much more than listening to a 20-minute audio recording.

The same instructions are also part of many movement practices. For many participants focusing on the movement automatically evoked a shift in attention.  Their attention is with the task and they are instructed to be present in the movement.

Areas to explore.

Although Mindfulness training with clients and patients has resulted in remarkable beneficial outcomes for the participants, it is not clear whether mindfulness training is better than well taught PR, AT, TM or other mind/body or body/mind approaches.  There are also numerous question to explore such as: 1) Who drops out, 2) Is physical exercise to counter sitting disease and complete the alarm reaction more beneficial, and 3) Strategies to cope with wandering attention.

  • Who drops out?

We wonder if mindfulness is appropriate for all participants as sometimes participants drop out or experience negative abreactions. It not clear who those participants are. Interestingly, hints for whom the techniques may be challenging can be found in the observations of Autogenic Training that lists specific guidelines for contra-, relative- and non-indications (Luthe, 1970).

  • Physical movement to counter sitting disease and complete the alarm reaction.

Although many mindfulness meditation practices may include yoga practices, most participants practice it in a sitting position.  It may be possible that for some people somatic movement practices such as a slow Zen walk may quiet the inner dialogue more quickly. In our experience, when participants are upset and highly stressed, it is much easier to let go of agitation by first completing the triggered fight/flight response with vigorous physical activity such as rapidly walking up and downs stairs while focusing on the burning sensations of the thigh muscles.  Once the physical stress reaction has been completed and the person feels physically calmer then the mind is quieter. Then have the person begin their meditative practice.  

  •  Strategies to cope with wandering attention.

Some participants have difficulty staying on task, become sleepy, worry, and/or are preoccupied. We observed that first beginning with physical movement practices or Progressive Relaxation appears to be a helpful strategy to reduce wandering thoughts.  If one has many active thoughts, progressive relaxation continuously pulls your attention to your body as you are directed to tighten and let go of muscle groups.  Being guided supports developing the passive focus of attention to bring awareness back to the task at hand. Once internally quieter, it is easier hold their attention while doing Autogenic Training, breathing or Mindfullness Meditation.

By integrating somatic components with the mindfulness such as done in Progressive Relaxation or yoga practices facilitates the person staying present.  Similarly, when teaching slower breathing, if a person has a weight on their abdomen while practicing breathing, it is easier to keep attending to the task: allow the weight to upward when inhaling and feeling the exhalation flowing out through the arms and legs.

Therapeutic and education strategies that implicitly incorporate mindfulness

Progressive relaxation

In the United States during the 1920 progressive relaxation (PR) was developed and taught by Edmund Jacobson (1938). This approach was clinically very successful for numerous illnesses ranging from hypertension, back pain, gastrointestinal discomfort, and anxiety; it included 50 year follow-ups. Patients were active participants and practiced the skills at home and at work and interrupt their dysfunctional patterns during the day such as becoming aware of unnecessary muscle tension (dyponetic activity) and then release the unnecessary muscle tension (Whatmore & Kohli, 1968).  This structured approach is totally different than providing an audio recording that guides clients and patients through a series of tightening and relaxing of their muscles.  The clinical outcome of PR when taught using the original specific procedures described by Jacobson (1938) was remarkable. The incorporation of Progressive Relaxation as the homework practice was an important cofactor in the successful outcome in the treatment of muscle tension headache using electromyography (EMG) biofeedback by Budzynski, Stoyva and Adler (1970).

Autogenic Training

In 1932 Johannes Schultz in Germany published a book about Autogenic Training describing the basic training procedure. The basic autogenic procedure, the standard exercises, were taught over a minimum period of three month in which the person practiced daily.  In this practice they directed theri passive attention to the following  cascading sequence: heaviness of their arms, warmth of their arms, heart beat calm and regular, breathing calm and regular or it breathes me, solar plexus is warm, forehead is cool, and I am at peace (Luthe, 1979). Three main principles of autonomic training mentioned by Luthe (1979) are: (1) mental repetition of topographically oriented verbal formulae for brief periods; (2) passive concentration; and (3) reduction of exteroceptive and proprioceptive afferent stimulation.  The underlying concepts of Autogenic Therapy include as described by Peper and Williams (1980):

The body has an innate capacity for self-healing and it is this capacity that is allowed to become operative in the autogenic state. Neither the trainer nor trainee has the wisdom necessary to direct the course of the self-balancing process; hence, the capacity is allowed to occur and not be directed.

  • Homeostatic self-regulation is encouraged.
  • Much of the learning is done by the trainee at home; hence, the responsibility for the training lies primarily with the trainee.
  • The trainer/teacher must be self-experience in the practice.
  • The attitude necessary for successful practice is one of passive attention; active striving and concern with results impedes the learning process. An attitude of acceptance is cultivated, letting be whatever comes up. This quality of attention is known as “mindfulness’ in meditative traditions.

The clinical outcome for autogenic therapy is very promising. The detailed guided self-awareness training and uncontrolled studies showed benefits across a wide variety of psychosomatic illness such as asthma, cancer, hypertension, anxiety, pain irritable bowel disease, depression (Luthe & Schultz, 1970a; Luthe & Schultz, 1970b). Autogenic training components have also been integrated in biofeedback training.  Elmer and Alice Green included the incorporation of autogenic training phrases with temperature biofeedback for the very successful treatment of migraines (Green & Green, 1989).  Autonomic training combine with biofeedback in clinical practices produced better results than control group for headache population (Luthe, 1979). Empirical research found that autonomic training was applied efficiently in emotional and behavioral problems, and physical disorder (Klott, 2013), such as skin disorder (Klein & Peper, 2013), insomnia (Bowden et al., 2012), Meniere’s disease (Goto, Nakai, & Ogawa, 2011) and the multitude of  stress related symptoms (Wilson et al., 2023).

Bio/neurofeedback training

Starting in the late 1960s, biofeedback procedures have been developed as a successful treatment approach for numerous illnesses ranging from headaches, hypertension, to ADHD (Peper et al., 1979; Peper & Shaffer, 2010; Khazan, 2013).  In most cases, the similar instructions that are part of mindfulness meditation are also embedded in the bio/neurofeedback instructions. The participants are instructed to learn control over some physiological parameter and then practice the same skill during daily life. This means that during the learning process, the person learn passive attention and is not be captured by marauding thoughts and feeling.  and during the day develop awareness Whenever they become aware of  dysfunctional patterns, thoughts, emotions, they  initiated their newly learned skill.  The ongoing biological feedback signals continuously reminds them to focus.

Transcendental meditation

The next fad to hit the American shore was Transcendental Meditation (TM)– a meditation practice from the ancient Vedic tradition in India.  The participant were given a mantra that they mentally repeated and if their attention wanders, they go back to repeating the mantra internally.  The first study that captured the media’s attention was by Wallace (1970) published in the Journal Science which reported that “During meditation, oxygen consumption and heart rate decreased, skin resistance increased, and the electroencephalogram showed specific changes in certain frequencies. These results seem to distinguish the state produced by Transcendental Meditation from commonly encountered states of consciousness and suggest that it may have practical applications.” (Wallace, 1970).

The participants were to practice the mantra meditation twice a day for about 20 minutes. Meta-analysis studies have reported that those who practiced TM as compared to the control group experienced significant improved of numerous disorders such as CVD risk factors, anxiety, metabolic syndrome, drug abuse and hypertension (Paul-Labrador et al, 2006; Rainforth et al., 2007; Hawkins, 2003).

To make it more acceptable for the western audience, Herbert Benson, MD, adapted and simplified techniques from TM training and then labelled a core element, the ‘relaxation response’  (Benson et al., 1974) Instead of giving people a secret mantra and part of a spiritual tradition,  he recommend using the word “one”  as the mantra. Numerous studies have demonstrated that when patients practice the relaxation response, many clinical symptoms were reduced. The empirical research found that practiced transcendental meditation caused increasing prefrontal low alpha power (8-10Hz) and theta power of EEG; as well as higher prefrontal alpha coherence than other locations at both hemispheres. Moreover, some individuals also showed lower sympathetic activation and higher parasympathetic activation, increased respiratory sinus arrhythmic and frontal blood flow, and decreased breathing rate (Travis, 2001, 2014). Although TM and Benson’s relaxation response continues to be practiced, mindfulness has taking it place.

Conclusion

Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) are very beneficial and yet may be considered ‘old wine in new bottles’ where the metaphor refers to millennia old meditation techniques as ‘old wine’ and the acronyms such as MBSR or MBCT as ‘new bottles’.  Like many other ‘new’ therapeutic approaches or for that matter, many other ‘new’ medications, use it now before it becomes stale and loses part of its placebo power.  As long as the application of a new technique is taught with the intensity and dedication of the promotors of the approach, and as long as the participants are required to practice while receiving support, the outcomes will be very beneficial, and most likely similar in effect to other mind-body approaches. 

The challenge facing mindfulness practices just as those from Autogenic Training, Progressive Relaxation and Transcendental Meditation, is that familiarity breeds contempt and that clients and therapists are continuously looking for a new technique that promises better outcome. Thus as Mindfulness training is taught to more and more people, it may become less promising.  In addition, as mindfulness training is taught in less time, (e.g. fewer minutes and/or fewer sessions), and with less well-trained instructors, who may offer less support and supervision for people experiencing possible negative effects, the overall benefits may decrease.  Thus, mindfulness practice, Autogenic training, progressive relaxation, Transcendental Meditation, movement practices, meditation, breathing practices as well as the many spiritual practices all appear to share common fate of fading over time.  Whereas the core principles of mind-body techniques are ageless, the execution is not always assured.

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Paul-Labrador, M., Polk, D., Dwyer, J.H. et al. (2006). Effects of a randomized controlled trial of Transcendental Meditation on components of the metabolic syndrome in subjects with coronary heart disease. Archive of Internal Medicine, 166(11), 1218-1224. https://doi.org/10.1001/archinte.166.11.1218

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Enhance Yoga with Biofeedback*

Posted: August 6, 2017 | Author: | Filed under: Uncategorized | Tags: , , , , , , , | Leave a comment

How can you demonstrate that yoga practices are beneficial?

How do you know you are tightening the correct muscles or relaxing the muscle not involved in the movement when practicing asanas?

How can you know that the person is mindful and not sleepy or worrying when meditating?

How do you know the breathing pattern is correct when practicing pranayama?

The obvious answer would be to ask the instructor or check in with the participant; however, it is often very challenging for the teacher or student to know. Many participants think that they are muscularly relaxed while in fact there is ongoing covert muscle tension as measured by electromyography (EMG). Some participants after performing an asana, do not relax their muscles even though they report feeling relaxed. Similarly, some people practice specific pranayama breathing practice with the purpose of restoring the sympathetic/parasympathetic system; however, they may not be doing it correctly. Similarly, when meditating, a person may become sleepy or their attention wanders and is captured by worries, dreams, and concerns instead of being present with the mantra. These problems may be resolved by integrating bio- and neurofeedback with yoga instruction and practice. Biofeedback monitors the physiological signals produced by the body and displays them back to the person as shown in Figure 1.

Slide1

Figure 1: Biofeedback is a methodology by which the participant receives ongoing feedback of the physiological changes that are occurring within the body. Reproduced with permission from Peper et al, 2008.

With the appropriate biofeedback equipment, one can easily record muscle tension, temperature, blood flow and pulse from the finger, heart rate, respiration, sweating response, posture alignment, etc.** Neurofeedback records the brainwaves (electroencephalography) and can selectively feedback certain EEG patterns. In most cases participants are unaware of subtle physiological changes that can occur. However, when the physiological signals are displayed so that the person can see or hear the changes in their physiology they learn internal awareness that is associated with these physiological changes and learn mastery and control. Biofeedback and neuro feedback is a tool to make the invisible, visible; the unfelt, felt and the undocumented, documented.

Biofeedback can be used to document that a purported yoga practice actually affects the psychophysiology. For example, in our research with the Japanese Yogi, Mr. Kawakami, who was bestowed the title “Yoga Samrat’ by the Indian Yoga Culture Federation in 1983, we measured his physiological responses while breathing at two breaths a minute as well as when he inserted non-sterilized skewers through his tongue tongue (Arambula  et al, 2001; Peper et al, 2005a; Peper et al, 2005b). The physiological recordings confirmed that his Oxygen saturation stayed normal while breathing two breaths per minute and that he did not trigger any physiological arousal during the skewer piercing. The electroencephalographic recordings showed that there was no response or registration of pain. A useful approach of using biofeedback with yoga instruction is to monitor muscle activity to measure whether the person is performing the movement appropriately. Often the person tightens the wrong muscles or performs with too much effort, or does not relax after performing. An example of recording muscle tension as shown in Figure 2.

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Figure 2: Recording the muscle tension with Biograph Infinity while performing an asana.

In our research it is clear that many people are unaware that they tighten muscles. For example, Mcphetridge et al, (2011) showed that when participants were asked to bend forward slowly to touch their toes and then hang relaxed in a forward fold, most participants reported that they were totally relaxed in their neck. In actuality, they were not relaxed as their neck muscles were still contracting as recorded by electromyography (EMG). After muscle biofeedback training, they all learned to let their neck muscles be totally relaxed in the hanging fold position as shown in Figure 3 & 4.

Slide3

Figure 3: Initial assessment of neck SEMG while performing a toe touch. Reproduced from Harvey, E. & Peper, E. (2011).

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Figure 4: Toe touch after feedback training. The neck is now relaxed; however, the form is still not optimum. . Reproduced from Harvey, E. & Peper, E. (2011).

Thus, muscle feedback is a superb tool to integrate with teaching yoga so that participants can perform asanas with least amount of inappropriate tension and also can relax totally after having tightened the muscles. Biofeedback can similarly be used to monitor body posture during meditation. Often participants become sleepy or their attention drifts and gets captured by imagery or worries. When they become sleepy, they usually begin to slouch. This change in body position can be readily be monitored with a posture feedback device. The UpRight,™  (produced by Upright Technologies, Ltd https://www.uprightpose.com/) is a small sensor that is placed on the upper or lower spine and connects with Bluetooth to the cell phone. After calibration of erect and slouched positions, the device gives vibratory feedback each time the participant slouches and reminds the participant to come back to sitting upright as shown in Figure 5.

Slide5

Figure 5: UpRigh™ device placed on the upper spine to provide feedback during meditation. Each time person slouches which often occurs when they become sleepy or loose meditative focus, the device provides feedback by vibrating.

Alternatively, the brainwaves patterns (electroencephalography could be monitored with neurofeedback and whenever the person drifts into sleep or becomes excessively aroused by worry, neurofeedback could remind the person to be let go and be centered. Finally, biofeedback can be used with pranayama practice. When a person is breathing approximately six breaths per minute heart rate variability can increase. This means that during inhalation heart rate increases and during exhalation heart rate decreases. When the person breathes so that the heart rate variability increases, it optimizes sympathetic/parasympathetic activity. There are now many wearable biofeedback devices that can accurately monitor heart rate variability and display the changes in heart rate as modulated by breathing.

Conclusion: Biofeedback is a useful strategy to enhance yoga practice as it makes the invisible visible. It allows the teacher and the student to become aware of the dysfunctional patterns that may be occurring beneath awareness.

References

Arambula, P., Peper, E., Kawakami, M., & Gibney, K. H. (2001). The physiological correlates of Kundalini Yoga meditation: a study of a yoga master. Applied psychophysiology and biofeedback, 26(2), 147-153.

Harvey, E. & Peper, E. (2011). I thought I was relaxed: The use of SEMG biofeedback for training awareness and control. 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, 144-159.

Mcphetridge, J., Thorne, E., Peper, E., & Harvey, R. (2011) SEMG for training awareness and muscle relaxation during toe touching. Paper presented at the 15th Annual Meeting of the Biofeedback Foundation of Europe. Munich, Germany, February 22-26, 2011.

Peper, E., Kawakami, M., Sata, M., Franklin, Y, Gibney, K. H. & Wilson, V.S. (2005a). Two breaths per minute yogic breathing. In: Kawakami, M. (2005). The Theses of Mitsumasa Kawakami II: The Theory of Yoga-Based Good Health. Tokyo, Japan: Samskara. 483-493. ISBN 4-434-06113-5

Peper, E., Kawakami, M., Sata, M. & Wilson, V.S. (2005b). The physiological correlates of body piercing by a yoga master: Control of pain and bleeding. Subtle Energies & Energy Medicine Journal. 14(3), 223-237.

Peper, E., Tylova, H., Gibney, K.H., Harvey, R., & Combatalade, D. (2008). Biofeedback Mastery-An Experiential Teaching and Self-Training Manual. Wheat Ridge, CO: AAPB. ISBN 978-1-60702-419-4

*Reprinted from: Peper, E. (2017). Enhancing Yoga with Biofeedback. J Yoga & Physio.2(2).*55584. DOI: 10.19080/JYP.2017.02.555584

**Biofeedback and neurofeedback takes skill and training.  For information on certification, see http://www.bcia.org  Two useful websites are:

 

 

 

A breath of fresh air-Improve health with breathing

Posted: September 11, 2014 | Author: | Filed under: Breathing/respiration, Pain/discomfort, stress management, Uncategorized | Tags: , , , , , , , | 12 Comments

“My breathing was something that took me a long time to adjust. I had been breathing almost entirely from my chest and my stomach was hardly moving when I breathed. I made a conscious effort all throughout the day to breathe slowly and with my stomach relaxed. I’ve noticed that my mood is much better when I am breathing this way, and I am much more relaxed. Immediately before I feel like I would have a seizure, if I would change my breathing technique and make sure I was breathing slowly and with my stomach. It would avoid the seizure from developing… This is a huge improvement for me.”  –24 year old student who previously experienced 10 epileptic seizures per week

“I blanked out and could not remember the test material. I then reminded myself to breathe lower and slower while imagining the air slowly flowing down my legs. After three breaths, I could again process the information and continue to take the exam. A week later I got my grade back– an A-. Better than I had expected.”  –21 year old student

Breathing occurs without awareness unless there are specific problems such as asthma, emphysema or when we run out of air while exercising. Breathing is more than just the air moving in and out. It is the boundary between the conscious and the unconscious—the voluntary and involuntary nervous system— and affects the sympathetic and parasympathetic activity of our body. The way we breathe,  such as chronic low level hyperventilation,  may contribute to increasing or decreasing anxiety, pain, epileptic seizure, exhaustion, abdominal pain, urinary incontinence or fertility.

We usually think of breathing occurring in our chest. Thus, during inhalation, we puff-up our chest so the lungs will expand. Observe that many people breathe this way and call it normal. Experience how you breathe:

Put your right and on your stomach and your left hand of your chest. Now take a quick big breath. Observe what happened. In most cases, your chest went up and your abdomen tightened and even pulled in.

This breathing pattern evokes a state of arousal and vigilance and activates your sympathetic nervous system. You tend to automatically tighten or pull in your stomach wall to protect your body. When we’re in pain, afraid, anticipate danger or have negative and fearful thoughts, “Do I have enough money for the rent,” or “Feeling rushed and waiting for a delayed Muni bus,” we instinctively hold our breath, slightly tense our muscles and breathe shallowly. Unfortunately, this makes the situation worse—symptoms such as pain, anxiety or abdominal discomfort will increase. This type of breathing is the part of the freeze response—a primal survival reflex. It may even affect our ability to think.  Experience how dysfunctional breathing effects us by doing the following exercise (Peper & MacHose, 1993; Gorter & Peper, 2011).

Sit comfortably and breathe normally.

Now inhale normally, but exhale only 70 percent of the air you just inhaled.

Inhale again, and again only exhale 70 percent of the previously inhaled volume of air. If you need to sigh, just do it, and then return to this breathing pattern again by exhaling only 70 percent of the inhaled volume of air.

Continue to breathe in this pattern of 70 percent exhalation for about forty-five seconds, each time exhaling only 70 percent of the air you breathe in. Then stop, and observe what happened.

What did you notice? Within forty-five seconds, more than 98 percent of people report uncomfortable sensations such as lightheadedness, dizziness, anxiety or panic, tension in their neck, back, shoulders, or face, nervousness, an increased heart rate or palpitations, agitation or jitteriness, feeling flushed, tingling, breathlessness, chest pressure, gasping for air, or even a sensation of starving for air. This exercise may also aggravate symptoms that already exist, such as headaches, joint pain, or pain from an injury. If you’re feeling exhausted or stressed, the effects seem even worse.

On the other hand, if you breathed like a happy baby, or more like a peaceful dog lying on its side, the breathing movement occured mainly in the abdomen and the chest stays relaxed. This effortless diaphragmatic breathing promotes regeneration by allowing the abdomen to expand during inhalation and becoming smaller during exhalation as shown in Figure 1.

Figure 1

Figure 1. Illustration of diaphragmatic breathing in which the abdomen expands during inhalation and contracts during exhalation (reproduced by permission from Gorter, R. & Peper, E. (2011). Fighting Cancer-A Non Toxic Approach to Treatment. Berkeley: North Atlantic).

The abdominal movement created by the breathing improves blood and lymph circulation in the abdomen and normalizes gastrointestinal function and enhances regeneration. It supports sympathetic and parasympathetic balance especially when the breathing rate slows to about six breaths per minute. When breathing slower, exhaling takes about twice as long as the inhalation. When you inhale, the abdomen and lower ribs expand to allow the air to flow in and during exhalation the abdomen decreases in diameter and the breath slowly trails off. It is as if there is an upside down umbrella above the pelvic floor opening during inhalation and closing during exhalation.

Most people do not breathe this way . They suffer from “designer’s jean syndrome”. The clothing is too constricting to allow the abdomen to expand during inhalation (Remember how good it felt when you loosened your belt when eating a big meal?). Or, you are self-conscious of your stomach, “What would people thinks if my stomach hung out?” Yet, to regenerate, allow yourself to breathe like peaceful baby with the breathing movements occurring in the belly.  Effortless diaphragmatic breathing is the cheapest way to improve your health. Thus observe yourself and transform your breathing patterns.

Interrupt breath holding and continue to breathe to enhance health. Observe situations where you hold your breath and then continue to breathe. If you expect pain during movement or a procedure, remember to allow your abdomen to expand during inhalation and then begin to exhaling whispering “Shhhhhhhhh.” Start exhaling and then begin your movement while continuing to exhale. In almost all cases the movement is less painful and easier. We observed this identical breathing pattern in our studies of Mr. Kawakami, a yogi who insert unsterilized skewers through his neck and tongue while exhaling—he did not experience any pain or bleeding as shown in Fig 2.

Figure 2

Figure 2. Demonstration by Mr. Kawakami, a yogi, who inserted non-sterile skewers while exhaling and reported no pain. When he removed the skewers there was no bleeding and the tissue healed rapidly (by permission from Peper, E., Kawakami, M., Sata, M. & Wilson, V.S. (2005). The physiological correlates of body piercing by a yoga master: Control of pain and bleeding. Subtle Energies & Energy Medicine Journal. 14(3), 223-237).

Shift shallow chest breathing to slower diaphragmatic breathing. Each time you catch yourself breathing higher in your chest. Stop. Focus on allowing your abdomen to expand during inhalation and become smaller during exhalation as if it was a balloon. Allow the air to flow smoothly during exhalation and allow the exhalation to be twice as long as the inhalation. Over time allow yourself to inhale to the count of three and exhale to the count of 6 or 7 without effort. Imagine that when you exhale the air flows down and through your legs and out your feet. As you continue to breathe this way, your heart rate will slightly increase during inhalation and decrease during exhalation which is an indication of sympathetic and parasympathetic restorative balance. A state that supports regeneration (for more information see, Peper, E. & Vicci Tibbetts, Effortless diaphragmatic breathing).

For many people when they practice these simple breathing skills during the day their blood pressure, anxiety and even pain decreases. While for other, it allows clarity of thought.

 

 

 

 

Focus On Possibilities, Not On Limitations. Youtube interviews of Erik Peper, PhD, by Larry Berkelhammer, PhD

Posted: March 18, 2013 | Author: | Filed under: Uncategorized | Tags: , , , , , | Leave a comment

Focus On Possibilities, Not On Limitations

This interview with psychophysiologist Dr. Erik Peper reveals self-healing secrets used by yogis for thousands of years. Mind-training methods used by yogis like Jack Schwarz were explored. The underlying message throughout the discussion was that suffering and even actual tissue damage are profoundly influenced by both our negative and our positive attributions. The methods by which yogis have learned to self-heal is available to all of us who are willing to assiduously adopt a daily practice. It is very clear that when our attention goes to our pain or other symptoms, our suffering and even tissue damage worsens. When we focus all our attention on what we want rather than on what we are afraid of, we achieve a healthier, more positive, and more robust level of healing. We suffer when we have negative expectancies and we reduce suffering when we focus our attention on positive expectancies. We can train the mind to fully experience sensations without negative attributions. For the vast majority of us, we have far greater potential than we believe we have. Biofeedback, concentration practices, mindfulness practices, and other yogic practices allow us to condition ourselves to concentrate on the present moment, rather than on our negative expectancies, limitations, attributions, and fears.

Belief Becomes Biology

Dr. Larry Berkelhammer speaks with Dr. Erik Peper about the connection of our beliefs and our health.