CONTENTS

1. Title Page

2. Praise for Tech Stress

3. Copyright

4. Introduction

5. Part 1: How Technology Is Hijacking Our Lives

1. 1: Getting Back in Sync

2. 2: Genetics: We’re Hardwired Like Ancient Hunters

1. Hardwired for Danger

2. Evolutionary Traps Defined

3. 3: Stress: Do I Feel Safe?

1. When the Reptilian Brain Takes Charge

2. What You Can Do about Stress

4. 4: A Closer Look at Stress

1. How the Brain Sorts Out Stress

2. Understanding the Freeze Response

3. Stressed or Hypervigilant?

4. Safe? Risky? or Life-Threatening?

5. Breath: The Mirror of Your Reactivity

6. A Threat or a Stimulating Challenge?

7. What You Can Do

5. 5: Inactivity: Why Sitting Is the New Smoking

1. Sitting Nine Hours a Day

2. Creating a Dynamic Workstyle

3. What You Can Do

6. 6: Strain: How Strain Causes Pain

1. Documenting the Role of Tension in Injury

2. Consequences

3. What You Can Do

7. 7: Am I Addicted to My Phone?

1. The Addictive Nature of Media

2. Evolutionary Traps Revisited

3. Knowledge Is Power, unless It’s Fake News

4. A Culture of Immediacy

5. Multitasking, Interruptions, and Distractions

6. Reducing the Risk of an Accident

7. Is My Phone Dumbing Me Down?

8. What You Can Do

8. 8: Is My Phone Depressing Me?

1. Posture, Strain, and Pain

2. How Posture Can Drain Energy

3. Slouching Can Drive Down Your Hormones

4. Practical Things You Can Do About Your Posture

9. 9: Caught Up in the 24/7 Lifestyle?

1. The Importance of Biorhythms

2. Consequences of Shift Work and Sleep Debt

3. Astronauts and the 24/7 Lifestyle

4. Virtual Binging

5. Jet Lag, Sleep Lag, and Life Lag

6. What You Can Do

10. 10: Living a Virtual Life?

1. Farmer to Office Worker in Just Eighty Years

2. Social Life in the New Economy

3. Our Kids Living Virtual Lives

6. Part 2: Coping Strategies

1. 11: Thirty Hacks for Sleep

1. Fear of the Dark

2. The Downside of Artificial Light

3. Restorative Sleep

4. Thirty Things You Can Do to Get to Sleep

2. 12: Getting Off the Grid

3. 13: Hangry? Low Blood Sugar?

4. 14: Taking Microbreaks

5. 15: Dynamic Movement (a.k.a. Exercise)

1. The Ideal Workout

2. How Often Do I Need to Exercise?

3. Getting Started

4. High-Intensity Interval Training (HIIT)

5. High-Level Fitness

6. Parenting: Finding the Time to Exercise

7. Make Yourself a Priority

6. 16: Coping with Chronic Stress

1. We’re Hardwired to Respond to Stress, but Not 24/7/365

2. How Chronic Stress Differs from Crisis Stress

3. Gender Differences in Stress

4. Know Your Coping Style: Fight or Flight?

5. What You Can Do

7. 17: Skills for Sanity

1. 17.1. Identifying Energy Drains and Gains—Reclaiming Lost Energy

2. 17.2. The Importance of Choice

3. 17.3. Knowing Who You Are

4. 17.4. Asking for What You Need

5. 17.5. Sharing Gratitude

8. 18: Reframing

1. 18.1. Turning Failure into Success

2. 18.2. Using Imagery to Change a Habit

3. 18.3. Overcoming Negative Self-Talk: Thought Stopping

4. 18.4. Rethinking Traumas from the Past

5. 18.5. Celebrating What You’ve Done Right

9. 19: Overcoming Burnout

1. The Stress Curve

2. Sleep

3. Depression

4. Transforming Chronic Stress

10. 20: Recovering from Injury

1. Make Healing Your Priority

2. Case Study: Biofeedback

3. Creating the Basis for Healing

4. Additional Resources for Recovery

7. Part 3: Practical Ergonomics

1. 21: The Basics

1. 1. Everyone Is Different: There Is No “Average” Person

2. 2. Arrange Your Physical Environment to Fit Your Body—to Your Specific Height, Weight, and Proportions—to the Extent That You Can

3. 3. Uncomfortable Posture Is a Risk Factor for Injury

4. 4. Remind Yourself That Adaptations Are Usually a Compromise

5. 5. Ergonomics Is Only One Piece of the Puzzle

6. Who Pays for What?

2. 22: Which Desk? Which Chair?

1. The New Workstyle

2. Optimizing Your Chair

3. Cost-Effective Ergonomics

4. Choosing a Chair

5. Re-envisioning the Desk

6. Options for a Desk

3. 23: Monitors and Mice

1. Adjusting the Monitor

2. Keyboarding

4. 24: Laptops, Tablets, and Phablets

1. Optimizing Your Laptop

2. Sharing a Desk at the Office

3. Working in a Coffee Shop

4. On the Road

5. Hotel Rooms

6. Working Informally at Home

7. At the End of the Day

5. 25: Minimizing Risk

1. EMF: Knowing Your Risks

2. Promoting Balance in Our Children’s Lives

6. 26: Final Thoughts

7. Acknowledgments: A Note from Erik Peper

8. Glossary

9. Appendix A

10. Appendix B

11. Tech Stress Reading and References

1. Part 1. How Technology Is Hijacking Our Lives

2. Part 2. Coping Strategies

3. Part 3. Practical Ergonomics

12. Index

13. About the Authors

14. About North Atlantic Books

Tech Stress

How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics

Erik Peper, PhD, BCB | Richard Harvey, PhD

with Nancy Faass, MSW, MPH

Praise for Tech Stress

“This comprehensive resource is invaluable and captures decades of research and learning through hands-on work with employees. Erik’s and Rick’s work breaks the cycle of injury and re-injury so often experienced in repetitive strain injuries. Once employers and employees understand and apply the concepts and tools within this book, they will never want to return to the monolithic ergonomic practices of the past.”

—Michael J. Martin, JD ARM, associate vice president Human Resources, Safety and Risk Management at California State University Maritime Academy

“Tech Stress is a timely call for active intervention in our digitally saturated environment. Distilled from two decades of collaborative research and successful treatments, the book provides us sobering lessons and a handy guidebook to improve our well-being through integrative self-care. Having benefited tremendously from the outlook and the micro-techniques introduced in this book, I hope the readers will enjoy the transformative experience in their work and life by incorporating the many tips provided by the authors. In our digitally dependent world, Tech Stress teaches us how to be human again, as we continue to evolve with technology.”

—Weihong Bao, PhD, author of Fiery Cinema: The Emergence of an Affective Medium in China, 1915–1945 and associate professor, Department of Film and Media, Department of East Asian Languages and Cultures, UC Berkeley

“In a world where we are increasingly working long hours in front of a computer, most of us don’t realize that we are at risk of occupational injury. Many of us encounter pain due to the poor ergonomics of our desk, chair, or keyboard. Additionally, our work lulls us into an unceasing work mode lacking breaks, adequate stretching, ideal nutrition, and proper breathing. Peper, Harvey, and Faass examine the ins-and-outs of these challenges in Tech Stress, detailing not only how computer work injures us, but also how we can optimize our workspace and minimize the risk of musculoskeletal pain, fatigue, depression, and burnout.”

—Jonathan Collin, MD, founder and editor-in-chief of Townsend Letter

“Tech Stress helps us recapture our physical and emotional well-being as it addresses the negative impacts in our altered world where technological tools have become the focal point of our social, familial, and work-world existence.”

—Leroy M. Morishita, EdD, president, California State University, East Bay

“Few have done the level of applied research into finding solutions that these authors have. Their leadership in this field is well known and evident in this sweeping work that is up to date, comprehensive, and contains all of the practical information you need to dramatically and positive impact your life. I have followed and benefited personally from their work for many years, called on them to speak at our technology and well-being events, serve as experts for the investment community and company founders, and more. It’s rare if not unheard of to find this level of applied wisdom on this topic in one place. Get this book, learn from it, and (most importantly) apply it!”

—Jeffery A. Martin, PhD, founder of Transformative Technology and lecturer at Stanford University

“Tech Stress is years overdue. This book reminds its readers that their bodies and reflexes are the products of human evolution, and are designed for activity and physical exertion—not for sitting and slouching. Erik Peper, Richard Harvey, and Nancy Faass have grounded their keen observations and practical suggestions in solid research as well as evolutionary theory. The very technological advances that were supposed to make life easier seem to have reduced life expectancy and enjoyment. Instead of saving time, technology has increased the amount of time people spend in tending to their phones, their computers, and other apps. But the readers of Tech Stress can find ways to foil the burdens of misapplied technology, embracing pleasure, happiness, and the appreciation of the very Nature in which they are embedded, whether they realize it or not.”

—Stanley Krippner, PhD, coauthor of PTSD: Biography of a Disease and coeditor of Integrative Care for the Traumatized

“Grounded in evolutionary theory and psychophysiology, this book is a must-read for anyone who spends time in front of a computer or using a mobile device. Peper, Harvey, and Faass present practical, easy-to-use solutions for combating the stress and pain many of us experience due to technology use and overuse. While this book offers extremely helpful tips for ergonomic use of technology, it goes way beyond that, offering simple suggestions for improving muscle health that seem obvious once you read them, but would not have thought of yourself: “Why didn’t I think of that?” You will learn about the connection between posture and mood, reasons for and importance of movement breaks, specific movements you can easily perform at your desk, as well as healthier ways to utilize technology in your everyday life.”

—Inna Khazan, PhD, BCB, licensed clinical psychologist, faculty member at Harvard Medical School, and author of Biofeedback and Mindfulness in Everyday Life and The Clinical Handbook of Biofeedback

“A must-read for every ‘stressed person!’ Key to well-balanced life in the modern era. The most comprehensive analysis I have read, a life-changing journey from understanding to action plan in gaining ownership of our lives in the modern era by balance, awareness, and setting boundaries.”

—Oded Cohen, CEO and founder of Upright® Technologies Ltd.

“Refreshingly clear and direct, Tech Stress offers much-needed explanations followed by scientifically backed advice on how to balance adapting our technology to our bodies and our bodies to our tech.”

—Dr. Mari K. Swingle, author of i-Minds: How Cell Phones, Gaming, and Social Media are Changing Our Brains, Our Behavior and the Evolution of Our Species and i-Minds 2.0: How and Why Constant Connectivity is Rewiring our Brains and What to Do about It

“Put down your phone. Read Chapter 7. Then think twice about picking up your phone again.”

—Deborah Quilter, host, RSIHelp YouTube and author of The Repetitive Strain Injury Recovery Book and Repetitive Strain Injury: A Computer User’s Guide

“Brilliant!!! Tech Stress: How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Sit to die! Inactivity is as risky as smoking 2 or 3 packs of cigarettes a day! The time has come to wake up to the serious health damage of technological physical inactivity.”

—C. Norman Shealy, MD, PhD, founding president of American Holistic Medical Association and author of Conversations with G: A Physician’s Encounter with Heaven

Copyright © 2020 by Erik Peper. All rights reserved. No portion of this book, except for brief review, may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without the written permission of the publisher. For information contact North Atlantic Books.

Published by

North Atlantic Books

Berkeley, California

Cover design by Howie Severson

Cover image © Artistdesign29/Shutterstock.com

Book design by Happenstance Type-O-Rama

Printed in Canada

Tech Stress: How Technology Is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics is sponsored and published by the Society for the Study of Native Arts and Sciences (dba North Atlantic Books), an educational nonprofit based in Berkeley, California, that collaborates with partners to develop cross-cultural perspectives, nurture holistic views of art, science, the humanities, and healing, and seed personal and global transformation by publishing work on the relationship of body, spirit, and nature.

Chapter 19: “Overcoming Burnout” © Steve Amoils, MD, and Sandi Amoils, MD/Alliance Integrative Medicine, www.myhealingpartner.com, 2011–2020.

MEDICAL DISCLAIMER: The following information is intended for general information purposes only. Individuals should always see their health care provider before administering any suggestions made in this book. Any application of the material set forth in the following pages is at the reader’s discretion and is his or her sole responsibility.

North Atlantic Books’ publications are available through most bookstores. For further information, visit our website at www.northatlanticbooks.com or call 800-733-3000.

Library of Congress Cataloging-in-Publication Data

Names: Peper, Erik, author. | Harvey, Richard, 1958- author. | Faass,

Nancy, author.

Title: Tech Stress : How Technology Is Hijacking Our Lives, Strategies for

Coping, and Pragmatic Ergonomics / Erik Peper PhD, BCB, Richard Harvey

PhD, Nancy Faass MSW, MPH.

Description: Berkeley, California : North Atlantic Books, [2020] | Includes

bibliographical references and index.

Identifiers: LCCN 2020003932 (print) | LCCN 2020003933 (ebook) | ISBN

9781583947685 (trade paperback) | ISBN 9781583947821 (ebook)

Subjects: LCSH: Technology—Psychological aspects. | Stress management. |

Human engineering.

Classification: LCC T14.5 .P46 2020 (print) | LCC T14.5 (ebook) | DDC

601/.9—dc23

LC record available at https://lccn.loc.gov/2020003932

LC ebook record available at https://lccn.loc.gov/2020003933

This book includes recycled material and material from well-managed forests. North Atlantic Books is committed to the protection of our environment. We print on recycled paper whenever possible and partner with printers who strive to use environmentally responsible practices.

“We are wired for whatever habitat we evolved in. Biologists who study animals in the wild describe this as habitat selection theory, and the general rule is that animals who are in their natural habitat do much better—thrive both physically and psychologically, and in terms of social behavior—compared to animals that are placed in an unnatural habitat such as a zoo.”

—Ming Kuo, associate professor, University of Chicago at Urbana-Champaign

“Organisms, when housed in unfit habitats, undergo social, psychological, and physical breakdown.”

—E.O. Wilson, professor emeritus, Harvard University, the father of social biology

“The behavior of other social animals is determined to a large extent by their genes … since the Cognitive Revolution, Sapiens have been able to change their behavior quickly, transmitting new behaviors to future generations without any need of genetic or environmental change.… Sapiens could transform their social structures, the nature of their interpersonal relations, their economic activities, and a host of other behaviors within a decade or two.….”

—Yuval Noah Harari, historian, Hebrew University of Jerusalem

“We wonder if our immersion in digital displays, and our sedentary workstyle and lifestyle, are factors contributing to ill health and social breakdown. We have found that respecting our evolutionary roots and incorporating this wisdom into our daily lives has the potential to promote health, well-being, and quality of life. When we look back at the past, at the big picture, it’s clear that we have the capacity for change.….”

—Erik Peper, PhD, BCB, Richard Harvey, PhD, and Nancy Faass, MSW, MPH

Introduction

This book is the outgrowth of our research, which began in 1994 with a request to help an employee in severe pain who had been diagnosed with repetitive strain injury. Even though his computer station had been ergonomically adjusted, and his employer had bought him a special ergonomically designed chair, he continued to experience pain. Eventually the pain became so great, he had to stop working.

The most common approach at that time (and currently today) was to assess ergonomics and optimize the arrangement of the screen, keyboard, desk height, and chair. Given our background in performance coaching, psychology, and physiology, it became clear that ergonomics was only one component of the problem.

Namely, even when the ergonomics was correct, that did not mean that the person’s psychology or physiology was optimized. And even with the correct ergonomics, some people still developed muscle tension that eventually manifested as injuries. In almost all cases, people were totally unaware that as they worked, they tightened their muscles unnecessarily (even muscle not needed for the task), that they did not relax those muscles after the task was completed (even though they thought they did), that they were developing eyestrain, and that they breathed too shallowly. What’s more, few people realized the total impact on their health of these subtle changes, day in, day out.

We found that the individuals’ stress levels, their reactions to their workload, deadline pressures, and relationships on the job (as well as family-related stress that they carried with them into the office), combined with the lack of awareness of tension, were all cofactors.

Based on what we learned from these early cases and consultations, we decided to do research to see if these insights applied to others as well. By 1996 we had performed a number of studies and developed a work-site program as more and more employees began reporting computer-related injuries. These computer-related disorders were occurring with greater frequency as computers continued to replace typewriters across the country. Although it seemed initially that these were just repetitive strain disorders, that did not explain why some people entered data very little and got injured, while others entered data for hours and never developed symptoms.

Lifestyle and workstyle shifts were evolving around screen use, associated with long hours of computer work, television viewing, and sedentary life. (Today the use of social media has added a fourth dimension to our culture’s fascination with on-screen visual images.) This workstyle is a disconnect from human genetics, physiology, and even behavior that evolved over millions of years. The introduction of new technologies in the workplace, like the introduction of mechanization more than a century ago, paired with urban lifestyle, is at the root of this evolutionary disconnect.

In response to these experiences, we offer strategies for coping with Tech Stress, an approach that we developed to optimize workplace health and well-being.

—Erik Peper and Richard Harvey

PART 1

HOW TECHNOLOGY IS HIJACKING OUR LIVES

1

Getting Back in Sync

A $50 billion problem. Every year, millions of office workers in the United States develop serious injuries or health problems on the job. You’d think that an office job would be safer than factory work, but the truth is that most of these conditions are associated with our deskbound workstyle.

Back injuries are just one example, with direct medical costs that top $50 billion every year. Back problems are not simply an issue for workers doing physical labor. Currently, the people at greatest risk of injury are those with a desk job making over $70,000 annually. We’re just not designed to sit in front of a computer all day and a TV all night.

Story of a Programmer

When I got my first big contract, I jumped at the chance to work at home. Make my own hours, work at my own pace, no pressure from the office … sweet, right? Wrong!

I’d been an athlete in college, so I wasn’t used to sitting at a computer all day. To meet the constant (insane) deadlines, I worked long hours and rarely took breaks. My body grew sore, and I felt tired and achy a lot of the time. Then my legs began to swell from poor circulation. Soon the swelling in my ankles was so bad I could hardly put on my socks.

The worst blow came when I began planning a trip to see my folks for Christmas. My doc told me that I couldn’t fly, because I was at risk of a heart attack. My circulation was so bad, he worried that a clot might damage my heart. I was forty years old. That’s when I realized I needed to make some serious changes.

This matters. The data show that one in two adults will report a musculoskeletal condition uncomfortable enough to require medical attention. Similarly, one of every three office workers in the United States experiences back pain.

- Fifty-five million employees report recurring fatigue.

- Forty-five million have back injuries linked to computer use.

- Forty-five million workers suffer from tension headaches or carpal tunnel syndrome.

More than 30 percent of North Americans who work at a computer develop a muscle strain injury in any given year. In Japan and the Middle East, similar rates of injury have been reported. Globally, computer-related disorders continue to be on the rise.

These conditions can affect anyone who spends long hours at a computer. In a large survey of high school students, 85 percent experienced tension or pain in their neck, shoulders, back, or wrists after working at the computer. Additionally, the longer they spent on social media or binge-watching, the greater their risk of depression.

How We Know What We Know

For the past twenty years, teams of researchers all over the world have been evaluating workplace stress and computer injuries—and how to prevent them. As researchers in the fields of holistic health and ergonomics, we observe how people interact with technology. What makes our work unique is that we assess employees not only by interviewing them and observing their behaviors, but also by monitoring their actual physical responses.

That means measuring muscle tension and breathing, in the moment, in real-time, while they work. To record shoulder pain, for example, we place small sensors over different muscles and painlessly measure the muscle tension using an EMG (electromyograph), a device that is employed by physicians, physical therapists, and researchers. Using this device, we can also keep a record of their responses and compare their reactions after we have them change the way they work.

The EMG enables us to graph and visually describe how a participant’s muscles react as they perform various tasks at the computer. We can see on the screen, second by second, how people are responding. When a muscle isn’t being used, the level of tension registers as zero. Then we measure how much the muscle is tightened and how long it is held in tension.

What we’ve learned is that people get into trouble if their muscles are held in tension for too long. Working at a computer, especially at a stationary desk or workstation, most people maintain a low level of chronic tension for much of the day. Shallow, rapid breathing is also typical of fine motor tasks that require concentration, like data entry (see figure 1.1). When these patterns are paired with psychological pressure due to office politics or job insecurity, the level of tension and the risk of fatigue, inflammation, pain, or injury increase. In most cases, people are totally unaware of the role that tension plays in injury.

Figure 1-1 Muscle tension and breathing rate usually increase during data entry or typing without our awareness.

How much is too much? These reactions differ from one person to the next. Some people have many quick-firing muscles, and others have muscles that react slowly. This is another factor in who gets injured and who doesn’t. As consultants, often we can predict who is most likely to develop an injury just by measuring their shoulder muscle tension. The absolute level of tension does not predict injury—rather, it is the absence of periodic little rest breaks (relaxation breaks) throughout the day that seems to correlate with future injuries. You can get a sense of how quickly tension builds up with the following exercise.

Experience It: Basic Concepts Underlying Tech Stress

- You can do this simple mousing exercise at the computer or as a simulation. If you’re at the computer, turn it off, and sit erect with your hand on the mouse next to the keyboard. To simulate the exercise, sit with erect posture as if you were in front of your computer and hold a small object you can use to imitate mousing.

- With the mouse (or the sham mouse), pretend to draw the letters of your name and your street address backward, right to left. Be sure each letter is very small (less than half an inch in height). After drawing each letter, click the mouse.

- Draw the letters and numbers as quickly as possible for ten to fifteen seconds, trying not to make any mistakes.

What did you observe? In almost all cases, you may note that you tightened your mousing shoulder and your neck, stiffened your trunk, and held your breath. All this occurred without awareness while performing the task. Over time, this type of muscle tension can contribute to discomfort, soreness, pain, or eventual injury.

We would like to provide a snapshot of what we’ve observed in our work and what we think is going on:

1. Good ergonomics are not enough. By studying the physical reactions of people with computer injuries, computer-related disorders, and workplace aches and pains, it became clear that just replacing the equipment was not enough. Improving the ergonomics was not sufficient. People were still getting injured, and many of those who got injured weren’t getting well. This observation raised questions about why simply applying ergonomic solutions often does not resolve the problem, and why we need more than ergonomics to solve workstyle injuries, conditions, and disorders.

2. People are usually unaware of muscle tension until it hurts. When we monitor muscle tension, employees often tell us that their muscles are relaxed. However, as measured by the equipment, we find that their muscles are contracted and tight. This is similar to being unaware that your shoes or belt are too tight. Yet the moment you kick off your shoes or loosen your belt, you feel better.

3. Sitting is the new smoking. Our bodies aren’t suited to the physical inactivity of the modern workplace. A quick look at human history shows why. The hunters and gatherers who roamed the earth for more than half a million years were very physically active. Today the majority of people live in urban settings. Many of us work in offices, and our jobs involve very little physical exertion. Yet we’re still genetically programmed like nomadic hunters and gatherers—our bodies and our reflexes are still hardwired for activity and physical exertion. (For more insight on this, see chapter 5.)

4. Physical tension has side effects. When we’re not getting enough physical activity, tension builds up in our bodies that eventually affects our muscles and nerves. Over time, this tension can cause insomnia, fatigue, and eventually, chronic pain conditions.

5. Mental stress is another cause of injury. We’ve found that stress and tension are major factors in these conditions—particularly in back and neck problems and repetitive strain injuries. Mental and emotional stress, like inactivity, can underlie chronic muscle tension and contribute to workplace injuries. In call centers, for example, when calls are monitored by a supervisor, those workers have a higher rate of muscle tension and eventual health issues compared to workers who can work more independently.

Once we realized that stress (both external and self-induced pressures) contribute to injury, we knew that we needed a more holistic approach to computer-related health issues and workplace burnout. In response, we developed a practical self-help program to reduce stress and prevent injury. The program is based on more than one hundred of our research studies in biofeedback, physiology, and body mechanics. At least twenty of these studies looked specifically at what happens to our bodies when we use a computer. We also drew on leading-edge research from around the world.

The Story of an Accountant

A busy professional, Sarah was still suffering two years after she began having neck pain. Her supervisor had brought us in as ergonomics consultants, and her boss had followed our recommendations. The company purchased a new chair and a keyboard, but Sarah was still in a terrific amount of pain.

Despite correct ergonomics, she continued to suffer—yet the worker in the next cubicle with a lousy ergonomic setup had no history of injury. How come? Sarah realized that it was time to get serious about the pain. Candice, her best friend at work, was home on leave after failed back surgery. The employer was sobered by the $75,000 price tag on the surgery—with no end in sight to the bills for rehab and disability leave.

One of our first strategies as consultants to Sarah’s firm was to measure the tension in her neck muscles using an EMG device. It showed that her neck and shoulders were a mass of knotted tension when she worked at the computer. The tension was driving the pain. With the readout in front of us, we began to sort through the possible causes of the problem, beyond the ergonomics. Soon it became clear that Sarah’s overreactive boss was a key factor. Her response? “I’m out of here.” She put in for a transfer, joined a gym, and never looked back. It has been two years, and today Sarah has no more neck pain.

—Erik Peper and Richard Harvey

Health issues similar to those described in the sidebar are often problems that cannot be fixed with a single solution—neither ergonomics, nor exercise, nor stress management alone is enough to overcome the strain and drain of modern workstyle. We need to look at the problem from new, more holistic perspectives.

Figure 1-2 Even at the beach, we cannot leave the digital world behind. (Photo by Erik Peper)

The Caveman at the Computer

We began our research in 1996. The Human Genome Project was completed in 2003, cracking the code on human genetics. Given what we know today about genetics, it’s clear that we need to evolve a healthier workstyle. Although our environment is changing at warp speed, our genetics have scarcely changed over the past half million years. Computers and similar technologies became an integral aspect of our workstyle less than forty years ago. The first smartphone—the iPhone—was just introduced in 2004.

Yet according to the Human Genome Project, we’re still genetically wired like the hunters and gatherers. We’re better suited for hunting and gathering than typing and clicking. Today we sit for hours at the keyboard and spend hours on the phone, texting, pecking away, moving just the muscles of our fingers instead of walking, climbing, reaching, digging, pounding, lifting, pushing, pulling, running, or swimming.

Today most of us spend more time with our phone and our computer than we do with our life partner or our best friend. We take our electronics with us everywhere, use them anytime, and typically can’t engage in work, play, shopping, or communication without them.

We rush to buy the latest technology, thrill at the latest breakthrough, are primed and ready to adopt the next-new-thing to do more, faster, and better than last year’s tech. We put up with all kinds of aches and pains without giving them a second thought, just to stay in the game. Using the latest gadgets, many of us become stoic sufferers, sore and tired. Note that four of the top health complaints people take to their family doctor—fatigue, tension headaches, back pain, and repetitive strain—can be caused by long hours on the phone or at the computer.

Figure 1-3 Despite a modern appearance, we carry the genes of our forebears—for better and for worse. (Art courtesy of Peter Sis)

Even our eye muscles are getting out of shape! Instead of scanning the horizon for dangerous animals or searching for food, we stare at a screen for hours on end. Our bodies are built to move, so modern workstyle is vastly out of sync with our genes. As a result, many of us pay the price with anxiety, depression, insomnia, or chronic pain. In parts of the world where tech is prevalent, children now develop nearsightedness at a young age and often need to wear glasses. For context, nearsightedness is a condition that typically develops after age forty. We’re not designed to be glued to a screen morning, noon, and night, nor are we designed to text while we eat. We need to adapt—to develop new skills so we can survive the limits of our technology, our workplace, and lifestyle.

The Missing Manual for the Human Frame

Although every computer comes with volumes of detailed instructions on how to use the hardware and software, almost nothing is mentioned about how to develop a healthy, productive, and creative work environment. Companies spend billions on equipment and training, yet often little is spent to prevent injury.

How to Use This Book to Overcome Tech Stress

This book was written for everyone who has ever walked away from a computer at the end of the day, sore and exhausted, wondering if there could be more to life.

- In an unhealthy relationship with your phone? We all struggle with this one at times. Chapters 7, 8, and 12 offer strategies you might take to “break up” with your phone (at least for a few hours).

- Developing headaches or neck pain? Chapter 8 explains how smartphones and tablets can be a pain in the neck and what to do about it.

- Ready for something new? Chapters 11 through 20 will help you ease out of that old lifestyle and into a new you.

- Bone tired? To reduce the annoying aches and pains we all get after long hours at the computer, see chapter 11, “Thirty Hacks for Sleep.” The backstory can be found in chapters 6 and 12.

- Frazzled foodie? Dieting and wondering why that old injury still hasn’t healed? Chapter 13 could help you get a jump-start on food issues and reduce your inflammation at the same time.

- Need a break? At last, a book that gives you permission to take a break, and the rationale for justifying breaks to your boss. Don’t miss chapter 14, “Taking Microbreaks,” and chapter 15, “Dynamic Movement.”

- Unrelenting stress? Chapters 16 through 20 offer useful tools for sorting through big stress issues and making tough decisions.

- Fixed your ergonomics, but that didn’t fix the problem? This book fills in some important missing pieces (see chapters 21 through 25 on practical ergonomics).

Ready for a change? You’ll find useful strategies, work-arounds, and hacks for work and life. Enjoy!

2

Genetics: We’re Hardwired Like Ancient Hunters

Figure 2-1 Ascent of Man. (Illustration by Braldt Bralds, with permission to alter the image)

Modern humans have moved from hunting and gathering to the information age in a moment of evolutionary time. Yet to continue to thrive, we need to appreciate how we have evolved and survived.

Hardwired for Danger

Our genes reflect behaviors that gave our forebearers definite survival advantages, enabling them to endure, have offspring, and pass their genes on to us. These genetic patterns have been transmitted over millions of years, increasing our survival as a species. To adapt in the present, it is helpful to understand these survival patterns and see how they operate in us today.

Consider our reflexes. We’re still genetically designed to respond to danger—we were once the preferred food of lions, tigers, and bears. We were their prey. (This is evident from Paleolithic art worldwide, which frequently includes depictions of lurking creatures, as in figure 2.2.) Even today, when we’re stressed, our first instinct is to confront or run—recognized as the fight or flight response.

Figure 2-2 One of the oldest pieces of human art on the planet, a drawing of a feline predator. Namibia, 25,000 BC. (Wikimedia, public domain)

Today, most of us only encounter a life-threatening situation on rare occasions, if we have been deployed in a war zone, work in law enforcement or fire-fighting, or live in a neighborhood known for violence. For the rest of us, the stress response seems to be an inconvenience (until we need it, in which case, it could be life-saving). However, the hunter-gatherers from whom we are descended lived in a much more dangerous world. The stress response, which occurs in all mammals, has ultimately served as the basis for our species’ survival. This physiology has enabled us to live on and fight another day, to breed and pass on our genes.

Today we respond to threats—both actual, physical threats as well as perceived, psychological threats—with the same type of defenses. The stress response may be triggered by an angry dog or an angry supervisor. Our reaction could be caused by the drunk driver that just cut in front of us on the freeway, but it might also be triggered by the inconsiderate jerk who just cut in front of us in line while we were waiting to see a movie with our partner. The result: a racing heart and intense anger or anxiety as we tense up, prepared to spring into action.

Here we want to give you tools to recognize stress and cope with it more effectively. For most of us, it takes a great deal of practice and some ingenuity to learn to manage these automatic survival responses, but we assure you, this is well worth the effort.

LIFE FORTY THOUSAND YEARS AGO

Imagine going back to the Paleolithic era, to the timeless lifestyle of the hunters and gatherers—a way of life that persisted over hundreds of thousands of years, changing only slightly from year to year. Envision the world through their eyes, forty millennia in the past.

The day began at sunrise and ended at sunset. No electricity, no electric lights. In the nighttime sky, thousands of stars clearly visible, constantly reminded us of the vastness of nature and our minute place in the scheme of things. This was a world without modern technology in any form, no cars or planes, a world without computers or cell phones. No refrigerators, no grocery stores, no packaged food. On the steppes of Asia, people stored meat in caches below the icy tundra, but for everyone else, getting dinner meant going hunting, foraging, or eating dried food (the first left-overs). Part of every winter was spent fasting as the root vegetables, dried herbs, and preserved meat and fish ran low.

Figure 2-3 Rhinoceros depicted on a wall of the Chauvet Cave in France, about 28,000 to 31,000 years ago. (Wikimedia, public domain)

Without antibiotics, an accident while hunting, such as a run-in with a rhino or a bison, could easily be fatal. Note how prominently the horns were emphasized by an unknown artist thirty millennia ago on the wall of a French cave, shown in figure 2.3. The danger involved in these encounters is evident in animal paintings found on rock walls and caves worldwide.

Evolutionary Traps Defined

Since the time of the first peoples, the world has changed radically, and we are attempting to survive and prosper in this new environment, in a world that is often at odds with our evolutionary past.

Although it’s the twenty-first century, we’re still predisposed, genetically, to react to signals of danger in our physical environment, whether that’s a forest or a concrete jungle. We respond as if we were reacting to signals in a natural landscape forty thousand years ago. Yet today, instead of supporting our survival, these signals often become evolutionary traps that contribute to chronic stress, psychological burnout, or even the risk of physical injury.

Evolutionary traps occur when adaptive behaviors that were once successful become maladaptive or even harmful. When this occurs, cues that were protective or beneficial can lead to reduced health and fitness.

Evolutionary Trap 1

We are genetically hardwired with an attraction to sugars and fats, high-calorie sources of energy for survival. Today this puts us at risk of obesity and diabetes.

Our sweet tooth has had tremendous survival value over the millennia. Surprisingly, the ability of any newborn to draw milk from their mother’s breast is a learned skill. One can see this in a litter of puppies or kittens. Those less effective at nursing do not grow as large and are often not as strong (referred to as the runt of the litter). In humans, babies with a poor appetite experience “failure to thrive.” To assure survival, human babies are born with an attraction to sweet flavors configured into their DNA, because mother’s breast milk is sweet.

Even newborns like sugar. We know about this preference for sweets through some ingenious research. Newborns are routinely tested for conditions such as PKU (phenylketonuria), a potentially life-threatening genetic error that renders humans unable to metabolize certain proteins. The PKU test involves a finger prick to draw a single drop of blood. Researchers tracked two groups of newborns—one group had the necessary finger prick and the other group got a finger prick and a drop of sugar. Researchers found that the tikes who got the drop of sugar stopped crying immediately, while those who did not continued to cry and needed comforting. The fact that the response is present at birth suggests that consuming sugar is comforting in a way that is associated with survival.

Three pounds of honey a year. Our preference for sweets has landed us in a world of trouble. People who lived thousands of years ago would have only eaten sweets as fruit or an occasional honeycomb. The current estimate is that they probably consumed 2 to 5 pounds of natural, unrefined, unprocessed sugars, such as honey, per year, in total. Today the current estimate is that the average American eats approximately 130 pounds of processed sugar a year—almost half a pound a day!

Enter high-fructose corn syrup and the obesity epidemic. Comparing trends in food consumption and health, researcher Gary Taubes observed that the year inexpensive high-fructose corn syrup was introduced in the food chain is the year attributed to the beginning of the obesity epidemic in the United States. The devastating effect of both these simple processed carbs is reflected in prediabetic status among more than one-third of American adults. Of those who develop type 2 diabetes, two-thirds will perish from some form of heart disease or stroke. Obesity also correlates with increased cancer incidence. In addition, obesity is now recognized as a major contributing factor in the development of dementias such as Alzheimer’s disease, which some researchers have labeled as “type 3 diabetes.”

Factory food. For the past hundred years or so, a portion of our food supply has been made in factories, whereas from an evolutionary perspective, our genes reflect millions of years eating foods from the natural environment. Eating factory-processed, manufactured food rather than fresh fruits, vegetables, and proteins is essentially a social experiment, and clearly the last word is not in on the results.

Blame the victim. The temptation to eat sweets is enormous, because sweets seem to be evolutionarily associated with survival. However, instead of blaming industrial and commercial interests who want to sell more processed products, it is the individual we tend to blame when they eat sweets and develop obesity. This message is particularly effective in cultures that emphasize rugged individualism and individual responsibility.

Today there is the concern that companies exploit evolutionary traps for the purpose of improving profits. This potentially constitutes a major health risk for humanity. Our preference for sweets is just one of the evolutionary traps that big business exploits.

Should we also factor in the role of the food industry, which caters to the demand for fast, convenient, cheap food and has exploited this evolutionary desire for sweet calories? Sugar is now found almost everywhere in the foods we consume. An obvious question is raised: Can we hold a small child responsible for wanting to eat the candy bar at the checkout counter in the supermarket, or should we hold the food industry responsible for exploiting this evolutionary trap—just as we now hold tobacco companies responsible for the addictive nature of their products and their role in human illness?

The more we respect our evolutionary past and acknowledge its influence on our lives, the more likely we are to stay healthy.

The Albatross’s Evolutionary Trap

The concept of an evolutionary trap applies to other species as well. Their behaviors are guided in part by their evolution just as ours are. For many of the species that are now endangered, there may be profound health impacts. An example in our era is illustrated by the death of albatross seabirds on Midway Island, captured in a photo essay by Chris Jordan (figure 2.4).

Figure 2-4 Albatross, Midway Island. Example of one of the thousands of dead albatross found on Midway Island in the North Pacific, two thousand miles from any other island. The birds confuse shiny pieces of plastic for food, a mistake that eventually proves fatal. (Photo by Chris Jordan)

In the past, through natural selection, the birds most effective at catching fish flourished and had more offspring. The birds that thrived were those that responded to the shimmer and scent of small fish near the surface of the water. Yet today, the descendants of those birds misidentify objects of plastic, shimmering on the surface of the ocean, as fish. These seabirds perish from injury and starvation, so their predisposition to eat shiny objects that look like fish functions as an evolutionary trap. Researchers Chris Wilcox, Erik Van Sebille, and Britta Denise Hardesty estimate that about 90 percent of all seabirds are currently ingesting plastic. Their research, published by the U.S. National Academy of Sciences, predicts that plastic ingestion will affect 99 percent of all seabird species by 2050.

One could argue that it is the birds’ fault for not being able to differentiate plastic from fish. However, the pattern is genetically hardwired into their DNA, passed on generation after generation. As they hunt for fish, they automatically repeat the successful behaviors that promoted survival in their ancestors.

Other evolutionary traps we will describe relate to patterns of behavior that enabled our ancestors to survive. Unfortunately, these survival patterns no longer serve us and, when triggered, may even harm us.

3

Stress: Do I Feel Safe?

We know that our ancestors were hunters, but for much of our evolution, we were also prey—humans were a tasty morsel for large predators. As a result, we’re hardwired to react at the first sign of possible danger, like rapid movement in our visual field or sudden, sharp noises. When we sense imminent danger, our bodies shift into a massive, superbly coordinated effort to fight or flee.

Evolutionary Trap 2

We are wired to identify danger. When we’re dealing with a major crisis or intensely angry, the stress response involves a full-blown acute physical reaction, with heart pounding and blood racing.

This reaction is triggered by signals from deep within the brain in the hypothalamus. That floods the body with stress hormones such as adrenaline, which stimulates the heart and muscles, and cortisol, which triggers the release of blood sugar. The goal is to power our muscles so we can run or defend ourselves.

Figure 3-1 An intense confrontation tends to call up the stress response. (Lion: Wikimedia, public domain)

During the Paleolithic period, humans were vastly outnumbered by predatory wildlife. Today, we’re no longer hunters encountering dangerous animals in the wild. In the United States, more than 90 percent of us live in urban areas, and at least one-third of us work in offices. What happens when an extreme stress response is triggered at work? Or at home? How can we learn to manage stress more effectively?

We are most vulnerable to the effects of distress when we feel threatened. In situations that jeopardize our survival, the flight or fight reaction is our natural default. (This is true whether the potential loss involves our reputation, social standing, status, or the loss of money, life, or limb). The fight response can range from lashing out verbally to physical violence; flight may manifest as passive silence or total withdrawal. When fear is added to the mix, the anticipation of danger immediately floods our body with adrenaline, then with cortisol, attaching a sense of urgency to the situation that travels quickly throughout the nervous system.

The risk of lashing out in the throes of stress. In very broad strokes, neuroscientist Stephen Porges has described how we perceive safety and danger. When we’re under immediate, emergent stress, our neurons process information with astonishing rapidity in the unconscious mind. Under stress, these signals are routed through two distinct areas of the brain:

The reactive reptilian brain. Your primal instincts are located just above your neck, at the base of your skull, in the brainstem (in the amygdala). Responsible for instinctual behavior involved in aggression, dominance, and territory, this area of the brain triggers automatic reactions when we’re under stress. The amygdala is associated with basic emotions such as fear, anxiety, and anger. These ancient brain structures date back to more than 500 million years ago and are present in species ranging from reptiles to humans.

The rational mind. Your cortex is a much later add-on to the brain that evolved in the last five million years or so. Located right behind your forehead, the cerebral cortex (new or neocortex) is unique to higher mammals, and in humans is the seat of abstract thinking, logic, planning, and language. This is where you make rational decisions. (Figure 3-2 shows the locus of your instinctive responses and of your rational mind.)

Figure 3-2 Your reptilian brain is conveniently located right above your spine, so these reflexes translate into action almost instantly. Your cortex is located just behind your forehead, so information reaches the cortex a little later. (Wikimedia, public domain)

When the Reptilian Brain Takes Charge

For better and for worse, danger signals reach the reptilian brain about 22 milliseconds before they reach the cortex, where we could logically analyze our options. These automatic reactions enable us to escape danger without thinking about it. However, we respond before we are consciously aware of our reaction. When we respond from our reptilian brain, we are acting out of our most primal response to danger, lashing out before our logical intellect can respond.

Your instincts are faster than your rational mind. This process is essentially unconscious, activating stress chemistry within thousandths of a second. It takes at least a quarter of a second longer (around 250 milliseconds, about ten times longer) for sensory information to become conscious. (These insights are based on the work of researcher David Ropeik.)

Acting in the heat of the moment. The downside of reflexive reactions is that we’re more likely to act without much conscious reflection or pause. We allow ourselves to be captured by our automatic defensive reactions, rather than tempering our response with logic. These reflexive, unthinking reactions also explain why we may say something cruel, even to someone we love, when we’re truly angry. As those cruel words leave our lips, we may desperately want to retract them, realizing that what we have just said could harm the relationship.

Focused on survival. When we’re in crisis, our awareness of the consequences of what we’re doing is reduced. At that moment we are totally in the present, doing anything we can to survive, unaware of the future. A signal in our environment (or in our psyche) has triggered an automatic survival response—which could be an evolutionary trap.

Responding to a perceived threat (real or not). In a confrontation, if we sense anger or anxiety in the other person, that is also likely to trigger the stress response. In that case, we interpret anything that person says or does as a threat (perceived as potential for loss or harm). The sympathetic mode of our nervous system becomes activated and stays that way until the perceived threat disappears. You can imagine, for example, how this would play out in someone with PTSD (post-traumatic stress disorder, also termed traumatic spectrum disorder) who has just returned from an active war zone. Every time they hear sudden loud noises such as fireworks or a car backfiring, it may sound like gunfire or remind them of incoming mortar shells, flipping them instantly into the stress response, flooding their body with overwhelming stress chemistry.

Workplace Stress

Work-related stress is common everywhere. In a study involving sixteen thousand employees across Europe, about half of them reported major stress in their workplace:

- poor job security and competition with coworkers: 72 percent

- deadlines, too much work, and too many hours on the job: 66 percent

- bullying or harassment: 59 percent

- lack of support from the supervisor or colleagues: 57 percent

Managing stress is as important to workplace health as good ergonomics. An effective strategy to reduce workplace injuries is to address sources of stress and tension, allowing employees to feel safe, be productive, and avoid injury. Only when we feel safe can our bodies relax and repair the daily wear-and-tear of work life. Having the tools to deal with stress could make the difference between success and failure, health and injury. We need effective strategies to reduce stress and a plan for dealing with a full-blown stress response when it occurs.

What You Can Do about Stress

1. Tuned in? If you feel yourself slipping into a full-blown stress response, overcome in the moment by anger or fear, that means you’ve been captured by your amygdala.

2. Out of control? Know that at that moment, you have lost a certain amount of rational control and will have to work hard to reverse some of your reactions.

3. Survival mode? Once the amygdala takes charge, it triggers the release of a cascade of stress hormones and neurotransmitters, starting with adrenaline.

4. No longer rational? “Think before you speak” no longer has meaning, because you are no longer thinking, merely reacting.

5. Primal response? The locus of control is no longer in your rational mind. At this point, you are in the reptilian brain, back in the wilderness, trying to survive.

Remaining Centered in a Crisis

1. Focus. Bring yourself immediately into the present moment. Become fully aware that this is an emergency. Without awareness, there is nothing you can do.

2. Be clear about the nature of the danger. Is the situation safe? Risky? Life-threatening? Or just massively irritating?

3. Decide what’s most important—triage. Triage is the process initiated by military medical personnel to decide who needs to be treated most urgently, and in what order. What can be fixed right now, and what is beyond our control? Define the problem as quickly as possible and then ask, “What is the most important thing that needs to be done right now?”

4. If you are in conflict with another person, take a time-out. Make the commitment to resolve the issue later today or tomorrow—but not at this moment. When we feel stressed, we have moved into a different physiological state—physically, chemically, emotionally—a state of defensive reactions. In that mode, we are no longer able to work through the logic or to think in terms of long-range planning.

5. Get back into balance. How can I get centered as quickly as possible? What has been most effective in the past, and can I apply a similar strategy now?

Getting Back into Balance

This is one of the most important ideas in the book. The best way to get rid of mental stress and strain is to work it off physically. We need to short-circuit emotional stress before it becomes disastrous. When we’re under deadline stress at work, for example, we may feel we don’t have the time for the kind of vigorous physical activity required to work off stress chemistry when it occurs.

Have a plan. It is important to have an immediate strategy to deal with any effects of physical distress (such as tight muscles and increased blood pressure) or emotional distress (such as anger, rage, fear, or grief).

- If you’re at work, consider brisk walking, jogging, or going to the gym (interval or weight training).

- If you’re at home, do yoga or martial arts, or take a quick shower.

- When the stresses and strains are more emotional in nature (anger, sadness, fear, boredom), move your body (for example, thirty minutes of physical activity such as yoga, tai chi, or aerobic exercise).

- When the stresses and strains are more physical in nature (pain, discomfort), quiet your mind (for example, meditation, prayer, imagery, hypnosis, biofeedback).

Coping When You Can’t Get Away

What can you do when you are stressed out and cannot leave the situation? You may be at work or in a business or social gathering. Instead, excuse yourself and go to a more private space, such as a restroom. On your own, do the following five-minute Nyingma exercise, taught by Tarthang Tulku Rinpoche in the tradition of Tibetan Buddhism, as a form of thought stopping.

Stand on your toes with your heels touching each other. Your heels need to be lifted off the floor and your knees bent (see figure 3.3). Place your hands at your sides. Breathe slowly and deeply. Do this next to a wall so you can steady yourself if you need to. Stay in this position for as long as five minutes. Do not straighten up—keep squatting despite the discomfort. In a very short time, your attention will be captured by the burning sensation in your thighs. Continue. After five minutes, stop, shake your legs, and relax.

Today Was a Drag on Muni

Three big teens stole a guy’s phone. There was lots of shouting. The loudest one punched him in the face, hopped off the bus, and ran for it. I was pretty freaked out at that point, so I called in an hour late, put in forty-five minutes at the gym, and went to work in much better shape.

4

A Closer Look at Stress

How the Brain Sorts Out Stress

Our reaction to stress can take a number of forms. Hypervigilance is an inborn protective response that is ever-present. We are always unconsciously scanning our environment for physical, social, or emotional threats. Even when we’re asleep, we unknowingly sense the world, listening to our surroundings, processing incoming auditory information such as sirens, comparing them to other sounds that we ignore. If the world seems safe, we are able to adjust our awareness, so we pick up only what’s important. Mothers, for example, become highly attuned to their baby’s cry and awaken for that sound alone. Incoming information is constantly being sorted. Is the situation safe? Dangerous? Or is it life threatening?

Our past experience and future anticipation can skew the meaning of what we hear and see. Our perception of the seriousness of the situation activates different neurological and physiological pathways, triggering a range of possible reactions. (This insight is based on the work of neuroscientist Stephen Porges.)

Strategies for Handling Stress in the Special Forces

We use different breathing patterns to achieve a calm mind-body and to improve performance by focusing attention on the breath. During long treks, to stay in focus, we count breaths or steps or change the breath pattern to intermittent exhaling with the pace of the steps. In tough physical training, counting or focusing on the outbreath while running long distances or carrying heavy weights makes each outbreath a brief opportunity to relax, even while engaged in very boring or Sisyphean actions. Focusing on the outbreath helps not to focus on pain or negative thoughts like wanting to stop or quit.

Memorize by heart the sequence of actions in case of an emergency. This is the automatization of actions needed to be perfectly performed under stress. For instance, to save the life of a wounded soldier, we practice these sequences again and again until they become habit, a series of automatic actions. (This is an example of procedural memory.)

We visualize these actions or actually practice them, if possible. We call it a “dry drill” if we do not use real ammunition and a “wet drill” if we do. We also memorize the whole path leading to a specific geographic point, so no map is needed, freeing us for other activities. We break a big task into smaller tasks to feel we are in control and that it is possible to achieve.

Training ourselves to switch our emotions off enables us to function in an “automatic mode.” This is a bit difficult to explain: it’s somewhat like emotional isolation. Some of us were able to do this as children, and some acquired the ability and mastered it in harsh military training. This ability has enabled us to stay very focused under situations so difficult that when remembering them later, we could not understand how we were able to function in such conditions.

Affirmations of all kinds can be used to maintain perspective. During long and painful physical training or operations, we would get into perspective by saying to ourselves, “It’s temporary” (contrary to “It’s endless”) or “All difficult tasks have an end.” We focus on how we will feel after we have completed this task successfully. We can focus on the fact that we have coped with situations more difficult than this one. Sometimes we say to ourselves that we are doing this to protect our dearest ones (family, girlfriend) and that we can’t crack under pressure—for their sake.

Humor can effectively interrupt boredom, tension, or fear. During long periods of waiting for something to happen, or staying in uncertain situations, or before dangerous operations, we use humor to break the tension.

Future projection and visualization enable us to focus on performing a task optimally, step by step. In situations in which we feel we have no control or when we are in physical pain (like carrying a stretcher for long hours, not knowing when it will end), we dissociate to a certain extent, thinking of pleasant moments with our girlfriend, for example.

Favorite de-stressors. Coffee to stay awake, long hot showers to calm down, time with our lover, krav maga training (a form of self-defense practice), grabbing a nap whenever we get the chance (on helicopter flights or short breaks between training).

—Dr. Yuval Oded, FORMERLY OF THE Israeli Defense Forces

Understanding the Freeze Response

Have you ever been confronted by a stressful situation in which you were unable to respond? (This type of reaction can range from brain freeze to total shutdown. In its minor form, this could mean feeling utterly overwhelmed or startled by an unexpected confrontation.) In essence, the freeze response is an inborn survival mechanism.

Shutting down in an argument. Consider a situation in which there is conflict between a boss and an employee. The boss may not realize that the employee has gone into freeze mode. Anger tends to make us less sensitive to others, so the boss may not even notice that the employee is no longer responding. The boss may assume that the employee is listening, but in the freeze response, the employee is withdrawn and may only hear “white noise.”

Total shutdown. These responses occur across a spectrum of behavior. The perception of a life-threatening situation can evoke a total shutdown of our reactions, immobilizing us to freeze like a deer in the headlights. A freeze response in the face of danger is generated by our primal reptilian brain, moving us into profound withdrawal. We blank out, unable to take action. Total immobilization is essentially feigning death, the body’s automatic mode in a last-ditch attempt at survival when facing an overwhelming, life-threatening situation.

A potential lifesaver. When we freeze, our heart rate goes down, and perceptions are reduced. Our sensory system downregulates, so we actually feel less. If we’re in the freeze response, we essentially lose our ability to act, becoming almost paralyzed. A relevant example is the mouse that is being toyed with by a cat. The moment the cat grabs the mouse, the mouse becomes paralyzed and freezes, unable to do anything. Under stress it goes dormant, slowing its heart so it seems dead, and thus may survive if the cat does not want to eat dead food that day. The freeze response is also a form of protective numbness, to reduce pain if the creature is about to be eaten. When the mouse goes limp, if the cat is not hungry, it may play with the mouse for a moment, get bored, and then drop it. If the mouse is lucky, once the cat goes away, it can revive and escape.

Response to an assault. The dynamics of a human freeze response play out in situations involving assault, serving as a protective mechanism, in some ways having an anesthetic effect. In horrific, extreme situations, victims may seemingly allow themselves to be assaulted and do not resist. However, capitulation is one aspect of our normal stress response. For example, during interviews of victims of assault, it has been reported by college students that they did not call out during an assault, even though their roommate might have been in the next room. If they had shouted, they might have been rescued. In retrospect, the victim may be baffled by their own behavior and often feels unbelievably guilty afterward.

Most people don’t realize that in an extreme state of stress, most victims are in the freeze response and literally cannot call out. They are totally paralyzed. Those cases often involve acquaintance rape. Because the victim is not fighting back or saying “No,” the rapist has the impression that the person is acquiescing and saying “Yes.”

In some situations, this response may save the victim’s life. If they don’t fight, the rapist will eventually leave, whereas if they resist, the rapist may become angered, resulting in even greater harm. These dynamics also play out when people are mugged and become temporarily paralyzed by fear, unable to protest or call out. However, protesting can also put one at risk of injury in a mugging, so here, too, this may be a form of protective response. In the wild, this is the ultimate survival mechanism when threatened by a grizzly bear or some other dangerous animal.

Story: Trained to Deal with Stress

Working full time, finishing her degree, and caring for her son, Sarah felt like the poster child for a distracted mom. Rushing back to work on her lunch break, she tripped and landed flat on her face on the pavement. She picked herself up, brushed herself off, and burst into tears. At that moment, a guy with the look of a friendly cop stopped, flashed his FBI badge, and offered to help. Sarah was bleeding and sobbing quietly, at risk of going into shock.

The agent was the picture of dynamic focus—he took her gently but firmly by the arm, and began directing her thoughts away from the cut on her face, talking her through a simple plan. “Let’s get some cold water on that cut so you can get back to work.” They ducked into an office building nearby, into the restroom. He applied a cold compress to her forehead and put her to work, cleaning the blood off her suit. Once she got washed up, it was clear that the cut was not as bad as it seemed and would only leave a minor scar. He just kept talking, softly, constantly focusing her on the present and the practical steps she could take. At that point, she was centered, level-headed enough to go back to work, and he said good-bye. Clearly, he was well-trained in dealing with stress and knew how to apply that training in real-life situations.

Stressed or Hypervigilant?

The experience of feeling unsafe and therefore hypervigilant is different than the stress response. Stress is our biological reaction to a specific situation and once the event has resolved, we can relax, revive, and get back to normal. In situations of crisis stress, the danger is usually immediate and intense.

In contrast, hypervigilance is the persistent sense that the world is dangerous. When we have the experience of constant vigilance, we remain on guard and cannot relax, a state of being continuously alert to undefined dangers. Consider the situation, for example, of combat troops patrolling an area that may harbor the enemy, whose presence and location are unknown. This triggers constant hypervigilance and extreme tension. The larger context in a dangerous situation is our sense of safety. If we feel unsafe, then we remain vigilant.

Figure 4-1 This painting of lions in the Chauvet Cave is another example of our ancestors’ preoccupation with predatory beasts (southern France, about 33,500 to 37,000 years ago). (Wikimedia, public domain)

Our ancestors were obsessed with predators. Caves and rock walls the world over are covered with images of sharp horns, big teeth, and aggressive animals. Today, we have the same capacity for vigilance that haunted the hunters and gatherers for thousands of generations. This is the heightened sense of tension, wariness, and focus seen in a cat while it is stalking a mouse. Similarly, in a hunter, this set of emotions would have been engaged during the hunt and then released through physical activity. However, when we are in a setting that triggers continuous vigilance, whether in combat, in a combative workplace, or living with combative individuals, the drain on our energy is tremendous.

The Last Straw

Luis received the cancer diagnosis about the time his department started downsizing. The tension throughout the office was extraordinary, and he shifted into a state of constant hypervigilance. He came home every evening exhausted. Well liked, he survived round after round of cuts, while jumping all the hoops of standard cancer treatment. Although he seemed to be maintaining, the price was enormous. When it became clear that his position was going to be eliminated, that was the last straw. His immune system shut down, and within a matter of months, he was gone.

Safe? Risky? or Life-Threatening?

One of the challenges for human beings is that we respond not only to our external environment, but also to our imagination. We react to thoughts and images just as we would to reality. When we watch horror films, thrillers, murder mysteries, action films, or even competitive sports, our bodies react as if we were living the experience. Reflect on your experience while you watch a CSI sequence or play an aggressive computer game. We don’t even have to see or hear the danger. When we imagine danger, our body responds as if it were totally real.

Thoughts and imagery that trigger hypervigilance tend to perpetuate stress. The trigger could be anything—a scowling look from our boss, competition from a coworker who would like our job, or thoughts of a looming deadline. We may be tempted to obsess on these types of thoughts. At some point, our body gets in on the act, with the potential to trigger stress chemistry and tension.

The temptation to imagine potential danger can feed hypervigilance and may become an extreme form of paranoia if we’re under intense stress. At other times, even when our boss is no longer present, we may get stressed out by our own repetitive thoughts and fears, ruminating over past failures, or potential threats to our security. Unfortunately, our brain chemistry makes no distinction between real and imagined danger. We respond with some of the same physiological patterns of primal stress triggered by the fear of being fired, perceived insults by a supervisor, being bullied, or being sexually harassed by a coworker. The moment we think of an extremely stressful event, our breath may quicken, our heart rate increases, blood pressure goes up, and our shoulders tighten, along with a whole host of other physical, behavioral, and psychological stress reactions.

Breath: The Mirror of Your Reactivity

We cannot stress enough the importance of breathing. We hold our breath in anticipation of danger and give a sigh of relief when it is all over. We breathe shallowly when fearful and more slowly and deeply when we’re calm. Changes in breathing significantly impact health since continued rapid, shallow breathing can lead to hyperventilation, increasing anxiety and stress-related symptoms. Slowed, effortless breathing facilitates regeneration and health.

In almost all cases, changes in breathing occur beneath our level of awareness (unless we have asthma or emphysema, or become out of breath while exercising). Our typical pattern of breathing includes the rate of breathing (how quickly we breathe), the location of our breathing (abdomen or chest), and the speed of inhaling or exhaling (gasping for air or allowing the air to flow in or out).

Often, breathing changes are an indicator that we are reacting, stressed out, or getting sick. When stressed, people may initially hold their breath and then breathe shallowly in their chest. When people feel relaxed and safe, their breathing is usually slower and lower, a pattern that is described as effortless diaphragmatic breathing. When relaxed, the transition between inhalation and exhalation is smooth, and the exhalation takes longer than the inhalation. We experience no effort in breathing, and the predominant movement is around the waist (an increase in the diameter of the waist during inhalation and a decrease of the diameter during exhalation).

Experience It: How Breathing Changes without Our Awareness

Sit or stand comfortably. Now, without moving your head, dart your eyes back and forth as quickly as possible from the extreme right to the extreme left, as if you are looking for something dangerous to the side of you. Continue to look back and forth quickly from right to left while trying to identify what you see for about five times.

What did you experience as you did this exercise? If you are like most participants, you automatically tensed up and held your breath. From an evolutionary perspective, when we attempt to identify an object in our peripheral vision, we react automatically and put ourselves on guard anticipating danger. Thus, we hold our breath.

Take an emotional time-out. Holding one’s breath is often unconsciously triggered during times of stress or fear. Develop the habit of an emotional time-out. In almost all cases, before reacting automatically, if you take three slow breaths lasting about ten seconds each, you will be able to regain emotional and physical control.

Be proactive. Under stress, most of us tend to hold our breath. Make it a point to notice the situations in which this is the case. Use your increased awareness to change your response to this type of situation by learning new coping strategies, so breath holding is no longer triggered. Additionally, learn to continue breathing during those stressful situations to reduce their negative effects.

Become adept at relaxed, deep breathing. Consider the relationship between your breathing and how you feel:

- Normal breath rate. Normal adult breathing is about twelve to fifteen breaths a minute.

- Rapid, shallow breathing. When we double our breathing rate, we may be breathing every two seconds or about thirty breaths a minute.

- Relaxed, deep breathing—the sweet spot. When we slow down our breathing by half, we may be breathing in and out over ten seconds or about six breaths a minute. Continue breathing slowly for a few minutes.

A number of researchers, including Richard Gevirtz, Paul Lehrer, Don Moss, and Fred Shaffer, have suggested that when we breathe closer to a rate of six breaths a minute, heart rate and breathing rate will synchronize and resonate in harmony. The frequency of breathing that helps the heart and lungs synchronize is called the resonant frequency, and the resonant frequency of breathing for adults is around six breaths per minute. There are many types of breathing exercises to try, including yoga breathing techniques that vary patterns of longer or shorter breaths.

A Threat or a Stimulating Challenge?

Perceptions of the world (neuroception) can be viewed in terms of threatening or challenging circumstances. Circumstances perceived as a threat have the potential to result in some kind of loss (loss of life or limb, loss of face, or loss of a job), or harm (injury or exposure to harsh conditions). Potential loss triggers a physical distress reaction, with sustained heart rate, muscle tension, and blood pressure due to excessive adrenaline and cortisol.

In contrast, circumstances perceived as a challenge have the potential for learning or growth (improved knowledge, skills, or abilities). A challenge can potentially trigger a more positive reaction than a threat, with surprisingly less drastic physical effects. Adrenaline and cortisol are stress chemicals released in greater abundance when we perceive the world as threatening, whereas oxytocin, a hormone produced in the brain, is released when we perceive difficult circumstances as more of a challenge than a threat. Oxytocin reduces blood pressure and cortisol levels and therefore has the effect of reducing the toxic effects of stress hormones.

Dynamic stress. Normally people think of stress as harmful. However, we need episodic stress in order to stay at the top of our game. Think of the excitement of sports or the challenge of a major deadline. This type of stress has been defined as beneficial stress (eustress) by researcher Hans Selye, the man who did the original work in this field. Many people thrive under eustress conditions and are highly productive—this is true of surgeons, firefighters, soldiers, athletes, mountain climbers, journalists, and entrepreneurs. Stress associated with positive outcomes enables us to become stronger and more proficient, as long as we allow enough time to rest, repair, and recover.

The relaxation response. Our bodies function through an elegant system of checks and balances. Ideally, stress is followed by the relaxation response regulated by the parasympathetic nervous system. As relaxation deepens, levels of adrenaline and cortisol begin to drop, heart rate goes down, muscles become relaxed, and digestion improves. Neurotransmitters such as GABA (gamma-amino-butyric acid) slow electrical activity in the brain, rejuvenating brain chemistry and promoting a calmer state of mind. This physiological state of calming or slowing is a primary mode of engaged immune function associated with relaxation, regeneration, healing, and repair.

What You Can Do

Reducing stress in an intimate relationship. Researchers at the Seattle Love Lab of John Gottman found that when couples argued and their heart rates went over one hundred beats per minute, arguments were more likely to escalate. The elevated heart rate is a logical biological marker of the stress response. If the partner whose heart rate went up took a time-out and did self-soothing, the couple had less likelihood of divorcing and greater happiness in their marriage, compared with couples who continued to argue, maintaining a high heart rate reaction and a sustained stress response. This insight can be applied to essentially any relationship.

Reminder: To work off mental stress, get physical. We now know that stress hormones can be toxic if they linger too long in the body. Clearly, we need to deal with emergencies, but once they’re over, we also need a plan for working off toxic stress chemistry. Excessive cortisol production is known to be destructive to brain cells and to suppress the immune response.

When toxic stress occurs in the office, don’t go back to your desk to sit and stew. An effective way to cope is to simply leave the situation and first complete the fight or flight reaction. Whenever possible, this means interrupting whatever you’re doing and exercising vigorously, whether that involves walking around the block (fast), going running, hitting the gym, or practicing high-intensity interval training. After you’ve completed a vigorous workout, emotional coping is much easier because your stress chemistry has been filtered away, and negative thoughts have usually decreased or stopped. An acute stress reaction may save your life in an emergency, but you want to have a plan to avoid the “stress hangover” afterward.

Pause. The paradox is that the more one is stressed, the more one needs a moment to drop the stress, to let the body relax, a moment to be held, and to feel secure. Only then can we reflect back on the stressors, what to do, and what the future holds. Otherwise, we end up like a squirrel on a treadmill going faster and faster and not getting anywhere. Using this metaphor, we have to jump off the treadmill and pause for a moment. Only in pausing are we likely to see new options.

Relax fully at least once a day. Under stress, when neck and shoulder muscles tighten, they will tend to continue to be tight until we work off the stress. In this mode, we remain on guard. Heightened muscle tension is exhausting, and when it occurs beneath our level of awareness, we’re less likely to make the effort to dispel the tension. What’s more, when the world is dangerous, it’s more difficult to get to sleep, and we’re more easily awakened. This is our body mobilized for action in the face of danger.

Consider practicing qigong or yoga. Qigong, tai chi, and yoga emphasize close attention to the body and the breath, pairing slow, conscious movement with mindfulness. These ancient practices are useful tools that train our ability to focus while strengthening us physically. When people become adept at qigong or yoga, it is apparent—they exhibit elegant posture and a quality of relaxed presence and attention.

Walking meditation. You can experience walking as an exercise in mindfulness. While you walk, be aware of everything around you—feeling the wind against your skin, the warmth of the sun on your neck, the changing pressure in your feet as you walk. Alternatively, focus on the changes in the environment around you. Look upward at the trees and see the detail of the limbs and leaves or the changes in roof architecture. Be totally present as you observe the sensations either within your body or the scenery around you. The moment your attention shifts to rumination or worry, focus on being present.

Check your pulse with an app. Become attuned to how your heart is reacting in various situations. Use a smartphone app to alert you when your heart rate increases twenty or thirty beats above your baseline rate, for example, during a difficult discussion or interpersonal conflict. Use feedback from the device to discover how you can slow or reverse a racing heart during negative emotional reactions. Then make it a point to be physically active—exercising, or walking, for example—while consciously engaging in deep breathing. When you feel that your physiology has normalized, return to whatever you were doing.

Practice longer, slower breathing. Many of the apps focus on teaching people to breathe at about six breaths a minute, which supports physiological balance and regeneration. Practicing a slower, more effortless breathing pattern of about six breaths per minute will also enhance heart rate variability (HRV) in which heart rate increases as you inhale and decreases as you exhale. Research has found that people with low HRV have reduced capacity to respond to stress. People with higher HRV tend to be healthier because two important aspects of their nervous system are in sync—the sympathetic (which mounts the stress response) and the parasympathetic (which elicits the relaxation response).

We are often unaware of changes in breathing or heart rate when they occur. A wearable device such as a smartwatch or an app on our cell phone can help us recognize when we are holding our breath and when our heart is racing. We can also use devices and apps to help us master slower breathing patterns and improve our heart health. Three types of apps and devices that are easily available include

1. Breathing pacers. These apps guide you to breathe at a rate you specify, such as six breaths a minute. The apps have you pace your breathing by following a visual image that fades in or out, or sounds that rise and fall in pitch. Examples of breath pacing apps that can be downloaded for Apple from the App Store or for Android from the Google Play Store are

- Paced Breathing: https://paced-breathing.soft112.com

- Awesome Breathing: https://isjustawesome.com/awesome-breathing/

2. Heart rate variability (HRV) apps. These apps enable you to monitor your heart rate by holding your finger over the smartphone camera lens. The app determines your heart rate and then guides you with breathing feedback to improve your heart rate and, ultimately, your heart rate variability. Examples of heart rate monitoring apps that can be downloaded for Apple from the App Store or for Android from the Google Play Store are

- Leo: https://ciaoleo.com

- HRV4Training: www.hrv4training.com

- Welltory: https://welltory.com

- Elite HRV: https://elitehrv.com

- emWave: www.heartmath.com

3. Heart rate monitoring devices. These devices use a finger sensor that measures the pulse and provides feedback so that you can practice breathing slower. These sensors are available from a variety of places such as Apple via the App Store or for Android from the Google Play Store (for example, iChoice: www.ichoicerelax.com).

Many people report that when they use these apps and devices, they have more control over their heart rate and thus reduce their stress response and enhance their relaxation response. Simply taking four or five breaths very slowly right in the moment will usually affect your heart rate, and you can experience benefits immediately.

5

Inactivity: Why Sitting Is the New Smoking

Story: We’re Not Built to Sit All Day

Chris always knows what’s leading-edge. The picture of efficiency, he sits at the computer like a pilot, with two nineteen-inch computer screens, a split-ergonomic keyboard with a vertical mouse, and a color laser printer right at the ready beside his computer. Given the cascading deadlines, he and his buddies rarely meet by the water cooler. Instead, they make contact more and more by text and email, or message each other on Facebook and Instagram.

After a day at the computer, he relaxes at home in a recliner parked in front of the big screen. With cable and internet, he has access to hundreds of channels—sports, tech updates, the latest thrillers—so he’s often up until after midnight. Last summer, he took a ten-day vacation with his partner, “just to get away from it all,” driving up the coast from LA to Seattle. Relaxation is not a problem for Chris.

Two or three times a year, his back goes out. “You’ll just have to learn to live with it,” says his physician. The doctor has cautioned that Chris’s extra weight is putting a strain on his back, so he is trying to cut back on sweets, but so far, his weight hasn’t budged.

Evolutionary Trap 3

We inherently conserve energy in order to heal and regenerate. This aspect of our genetic makeup also helps us burn fewer calories when food is scarce. Hence the potential for lack of movement and sedentary lifestyle (sitting disease).

Sitting can be a trap. In times of famine, the habit of sitting was essential because it reduced calorie expenditure, so it enabled our ancestors to survive. In a prehistoric world with a limited food supply, less movement meant fewer calories burned. They became active when they needed to search for food or shelter. Today, in a world where food and shelter are abundant for most people, there is no intrinsic drive to initiate movement. What’s more, burning fewer calories as we sit hour after hour has surely contributed to the current epidemic of obesity.

On the other hand, it is also true that we have survived as a species by being active. Chronic sitting is the opposite of our evolutionary pattern in which our ancestors alternated frequent movement while hunting or gathering food with periods of rest. Whether they were hunters or farmers, movement has always been an integral aspect of daily life. In contrast, working at the computer we may become like an unmoving slug. Maintaining static posture for hours on end, without getting up and moving around, can increase fatigue, muscle tension, back strain, and poor circulation, putting us at risk of injury.

Sitting Nine Hours a Day

Today, the average Westerner spends more than nine hours a day sitting (currently 9.3 hours, to be exact). This includes time at the office, driving, and using media. The statistics are sobering, because on average, we sit at least three hours a day more than we did twenty years ago. The data make it clear that people who exercise throughout their lives live longer and have fewer health issues as they age. (A Stanford University study found that age-related illness and injury were delayed by fifteen years in dedicated runners, compared with people who did not exercise.) People who watch six hours of TV a day are likely to live five years less than those who don’t watch any TV.

Figure 5-1 The spikes on the EMG recording show frequent periods of neck tension when sitting and typing, hunched over the keyboard. (Photo by Erik Peper)

The Effects

A surprising number of risky health problems result from immobility. Too much sitting has been linked to increased risk for osteoporosis, some cancers, and a range of other major health issues:

The back. Sitting puts tremendous pressure on the spine—about 140 pounds of pressure per square inch. Since more than one-third of Americans work at desk jobs, that helps to explain why there are now more than one million back injuries in the United States every year.

Type 2 diabetes. Food for thought! If we sit, drink coffee, and eat muffins, that food is going to settle on our hips and tummy. But the problem doesn’t stop there. A poor diet and chronic inactivity lead to poor glucose control. Over time, this often manifests as type 2 diabetes.

Heart health. In the extreme, sedentary workstyle can increase the risk of health issues ranging from tension headaches to dangerous blood clots.

Immune dysfunction. Our lymph glands produce a protective fluid that circulates throughout the body, washing away germs and toxins. The lymph is mechanically pumped by the action of our muscles. If we don’t move, neither does the lymph. We become aware of this whenever we spend a couple of days in bed or take a long airplane flight; the lymph can’t perform its function, and we’re left feeling tired and toxic.

How It Happens—Poor Circulation

Working in a static position without moving increases fatigue, muscle tension, and pressure on the spine while reducing blood flow. Muscles are less able to relax and repair, and other key systems start to malfunction if we’re too sedentary for too long.

Prolonged sitting without movement compromises blood circulation. That can increase fluid buildup (edema). Stabilizing a laptop on your lap means creating a stable base with your legs, thighs, and buttocks in a fixed, often tensed position. As a result, both the lymph and venous blood circulating up the legs are compromised. After working in this position, some people experience their legs as heavy and sluggish. This can occur whether you are using your laptop sitting on a chair, in an airplane seat, or on a couch.

When you’re walking, the muscles in your legs alternately tighten and relax. Researchers even refer to this movement of the leg muscles as the second heart, because the action of those muscles helps to pump the blood against gravity, back up to the heart, and to circulate the lymph. Despite the effort you expend, there is an almost effortless sense of energy created by the activity of walking.

Creating a Dynamic Workstyle

We would like to offer four big-picture strategies here for more dynamic living:

- alternating periods of activity and rest

- varying the tasks you do at work and at home

- exercising every day

- regenerating at some point daily

Alternating activity and rest. All of life is the alternation between movement and rest, inhaling and exhaling, sleeping and waking. Performing alternative tasks or different types of activities and movement is one way to interrupt the couch potato syndrome. This honors our evolutionary background, a world in which those who did not work did not eat.

Our research has confirmed what others have observed: that it’s important to be physically active, at least periodically, throughout the day. Alternating activity and rest recreates the pattern of our ancestors’ daily lives. When we alternate sedentary tasks with physical activity, and follow work with relaxation, we function much more efficiently. In short, move your body more.

Doing More with Less

Minh is a survivor. After the fall of Saigon, he endured two grueling weeks at sea. Today, he’s the fastest typist in the company, liked by everyone and valued by his supervisors for his accurate work, impressive output, and cheerful attitude. The secret to his success? His daily ritual of a brisk lunchtime walk, often bringing a friend along for company. Minh always carries a delicious lunch from home, so he’s able to have a good meal and still make time for a walk every day.

Varying tasks. Alternating time at the computer with opportunities to move or be active is central to your ability to pace yourself. When you change to a different type of task or movement, using a different set of muscles, this interrupts the contractions of muscle fibers and allows them to rest. For example, interrupt typing by getting up and filling the paper in the printer, or making a telephone call while standing. Periodically allow your shoulders, arms, wrists, and hands to relax.

Building exercise and movement into every day. Studies show that you get more benefit from exercising ten to twenty minutes, three times a day, than from exercising for thirty to sixty minutes once a day. The implication is that doing physical activities for even a few minutes can make a big difference. Dunstan and colleagues have found that standing up three times an hour and then walking for just two minutes reduced blood sugar and insulin spikes by 25 percent.

Relaxing fully to counter the Cinderella effect. When performing mechanical tasks, muscle fiber units within the larger muscles tighten in a cascading sequence. The first units within the muscle to contract are typically the last to relax. These fibers are described as Cinderella fibers, the term taken from the childhood story of the girl who was first to rise in the morning before her stepsisters, and last to go to bed after all of the household chores and tasks were completed. When we don’t relax all of the muscles fully, the part of the muscle that was first contracted may remain contracted. The key is to relax all the muscle fibers. Two strategies for achieving this include (1) alternating tasks when we’re working, and (2) setting time aside each day to fully relax.

Figure 5-2 A sit-stand desk allows greater flexibility in posture and movement. Note the balance board, which enables the user to periodically shift his weight to avoid a static position and reduce fatigue. (Photo by Erik Peper)

Case in point: Using a sit-stand desk. Having an office desk with a desktop that can be raised and lowered enables you to work either sitting or standing. When you work while standing, that supports the natural ability of your circulation to move blood from your feet back to your heart, comparable to what you experience when you’re walking or hiking. When you sit all day, there is a tendency for less circulation through the body. In contrast to static positions of sitting at work, a sit-stand desk facilitates dynamic positions of movement, and alternately engages different muscle groups in your legs and arms. The research shows major gains in energy over the course of a day.

Experience It: How Movement Can Increase Your Energy

1. Before you begin, rate your energy on a scale from 1 (little energy) to 10 (lots of energy).

2. Walk around the room (or the block) briskly and swing your arms a bit, or go up a flight of stairs quickly. Alternatively, skip around the room for a minute to get your blood moving.

3. Then stop, rest, and rate your energy.

4. Now assume a different mood. Walk slowly, shuffling your feet, looking down, and keeping your body in a collapsed posture as if you were tired or depressed.

5. Stop and rate your energy again. Compare your energy level in each practice, Did your energy increase, decrease, or stay the same?

We have found that almost everyone who tried the first exercise for just one minute reported increased energy and alertness. On the other hand, walking in a slouched pattern was reported to reduce energy significantly, especially for those with a history of depression.

What You Can Do

Here are a few pragmatic strategies you can incorporate into your workstyle:

Set up your office so you can stay active:

- Make some of your phone calls standing up.

- Put the printer in another room or away from your desk, requiring you to get up to retrieve printouts.

- Place files you need frequently away from your desk so that you have to stand up to get them.

- Install a sit-stand desk and alternate standing and sitting some of the day.

Take microbreaks: Pause as you work to take microbreaks (brief breaks of less than thirty seconds). For frequent microbreaks, you don’t even need to get up—just drop your hands in your lap or shake them out, move your shoulders, and then resume work. Any type of shaking or wiggling movement is good for your circulation and kind of fun. (See chapter 14 for more ideas on microbreaks.)

Pace yourself:

- Leave your desk periodically. Walk to the copy machine. Get up for a cup of tea. Pick up the mail.

- Deliver memos personally instead of by email.

- Run your own errands to keep your circulation up. If you’re going between floors, take the stairs whenever possible.

- At lunch, develop the habit of a brisk walk (even ten minutes can make a difference) or a workout at the gym.

At meetings, literally think on your feet:

- If you’re meeting one-on-one, opt for a “walking meeting.”

- Hold team meetings standing as they do in companies that use the Scrum workstyle. Meetings are limited to fifteen minutes, once a day, first thing in the morning, with the entire team standing throughout the meeting. That keeps the team up to date and motivated, maximizes everyone’s time and energy, and limits long meetings.

Vary your activities and movements as much as possible. By changing your posture and making sure you exercise, you’ll find that your circulation and your energy improve, and you’ll experience fewer aches and pains. In a short time, it usually becomes second nature to vary your activities throughout the day.

On your day off: Know that you will be captured by the screen. Once you start one episode of your favorite program, you will very likely continue to watch the next episode and the next, especially if you are streaming them. Suddenly three hours have passed, and all you have done is sit and sit. Be proactive. Arrange social activities and tasks in advance, and have your friends or family participate with you. Arrange with colleagues to go to a lecture, participate in political action, invite friends to come for a potluck dinner, study a foreign language, or take a cooking class.

There’s an app for that: Install a break program that will post reminders on your computer screen, cuing you to get up and move around or to stop and literally catch your breath:

1. MakeUseOf.com—Search for “Reminders to take a break.”

2. Medium.com—Search for “Breaks for eyes.”

3. PlumVillage.org—Under the tab “Mindfulness,” there is a listing for “Mindfulness Apps” that will connect you with several apps, free for personal use.

4. ParaTec.com—Computer break software.

5. RSIGuard.com—Software for avoiding repetitive strain injuries.

6. Work & Move software—This program serves as a workstyle coach to help you identify your optimal pace. Workflow alternates between work tasks, physical activity, mental tasks, and breaks based on your personal needs and helps you create your own rhythm. A free trial can be downloaded from Bakker Elkhuizen at www.bakkerelkhuizen.com.

Incorporate breaks to do a few strengthening or stretching exercises. Most office work consists primarily of fine motor movement involving your hands, so you’ll want to incorporate large motor activities such as those that require standing or moving.

6

Strain: How Strain Causes Pain

Story: Assessing Computer Injuries in Real Time

Chronic muscle tension can result in fatigue, headaches, back pain, or joint injuries. Fatigue, an occupational hazard of computer use, is now one of the top complaints people bring to their family doctor. Headaches are another symptom associated with computer work that ranks among the top five health issues seen by physicians. Back and joint pain are also rampant, affecting about 30 percent of U.S. workers.

When we consult at work sites, we measure people’s tension level while they work at the computer. We have found that the majority of computer users are totally unaware of their physical tension and muscle strain. When we compare their ratings of shoulder tension with the EMG recording, we find that they underestimate the level of tension by about 80 percent. Most people tend to ignore their body’s signals, and by the time they experience pain, the damage may already be done.

—Erik Peper and Rick Harvey

Good ergonomics involves more than simply getting a new keyboard or optimizing a workstation. Injuries occur when people are captured by their work, engrossed, fixated on the demands of their job, and unaware of physical discomfort or pain. In other cases, they may feel the pain but dismiss it. In our research, we found that almost all employees thought that their muscles were relaxed when they were sitting correctly at a computer or tablet. However, the actual physiological data showed a different picture. The printout usually recorded tremendous tension while they worked. Even when they stopped, pausing with their hands on the wrist rest or table, they did not totally relax their arms and shoulders. This is evident in the EMG printout in figure 6.1.

Figure 6-1 We find that unnecessary muscle tension in the shoulders and arms typically occurs whenever participants put their hands on the keyboard. The EMG provides them with visual feedback in real time if they are not relaxed. Once they become aware of the tension, and address it by dropping and relaxing their shoulders, the muscle tension decreases. (Photo and EMG printout: Erik Peper)

Documenting the Role of Tension in Injury

Our contribution to the field of ergonomics has been to document the level of tension when people are actually working at the computer, by recording information from their physiology. We have also used biofeedback to teach them awareness of muscle tension and breathing patterns. A common observation before training is that almost all of the participants unconsciously raised and tensed their shoulders and maintained a low level of tension in their forearms while keyboarding and mousing. Sustaining a posture of tension—raised shoulders, arms reaching forward, rapid shallow breathing, and, sometimes, colder fingers—inhibits the body from relaxation and places the employee at risk of injury. This increased arousal maintains a state in which healing and regeneration are constrained, referred to as a catabolic or breakdown state.

In contrast, both mental and physical relaxation promote a state in which healing and regeneration can occur, referred to as an anabolic or growth state. This occurs only when we have relaxed our muscles, muscle tension decreases, and breathing slows.

Muscle tension can be compared to driving a car while unconsciously riding the brake. We have to press on the gas pedal much harder to overcome the added resistance of the brakes—and we can’t go very fast. Over time, muscle strains related to low-level chronic tension can result in injury, often diagnosed as repetitive strain injury. Tensing a muscle 20 percent of maximum may reduce blood flow to the muscle as much as 80 percent.

Recognizing sources of neck and shoulder strain. Human beings are one of the few creatures that walks upright. Consider

- Standing erect is a major balancing act, since the human head weighs at least ten to twelve pounds.

- The head contains a number of vital organs—brain, eyes, ears, nose for breathing, and mouth for eating. (In an earlier world, compromising any of these functions would put survival at risk.)

- Every activity coordinated in the brain is transmitted through the nerves in the neck, within the spinal column.

Figure 6-2 Walking on two legs rather than four is a balancing act, reflected in the massive, elegant structure of the human back, shoulders, and neck. (Gray’s Anatomy, Plate 409, by Henry Vandyke Carter, public domain)

- Keeping the body (1) balanced, (2) the neck vertebrae aligned, (3) nerve conduction uninterrupted, and (4) circulation constant requires major structural support.

- The need for balance, alignment, nerve conduction, and constant circulation explains the massive musculature of the shoulders and neck, comparable to girders supporting the structure of a building. In the body, these anatomical structures not only maintain balance, but also keep the brain and sensory organs functioning.

Given the constant demands on the muscles supporting the head and neck, it’s not surprising that when we’re on the phone or the computer for hours at a time, these muscles are subject to wear and tear, strain, and soreness.

Balancing stress and dynamic tension. Tension, like stress, is experienced as a dynamic aspect of life. In fact, we need periodic tension and stress in our lives to keep us at the top of our game. The goal is to achieve a balance between relaxation/recovery on the one hand, and tension/stress on the other. By way of example, when we go to the gym and work out, the physical activity by its very nature puts a great deal of tension on our muscles. We may be sore the next day, but if we allow those muscles to rest, after a day or two they will be stronger than before. However, if we work out to the max every day, we are much more likely to get injured. The take-home message: There’s nothing wrong with muscle tension per se, as long as we can relax and allow time for repair. What we want to avoid is a state of constant, chronic muscle tension.

Physical Stress

In our evaluations we find that almost all participants believe their muscles are fully relaxed, although the instruments are recording tension. Even when they are sitting with correct posture, they are tense. Although ergonomic changes in equipment or furniture may be necessary, those changes are not enough to overcome Tech Stress. Employees still need to change their work habits to reduce stress and maintain their health. Lack of awareness of their physical patterns during computer use is a major factor in work-related pain and injury.

Overuse. Injury to muscles and nerves can be caused by repetitive tasks, forceful exertion, sustained or awkward positions, overuse, poor ergonomic technique, or ergonomically incorrect equipment. Muscle and trigger points become sensitized when a muscle is contracted for too long without brief periods of rest. The National Institutes of Health report that repetitive strain affects approximately 30 percent of all those engaged in computer work.

Data from the U.S. Bureau of Labor Statistics indicate that 60 percent of computer workers report wrist pain. Repetitive strain injuries in Great Britain incur up to US$6 billion a year in direct costs. Swedish research suggests that about half of those who work at the computer have some form of repetitive strain condition. In Brazil, approximately 30 percent of computer-related injuries involve some form of repetitive strain.

Neck strain. Whether we’re on a phone, a tablet, or a laptop, we’re usually bending over to look, to text, or to touch the screen. This face-forward position increases compression on the vertebrae of the neck—the cervical spine—and increases neck muscle tension as shown in figure 6.3. (If you struggle with neck or back pain, additional insight is provided on this topic in chapter 8.)

Figure 6-3 When we crane over the computer in a face-forward posture, neck and shoulder tension increases without our awareness, and breathing is more constricted. In contrast, when we sit erect, the tension in our shoulders and neck is lower. Sitting erect, our breathing tends to be freer and almost effortless, as shown in the lower line of the graphic. (Photo and EMG printout: Erik Peper)

Hands hovering over the keyboard. When we momentarily stop typing or entering data and rest our hands on the keyboard, our fingers hover over the keys, tensed. We’re always ready to respond to the next command of the machine. Often there is also tension in our forearms, without our awareness. When we pause, we may think that our muscles are relaxed, but in reality, they are not.

Bracing or slouching. Working at the computer, we’re usually totally unaware when we are bracing. Slouching causes other stresses and strains. We may move closer to the screen to see better, which increases the tension in our neck and back. As we bring our hands to the keyboard or mouse, we may also tighten our shoulder muscles, another form of bracing.

Fine motor tasks. When people text, they also have a tendency to brace their body. Even their breathing changes, typically becoming shallower and more rapid. This kind of intense concentration is essential to perform fine motor tasks with minimal errors, by reducing the movement that occurs with each breath. Yet the greater the effort to achieve a static posture, and the more intense the concentration, the greater the muscle tension. This is also true when using a mouse to enter data into an Excel spreadsheet or using a CAD (computer-aided design) program.

Experience It: Feel the Tension

For two minutes, hold your phone with your arms out straight in front of you and write a text. Monitor your reactions:

- Where do you feel the tension?

- Do you notice any muscle tension in your back, legs, arms, hands, or fingers?

- As you begin to concentrate more intently, do your shoulders tense up?

- Where is the locus of your breath? Is your breathing deep and relaxed—or shallow?

You probably found that you tended to hold your breath and tense your shoulders and your arms as you held the phone.

Deep fatigue. Muscle fatigue can result from accumulated muscle tension, although most of us don’t associate fatigue directly with long hours spent at the computer. When blood flow is impeded, the muscles may become exhausted because they have reduced access to the oxygen and nutrients needed to regenerate.

Subclinical pain. In medicine, symptoms that exist just below our level of awareness are referred to as subclinical, as in subclinical pain. Most of us carry this type of subtle tension throughout the day because we don’t completely release it. The tension becomes even more pronounced with long hours at the computer.

Stress injuries. The strain from computer work tends to trigger low-grade inflammation of muscles and nerves. Without periods of relaxation and adequate sleep, the body’s repair activities are cut short. We’re at risk of injuries such as carpal tunnel syndrome—but we’re also at greater risk of a freak fall or an accident. The body needs time to lower inflammation and then repair any damage to muscles and nerves. (You don’t want to suddenly pull a muscle, throw your back out, or take a fall because you’ve been soldiering on, wired and tired.)

Mental Demands

Intense concentration, working under pressure, problem solving, and intensive mental work can also cause tension and activate a low-level stress response. Anticipation plays a role in tension, as we wait for the computer to respond. If we’re under time pressure, we may become impatient when there is a lag of even a few seconds.

Adrenaline-driven workstyle. On deadline, many of us assume an intense workstyle, thinking that this enables us to work faster or better. Working at a brisk pace can make us feel energized, but by the end of the day, we may be exhausted. And the pace can become addictive, fueled by a kind of adrenaline high or a sense of being driven. However, without periodic breaks, the work takes a toll.

Big projects and sustained effort. We’re not built for long-term stress, which can put us at risk of depletion and burnout and make us more vulnerable to a stress injury. Learning (or relearning) to pace ourselves is a key to success.

Self-imposed, perfectionist demands. Work that demands precision carries its own form of psychological stress, which can trigger muscles and nerve symptoms. A good example is the pain we feel in our neck and shoulders when we’re under pressure—the classic “pain in the neck.”

Experience It: A Little Rest for Your Hard-Working Hands

If you’re sitting at the keyboard, but not actually working, it may seem like you’re relaxing. But that’s not always so. As long as your fingers are on the keyboard, even if you are not actively typing, the muscles in your hands are still tensed. (If you allowed your fingers to completely rest on the keys, the weight of your hands would depress the keys, resulting in unintended typing.)

It’s helpful to take your fingers entirely off the keys for a moment and completely relax your hands in your lap or on the desk. You’ll find that even brief moments of relaxation like this throughout the day will increase your energy level.

Consequences

There are a variety of consequences for ignoring muscle tension, resulting in fatigue, inflammation, pain, or activated trigger points. Following is a brief set of reminders relating to a stressful workstyle.

Tension/fatigue. Even a little tension can have big consequences. As the muscles contract, they narrow blood vessels, creating microscopic bottlenecks that slow the flow of blood, similar to the way a fully inflated blood pressure cuff constricts blood flow.

Painful trigger points. In spasm, trigger points are a source of localized pain within the muscle. However, inflamed trigger points can also cause referred pain, experienced in other areas of the body. Common causes of trigger point pain include

- Overstretching. The initial cause of trigger point pain can involve overstretching of a muscle.

- Overuse. Muscle injury and trigger point sensitivity occur if the muscle is contracted for too long without moments of rest.

- Emotional stress. Both local and referred pain are caused by the activation of trigger points during the stress response. When we feel stressed or remain emotionally tense, sympathetic activation (the stress response) increases, stimulating the trigger points, which can result in referred pain.

Wondering why stress would cause trigger points to flare and pain to set in? Sensitizing the trigger points increases our reactivity and therefore decreases the amount of time for our muscles to respond. As hunters and gatherers, these sensitized nerve fibers would have enabled our muscles to respond more quickly. Today, however, our bodies experience constant tension, and when chronic stress persists, the trigger points can remain sensitized; they become “tender points” chronically inflamed and usually exceptionally painful. Trigger points associated with strained muscle spasms are typically felt or perceived as knots (nodules) in the muscle.

As a case in point, most of us think of carpal tunnel syndrome as a condition associated with repetitive motion injuries. However, researchers have found that another primary cause is a low-grade stress response—comparable to what we see when people work under intense pressure. In repetitive strain injuries, a chronic, low level of continuous strain leads to inflammation, which then impacts the nerve fibers (trigger points that become inflamed and painful). For more information, see the work by physicians Simmons and Travell, who have written extensively on the trigger points.

Trigger points become activated when we are in the stress response. Thus, the sufferer needs to find a way to resolve the stress and the habit of arousal that is overstimulating nerves and muscles. To quiet the trigger points, the individual must feel safe in their work environment, and feel physically and emotionally relaxed, in order to shift into the relaxation response.

Referred pain. Activated trigger points can stimulate nerves that radiate pain signals to other areas of the body. The local site of discomfort is not always the origin of the pain. Referred pain caused by trigger point activation is often associated with working at the computer. The potential causes of referred pain due to muscle tension and/or inflamed trigger points are numerous:

- neck → headaches

- neck → tingling in arms and hands

- neck and shoulders → pain in wrists and forearms (carpal tunnel)

- shoulder (upper trapezius) → head and eye pain

- back (lower trapezius) → pain in the back of the head and shoulders

- chest muscles (intercostals) → pain in the arms and hands

- shallow breathing (scalene muscles) → pain in shoulders and hands

Figure 6-4 Referred pain tends to be underappreciated. The activated trigger points in this example can cause pain in the back of the head. (Trigger points added to Gray’s Anatomy, Plate 1211, Wikimedia, public domain)

When we develop aches and pains, we usually become more aware of our bodies; however, once the symptoms disappear, we may return to the same unconscious work habits that caused the difficulties. If the pain persists, we resort to painkillers and muscle relaxants, or learn to live with discomfort or disability. Yet learning preventative techniques is ultimately easier, cheaper, and healthier than the effort required to recover from an injury.

Story of a Production Typist: How Self-Awareness Can Reduce Pain

Inputting spreadsheet data, with long hours at the computer, I was beginning to experience pain in my right arm and wrist. When I took part in an ergonomic training program, I became more aware of my workstyle and noticed that I was holding my arm at an awkward angle when I used the computer. Apparently, that was causing muscle strain. The easiest place to begin was by changing my posture. Every time I took a break, I made it a point to notice how I was sitting, the position of my arm and wrist, and whether I was experiencing any pain. Then I would readjust my posture, move my arm into a more comfortable position, take a few deep breaths, and relax. After two weeks, the pain totally disappeared.

What You Can Do

We encourage you to create your own program. Many people are surprised to learn that health issues and injuries can be eliminated just by changing their workstyle. A study we did of employees with computer-related pain found major improvement in their symptoms after only three training sessions. Employees with similar conditions who were on a waiting list for the training showed no improvement. Many of those in the program were experiencing computer-related problems involving their back, neck, shoulders, arms, or wrists. Subsequently, they reported less fatigue, fewer headaches, and less pain overall. The basic step-by-step program we used has provided the basis for this book. This approach is quite practical and involves only a modest commitment of time. The general elements of the program are summarized below.

Make a commitment to yourself. Now that you realize how important it is to reduce tension, incorporate these strategies into your life. That means improving your ergonomics, being proactive about stress, staying physically active, and fully relaxing once a day.

Deepen awareness. The first step is to increase awareness of how our bodies function. Our muscles work by alternately tightening and relaxing—they’re like the strings on a puppet. Whenever we want to move, they tighten, making the muscles shorter. To stop the motion, they relax. But when we’re at the computer, we often hold our muscles in a state of constant tension for minutes without taking a break. At other times, we may unconsciously experience low-grade tension for hours, or even continuously throughout the day. The goal is to bring awareness back into the body so we can eliminate the drain on our energy from continuous low levels of muscle tension.

Recognize pain as an early warning. Most of us take symptoms such as fatigue for granted. We may also ignore aches and pains. Yet research has shown that chronic complaints can be an early warning sign. Researchers have found that painful conditions such as nerve damage and tendonitis often begin as neck or shoulder soreness that patients considered normal or ignored.

Prioritize quality sleep. When we reduce tension through relaxation, the body shifts out of the stress response into the relaxation response. Once in that mode, the immune system can ramp up, rebuilding tissue and repairing wear and tear. Our muscles need to be totally relaxed to regenerate fully. If we’re short on sleep and relaxation, our bodies don’t have a chance to repair the damage. Without deep restorative sleep, we’re missing out on the many forms of growth and repair that occur while we’re sleeping.

Move your body. Get active. Two of the most effective ways to resolve tension are through physical activity and deep relaxation. Aerobic activity increases circulation, filtering out toxins like lactic acid that build up when muscles become fatigued, and reduces stress hormones such as excess cortisol. Aerobic activity also helps the body filter carbon dioxide. Active physical movement shifts perspective away from stressful thoughts into greater awareness, paying attention to the body. After moving your body, remember to relax systematically, focusing on each area of the muscles that experience tension. If possible, get a massage, which will help remove additional toxins.

7

Am I Addicted to My Phone?

Arguably it is the smartphone that has driven the tectonic shifts in the way we communicate today. The iPhone was introduced in 2007, and the Android just a year later. So, the smartphone is essentially a decade-old phenomenon.

Figure 7-1 Our love of smartphones is universal. (Photo by Erik Peper)

Figure 7-2 The explosive growth of the internet.

Today about 4.5 billion people use the internet—a billion more than used it three years ago. More than one million people have been coming online for the first time each and every day for the past two years. Yet the internet as we know it has happened in less than thirty years. Google officially launched in 1998, and by the end of that year, had an index of sixty million pages. Mark Zuckerberg developed FaceMatch in 2003, which morphed into Facebook and went viral in 2011 as an online photo-hosting site. At the time of this writing, social media’s influence on our lives is about nine years old.

The Addictive Nature of Media

The internet and the smartphone tap into our historical love of—and addiction to—moving images such as movies (developed from 1905 to 1907), TV (first commercially broadcast in 1941 and popularized in the 1950s), and personal computers (introduced from 1971 to 1980). This romance with screen images also reflects our love of theater and storytelling. Before writing developed about five thousand years ago, the spoken word was the repository of all knowledge. Our addiction to media reflects our basic drive to track information that may be relevant to our survival.

Evolutionary Trap 4

We are wired to see artificial images and to hear reproduced sounds as real. The brain does not discriminate between actual and visual-auditory images that are human-made, which explains one aspect of our attraction to our phones, to binge-watching, and to gaming.

Today, the average American spends more than eleven hours of screen time per day watching, reading, listening to, or simply interacting with electronics—up from nine and a half hours just four years ago. This increase in screen time has extended the habit of screen addiction and sitting that developed with the introduction of TV in the 1950s, creating a whole evolution in human behavior.

The smartphone ups the ante as the Swiss Army knife of devices. When we respond to our phone and are rewarded with text, video, or music, powerful neurotransmitters are released in the brain. This is the same brain chemistry that reinforces behaviors ranging from survival strategies to heroin addiction—in particular, dopamine.

The role of dopamine in learning, according to researchers Everitt and Robbins, is to reinforce new learning that could help our short-term survival. Dopamine also reinforces information gathering that might help us anticipate the future and support our long-term survival. That may explain the little rush of pleasure we experience when we hear a particularly juicy piece of gossip that puts us in the know.

It’s the dopamine. As author Simon Sinek points out, dopamine is one of the chemicals that makes us feel good when we drink, smoke, or gamble. In other words, it’s extremely addictive. We have age restrictions on alcohol, smoking, and gambling. There are no age restrictions on social media or cell phones, which Sinek suggests, very convincingly, is the equivalent of offering booze to teens. The result appears to be an entire generation with access to an addictive, numbing chemical (dopamine) at the very time when they’re going through the high stress of adolescence without adult coping mechanisms to deal with that stress. When major stress shows up in their lives, they’re less likely turning to another person for support, and they’re more likely to turn to their phone.

And the endorphins. Screen addiction also triggers endorphins, neurotransmitters associated with pleasure and with pain relief. Endorphins are another form of brain chemistry—powerful opiods produced within our bodies that are similar to opium, heroin, and morphine. They are released as a reward during physical activity (the runner’s high), when we eat foods that taste good, and even for procreative activity. Researchers Darcq and Kieffer point out that endorphins may have been key to our ancestor’s survival by reducing the pain experienced as an aspect of the hunter-gatherer lifestyle. This chemistry turns out to be so potent that it’s another good reason to be sure we get to the gym, go running, or keep a yoga practice going.

Opioid neurotransmitters are released both to ease pain and enhance pleasure, so there is the argument that screen interactions serve both purposes: to rescue us from distress (or boredom) and to stimulate feelings of comfort and pleasure. The range of neurotransmitters that are engaged when we use our phone shows the complexity of the body’s response. Although the rewards from our surfing, scrolling, and clicking are intermittent, they serve to further deepen internet addiction, reinforcing the repeated release of dopamine and endorphins. The result is increasing compulsion to interact with the phone and a sense of anxiety when that is not possible, a pattern that underlies addiction to smartphones, computers, gaming, social media, and the internet in general.

I’m guilty, you’re guilty, we’re all guilty. These addictions are a global phenomenon at this point. The phone’s screen is often the first focus of attention when we wake up and the last one before sleep. We can’t even wait to finish a meal or complete a conversation before checking the phone for updates. For this addictive behavior, we can thank the major tech companies who have hired the brightest and the best engineers, programmers, and scientists to develop software and hardware that captures our attention and addicts us to these devices.

In Holland, where they’ve been providing addiction treatment for fifty years, clinics in Amsterdam today treat phone addicts as well as heroin addicts. Note that the most basic prerequisites for enabling addiction are availability and access. Most of us have our phone with us all the time. Whenever we look at the phone, there’s new information, and it’s continually updating. Every update essentially gets rewarded with a tiny rush of dopamine or other reinforcing neurotransmitters.

Evolutionary Traps Revisited

When human behaviors that were once successful become maladaptive, we know we have landed in an evolutionary trap. Smartphones meet some of our most basic survival needs, but when we become addicted to our phone, that can be a trap.

Evolutionary Trap 5

We are wired to react to any stimuli that suggests potential danger or the presence of game animals. Whether the stimuli is auditory, visual, tactile, or kinesthetic, it triggers excessive arousal. This makes us vulnerable to screen addiction, because our biology compels us to respond.

Hypervigilance is programmed into our DNA. Protecting ourselves from danger means being constantly vigilant. Frequent updates in our phones can trigger that vigilance. In fact, “Stay safe” is a frequent message in community-based social media. The covert message is “Watch out. There could be danger. Stay alert.” Every notification triggers our compulsion to interrupt what we’re doing and check the screen—and triggers the sense of hypervigilance.

Each notification activates the same neurological pathways that are activated when we perceive potential danger in our environment. These are the pathways that would have been triggered by the approach of a mountain lion or a bear—any predator that threatened our existence.

Evolutionary Trap 6

We are also wired to attend to social information about power within our group, a major factor in social media addiction.

For many people, cell phone addiction is largely driven by the desire to connect socially. We are intrinsically social creatures, and we continually want to know what’s going on, who’s doing what. We also need to stay current with our social network to know where the power structure will go. (Who’s out, who’s in, who’s going to be the next leader.) We are probably hardwired to be attuned to gossip, and ultimately, social media provides the perfect platform for gossip.

During the Paleolithic era, living in small clans pitted against a harsh environment, collaboration in social groups increased our chances of our survival. In a close-knit stone-age tribe, staying attuned to group norms would have been extremely important. Inappropriate behavior could result in abandonment, which would have put survival at risk. Researcher Robin Dunbar suggests that social media may be attractive from an evolutionary perspective because it helps support information exchange within small groups.

Once addicted, any cue that reminds us of our phone will trigger the compulsion to check the phone. Is there another message? Even when we are working or socializing, the moment we become aware of the phone—we see it or feel it in our pocket—we experience the urgency to check for texts or messages. American consumers now check their smartphones more than fifty times each day. This is not initiating calls or messages; it’s just checking for messages. This means that we check our phone to stay current about four to six times per hour. However, people ages eighteen to twenty-four, for example, look at their phones twice as much as other folks—more than eighty times a day.

Figure 7-3 Our phones tend to have a hypnotic effect. (Photo by Erik Peper)

The interaction keeps us involved. Smartphones are essentially small but powerful computers, audio-video communication devices, game consoles, and movie screens that we can carry in our pocket. It is unbelievable that the smartphone in your pocket has much more computing power than the computers used fifty years ago to send man to the moon—computers that occupied several rooms.

Each new image or piece of information captures our attention through infinite variety. Like cat and mouse, something that responds and interacts is always much more interesting. Almost all life-forms are attracted to other life-forms that are interactive. For instance, when a cat catches a mouse and the mouse plays dead, often the cat will let it go. Researcher Miyatake and colleagues suggest it is the interaction that keeps the cat interested, and it’s the interaction that keeps us involved with our phones.

Knowledge Is Power, unless It’s Fake News

For Paleolithic hunters and gatherers, the person in the group who knew where the deer grazed, or where the best mushrooms grew, was the one who brought home dinner. Today, we don’t hunt and gather food as much as we hunt and gather data and acquire various types of information and knowledge. However, the amount of raw data, information, and knowledge available via the internet is so vast, there is no equivalent in human history. The challenge is how to sort through the overload of information. What is false or fabricated? What is relevant and useful?

Historically, knowledge was vetted by leaders and sages. Now knowledge is stripped of the connection to a known (reliable) source, an authenticator; this is one factor in the rise of fake news. If the graphics look professional, it is generally assumed that the source is legitimate. However, appearing in print or on a website does not guarantee accuracy or avoid bias.

Given that there is some level of bias, the question is, how much bias is there? For example, information from an educational institution (.edu) may have less bias because the information has a high degree of peer review (“blinded” for neutrality) and scrutiny from educators and researchers who have a deep familiarity with the current and historical aspects of the subject, as well as training in critical thinking. The publishing industry has also made a significant contribution to the intellectual property of our culture by vetting authors, content, and the accuracy of information. What is the author’s motivation? It’s important to ask to what degree is there bias in the information provided by commercial interests (.com), government (.gov), and organizational (.org) websites?

The trap at this point is our dependence upon online information to do our jobs and manage our lives. That makes it difficult to avoid fake news and to determine what is actually true and what is false or irrelevant. The art of persuasion has been an aspect of the human experience for the past five thousand years. However, the global connectivity of the internet has allowed the introduction of a new level of bias, and fake news is now manufactured with extraordinary sophistication. With billions of people tuned in, the net provides a platform that allows dissemination of bias to an enormous potential audience.

A Culture of Immediacy

Due to shifts in our cultural and workplace expectations, a much broader range of occupations is affected by the increased pace of information, including the demand for immediate response associated with digital communication. Historically, if you wrote a report, it would be typed up, snail mailed, and read. Eventually someone would write a response. There was always a certain lapse in time, depending on the medium. Today, however, because emails and text are received seconds after they are sent, the expectation is an immediate response. The built-in expectation is that the reader will provide immediate feedback whenever possible.

The danger of immediacy in response is that it may lack thoughtful reflection. With an impulsive email, if I get upset and immediately blow up, the other person may blow as well. The suggestion here is, when a difficult or emotion-filled email is written, file it as a draft, and then go for a walk or sleep on it. Come back to the discussion, having had time to reflect on the emotional negativity, which is almost always reduced when we have time to cool off.

Paraphrasing a conversation overheard as one young woman empathizing with another, waiting for a text from her lover: “Don’t worry; it’s only been ten seconds. He probably still loves you.”

The expectation of immediacy frequently accompanies workplace demands and is reflected in many aspects of our work life. Once people leave work, they may feel as if they are still on call, depending on their profession. If you’re in sales, you may be on call. Supervisors are often on call. With electronic and digital media, almost every communication becomes top priority. The reality is that, in most situations, there are very few things that are truly urgent or require an immediate response.

Multitasking, Interruptions, and Distractions

Today, we’re all doing business on the fly—in the car, on the subway, in a coffee shop, and while we’re walking. Regardless of what we’re doing, if we have the phone, and it’s on, it’s going to break our concentration. This is a device that was designed to alert us to new information. With the integration of phone, email, computer, and internet in a single device, we’re much more likely to be interrupted.

Multitasking is a myth. It’s important to point out that multitasking is an urban legend—an illusion—because our brains are single track rather than binary, like a computer. We’re simply not designed to do more than one thing at a time, and when we do, it’s not that we’re achieving parallel goals, but that our mind is darting frantically, ricocheting back and forth from one task to the other.

The human mind works by sequential tasking. That means that if we’re driving, when we’re on the phone, our attention is there and not on the road. On the phone, whether we use our cell phone hands on, or on speaker, the accident rate is about the same—it increases. More people now also get killed talking on a cell phone and crossing the street.

Interruptions. If you liken deep thought to scuba diving, when you’re working on an idea or a project, to really get into it, you need to dive into the material. Once you have finally settled down to work, if you are able to continue working, if your energy is good, you can become productive. However, when you stop to answer the phone or check incoming texts, every time there’s a new notification, you have to pull your attention away, shift gears, and pop back up to the surface again. It takes a certain amount of time to reorient your thinking, respond to the incoming demand of the smartphone, and then focus back on the project at hand (see figure 7.4).

Distractions. In some cases, you may need to start over. If you were at a good stopping point when you were interrupted, it may be easier to jump back into the work. Whichever the case, immersing yourself in the project again is like reloading RAM (random-access memory) on the computer. You have to reorient yourself to the facts, retrace the thread of the logic in your thought process, and then grasp the next idea that you were reaching for. Little by little, you immerse yourself back into the project.

Figure 7-4 Scuba-diving analogy: interruptions reduce our ability to stay on task and focus, diminishing our performance. (Source: Erik Peper)

Clearly, there’s lost time and lost productivity. If you get a lot of calls or notifications, before you can integrate new information and work through to a conclusion, there’s another interruption. If you have constant interruptions when you’re trying to work, the content that you’re working on is simply not integrated in as meaningful a way. You also want to be able to link new information with other aspects of your experience and expertise so you can develop ideas that are substantive and meaningful. If we always stay on the surface, there could be a quality of superficiality to our thought process, because the information is never fully integrated.

Reducing the Risk of an Accident

In the first three years of smartphone use (2007 to 2010), the rate of pedestrian accidents tripled. Overall, accidents are now the leading cause of death in the United States from childhood through age forty-four.

Traffic accidents. Rates of accidents due to driving while texting are up—and so are accidents involving pedestrians. When we’re walking, whether we’re texting, listening to music, chatting on FaceTime, or playing Pokémon Go, our focus is on the screen. At those moments, we are much less aware of our surroundings. Audio or visual distractions while walking have resulted in making us the prime subject for auto accidents, tripping and falling, and even thieves or other criminals (see figure 7.5).

Figure 7-5 Injuries caused by cell phone use per year. Emergency room visits involving pedestrians have soared since the introduction of the smartphone. (Graphic by Erik Peper; data source: Povolotskiy et al., 2019)

Is My Phone Dumbing Me Down?

Passive Learning

My work at the university has included teaching, research, and participating in program development. What is relevant here, and today in many university settings, is frequently a style of passive learning in which students consume rather than create. More than ever before, students expect the material to be pre-digested, summarized, and often reflected in a brief fifteen- to thirty-minute video as a form of edutainment. When the syllabus is handed out, students expect several things: reminders of the next exam date, the pages they will be tested on, and what the questions will be. In short, students are reading less and less of the material that is arguably necessary for learning and for mastery of any given subject.

I have observed over the past decade that more and more students come to class unprepared, asking questions that were covered in the syllabus, which is posted online. Many only read what they are explicitly told to read: “You must read pages 95–98 because you will be quizzed on that reading.” They often expect that summary PowerPoint presentations will be provided to them, although they may not even look at them.

Intellectual curiosity underlies the joy of learning. Are we paying attention to electronic screens because the stimulus is evoking our attention, or do we pay attention because we are interested in the subject? Most all of us tend to be bombarded with more and more distracting information. The mental effort required to learn new, intellectually challenging material involves excitement about learning and self-motivation. These qualities appear to be slipping away from young people who have grown up in the digital revolution. Given the seismic cultural shifts of the past ten years, we need to be creative in developing new approaches to nurture academic achievement, critical thinking, and intellectual curiosity.

Erik Peper

The Phone as a Brain Extender

One of the seductive aspects of a smartphone is its usefulness as a brain extender, making a huge amount of information available to us at our fingertips at any moment in time. Physicians, for example, are able to use their phone to sort through prescription options in a matter of minutes, a valuable application of the phone in precision medicine. Throughout business, industry, and international commerce, there are thousands of examples of the phone as an enormous time-saver, linking all of us worldwide.

A no-brainer? The concern raised by the usefulness of this elegant device is the potential loss of memory capacity over time. Our phones perform so many mental functions that we rely on memory less than people did in the past. As an example, how well do you know your friends’ cell phone numbers? Much of the information we now store in our cell phone we would have stored in memory twenty years ago. The use of memory creates a rich network of connections in the brain, and arguably, using memory turns out to be neuroprotective of those memory circuits.

Are we outsourcing intellectual capacity? In essence, your phone is a massive external hard drive that you can carry in your pocket. Unfortunately, there may be a price to pay for this convenience, always at our disposal. We may be losing critical brain functions (based on the principle of “use it or lose it”). This raises another question: what are we putting there instead? The latest funny cat video? By outsourcing our own intrinsic brain function, we may be harming ourselves (as a species) in ways yet unknown. We have already outsourced much of our physical activity to cars, trains, escalators, and even people movers at the airport. There has always been a cost to outsourcing, and this is probably no exception.

Learning and Quality of Life

The benefits of a rich mental life extend far beyond the need to remember and retrieve practical information. Consider research by psychologist David Snowden, described in detail in his book Aging with Grace: What the Nun Study Teaches Us about Leading Longer, Healthier, and More Meaningful Lives. This fifteen-year study followed 678 nuns ages 75 to 102 from the School Sisters of Notre Dame. They had homogeneity of background: female, never married, no children, little or no alcohol, similar occupations, and good access to medical care. Every few years the nuns participated in neuropsychological testing to measure mental and emotional function and the possible development of dementia. All the nuns had given permission for an autopsy so that the actual structure of the brain and any damage could be assessed. In addition, Snowden analyzed the three-hundred-word autobiographies of 180 of the nuns written when they entered the convent at a young age. The goal was to assess idea density as a reflection of intellectual curiosity. Three prominent findings stood out.

Lack of curiosity and thought were associated with greater risk for Alzheimer’s disease. Those who did not have a particularly rich mental life were more likely to develop Alzheimer’s—and more serious symptoms of Alzheimer’s. Those who had a less developed mental life and lower pursuit of intellectual knowledge suffered the most when Alzheimer’s struck.

A rich mental life appeared to be protective against Alzheimer’s. Researchers found the short autobiographies that contained the highest idea density (expressing a greater number of ideas) had been written by the nuns with the least evidence of dementia. In short, those with an active mind appeared to be less vulnerable to Alzheimer’s disease.

Attitude and mood were found to be major factors in health. The researchers also reported that those who were depressed seemed to have the worst Alzheimer’s symptoms. Although counterintuitive in many cases, they had less actual physical damage. In contrast, those who had an optimistic mind-set throughout their lives functioned much better mentally than they should have, given their overall health and their brain health.

In the context of these findings, what is the impact of our simplification of language and thought? The complexity of the circuitry within the brain appears to protect us as we grow older. Once the brain starts pruning unneeded circuits or begins to develop a degenerative disorder, such as Alzheimer’s, our memory functions decline. Is there a parallel to the situation of the nuns who expressed fewer ideas in their autobiography and subsequently developed severe dementia? By reducing idea complexity in our communication, are we setting the stage for a future epidemic of early onset Alzheimer’s?

Dumbing Down the Language to Texts and Tweets

The digital revolution is likely to have a major impact on our use of language within a generation. Given that texting is currently our primary medium of communication, what changes will occur in our language and the depth of our expression over the next twenty years? What losses will we suffer as a culture? (Shakespeare did not achieve his body of great work through a series of texts or tweets.)

Linguists refer to changes in the meaning of words and phrases as a semantic shift, which can result in dumbing down the specific or nuanced meaning of words, a phenomenon that may be occurring with increasing frequency in contemporary society. There is a simplistic quality to the use of language in digital media.

Over time, will we come to think with less depth and expression? This is a question that will play out in the arena of human evolution. Structure tends to follow function. Are we reinforcing a simplistic communication process that will eventually have an impact on human brain structure? The classic rules of neurophysiology state that “neurons that wire together fire together” and “structures atrophy and are pruned if they are not used.” (These concepts are also popularly expressed as “use it or lose it.”) One possible implication of dumbing down our communication style is the potential for loss of cognitive functions with eventual impact on brain structure. Will the introduction of fantastical devices that amplify our intellectual capacity later be seen as some type of turning point in human evolution?

Is Your Phone a Problem?

We tend to take a fairly pragmatic view of these issues. When we do consulting work, most of our clients are people struggling with pain or injury. The question is: “Do you have a problem?” If you don’t think your phone is an issue, you’re probably not going to do anything about it. However, if you suspect that you’re spending more time on your phone than you want, do an experiment. Turn it off for half an hour or an hour, make real human contact, and see how that feels. Notice any changes in your body or your emotions.

What You Can Do

Recognize the possible ways that you are being manipulated by digital technologies and develop systems for limiting screen time and reducing interruptions. Strategies for reducing the negative effects of Tech Stress include

- Turning off all notifications from your devices when you’re working, socializing, or taking downtime.

- Using an app to monitor how much time you’re spending on your phone.

- Defining the time you want or need to spend on Facebook, Twitter, Instagram, Snapchat, TikTok, LinkedIn, or other social media, based in part on whether you use them for work, for marketing, purely for socializing, or a combination of these.

- Setting consistent time-of-day limits on media use so digital life doesn’t interfere with other priorities such as work, school, family meals, daily exercise, chores, and other responsibilities.

- Establishing times in your day or week when you are totally off the grid: for example, first thing in the morning, during meal times, or on weekends.

Practice impulse control.

- Become more conscious of your public messages or posts: for example, as you prepare to leave for vacation, avoid tipping strangers off that you will be gone and your house will be empty.

- Deal with intense emotional or physical stresses when they occur by using movement as your friend, by engaging in physical exercise, rather than by posting about the stress or rehashing it. Note that confiding in a friend or a counselor can be exceptionally helpful, but repeating the story of a traumatic event over and over can be counterproductive, in a sense, reliving it each time. (For more on this perspective, see chapter 18.)

Max your productivity.

- Schedule uninterrupted blocks of time for work at periods in the day when you are most alert. For many people this is morning, but not for everyone.

- Engage in demanding or creative work first before responding to social media; consider saving that for times when your attention and concentration are lower, unless your interaction on social media involves high-profile responses associated with your profession or business.

- Let your colleagues know that you are only available on technology during certain time periods and can’t be reached at other times.

- Set aside a specific time of day for responding to email. For example, you might only answer email during specific blocks of time, at work and at home.

- Dedicate certain activities to a specific device—for example, emailing only on your work computer and avoiding any email on your phone.

Allow yourself opportunities to integrate your thought processes.

- Review important information at bedtime, as the last thing you spend time thinking about before you go to sleep (but not emotionally upsetting information). You might also engage your thoughts, for example, while walking, jogging, or swimming.

- Permit your best thinking to surface while you are deeply relaxed, for example, taking a shower or having a hot soak.

- Allot time on your calendar that is Tech Stress-free and gradually increase that periodically to a full three-hour block of time in order to wrap your head around ideas and engage in deep thought.

Minimize multitasking. Bear in mind that multitasking can result in semitasking—getting twice as much done, half as well. Your brain can fully engage in only one thing at a time. When it seems to be doing two things (or three), that means your mind is darting frantically back and forth between these different activities. If you feel the need to do four things at once, you may be bored with the primary task, which can make it difficult to concentrate. Here are a few antidotes:

- Find something to work on that really interests you.

- Learn to meditate in a way that allows you to observe your internal mental processes, which will help you achieve the mental discipline you need to figure out why you are bored.

- Apply mindfulness in your everyday life to deepen the quality of your experiences—with friends, in nature, when exercising, when dining.

- Every day, make the effort to do some type of physical activity that you enjoy, whether it’s dancing, yoga, biking, tennis, rock climbing, or walking the dog. Exercise helps circulate oxygen to the brain and body, which supports a sense of clarity and shifts intention back toward a task.

Avoid semi-tasking on the job. At the work site, if you are an employee, it’s important to attend to the humans who are there in front of you. Similarly, the message to employers is pragmatic: Customers feel devalued if employees are on their phone instead of being helpful to the person in the store.

Maximize face time and socializing.

- Turn off your digital devices during social events (dinner or conversation). Make an active choice to be present with coworkers, friends, and family, talking rather than texting each other.

- Minimize interruptions when dining out. Consider leaving your phone at home (and just having one person bring theirs), swapping phones during the meal, or frequenting one of the restaurants where you can check your phone at the door, similar to a coat-check system.

- Take time out. When going out to dinner, agree that no one will answer their phone or text message. Rather, agree that the only time the phone will be used is as a tool for research—for example, to use a search engine, such as Google, to answer a question. If you’re talking about a country like Zambia and nobody knows the gross national product of Zambia, somebody might say, “OK, let me look that up for a moment.” Otherwise, don’t use the phones. Be fully present with those you care about.

- Make it a game. When you go to a restaurant, you might ask everyone to place their smartphone visibly in the middle of the table, and agree that the first person to touch their phone pays the bill for everyone.

8

Is My Phone Depressing Me?

Figure 8-1 (PEANUTS © 1960 Peanuts Worldwide LLC. Dist. By ANDREWS MCMEEL SYNDICATION. Reprinted with permission. All rights reserved.)

The link between our posture and our mood is reflected in phrases such as walking tall, standing proud, a stand-up person, and an upstanding citizen—in contrast with phrases such as in a slump, down in the dumps, a downer, and a slouch. Slumped posture is commonly seen in people experiencing depression. However, recent observations of our team suggest that when people adopt an upright posture, that increases their positive emotions and energy level. Becoming savvy about the role of posture when we use the phone or the computer offers the benefits of positive mood and uplift. This can help us avoid the negative effects of energy drain and mild depression associated with collapsed posture.

Posture, Strain, and Pain

We would like to offer insight on the effect of phone use, drawing from recent research by Dr. Kenneth Hansraj, chief of spine surgery at New York Spine Surgery and Rehabilitation Medicine. In a superb analysis, he found that pressure on the spine increases from about ten pounds when you are holding your head erect, to sixty pounds of pressure when you are looking down. Bending forward to look at your phone, your head moves out of the line of gravity and is no longer balanced above your neck and spine. As the angle of the face-forward position increases, this intensifies strain on the neck muscles, nerves, and bones (the vertebrae).

Using a tablet or laptop, you may also lean in, bending forward to see the screen, increasing pressure on the vertebrae. (See figure 8.2.) The more you bend your neck, the greater the stress, since the muscles must stretch farther and work harder to hold your head up against gravity.

This same collapsed head-forward position when you are seated and using the phone repeats the neck and shoulder strain. Muscle strain, tension headaches, or neck pain can result from awkward posture with texting, craning over a tablet (sometimes referred to as the iPad neck), or spending long hours on a laptop.

Repetitive strain of neck vertebrae (the cervical spine), in combination with poor posture, can trigger a neuromuscular syndrome sometimes diagnosed as thoracic outlet syndrome. According to researchers Sharan and colleagues, this syndrome can also result in chronic neck pain, depression, and anxiety. Another team of researchers, Morris and colleagues, have linked this form of neck strain to a condition referred to as vertebrobasilar insufficiency—a reduction in blood supply to the hind brain through arteries within the vertebrae. When neck compression is relieved, symptoms of vertebrobasilar insufficiency decrease.

Figure 8-2 A face-forward position puts as much as sixty pounds of pressure on the neck muscles and spine. (By permission from Dr. Kenneth Hansraj)

Caution: If you tend to have back or neck problems, you’ll want to pay special attention to your posture, particularly when you’re using your phone or computer. You may find the suggestions at the end of the chapter helpful.

How Posture Can Drain Energy

As consultants on ergonomics, when we visit work sites to help people who have been injured on the job, a common observation is that most people tend to slouch as they work at the computer. Most of us tend to crane our heads forward while reading the screen. We tense our neck and shoulders while entering data. We hunch over the tablet and bend our heads down and may squint to read our phone screen. By the end of the workday, we’re often exhausted from shallow breathing and muscle tension or in pain from muscle strain. Once at home, most people tend to slouch in an easy chair or on the couch as they watch TV or surf the web. Usually, we’re only aware that we’re slouching when we experience pain.

Experience It: Posture and Mood

In a slouched posture, almost everyone is more likely to feel somewhat depressed and find it more difficult to be optimistic. Recent research by our team suggests that, in a collapsed position, it is more difficult to solve problems successfully, to think creatively, and to convey leadership. Memories are embedded in our posture through conditioning, so posture covertly evokes memories, thoughts, and emotions as well as shifts in our energy level.

Figure 8-3 Sitting in a collapsed posture. (Photo by Erik Peper)

1. Sit collapsed or slouched (as in figure 8.3), and for the next thirty seconds think only of hopeless, helpless, powerless, or defeated memories.

2. Continue to sit collapsed or slouched, and this time, for thirty seconds think only of empowering and optimistic memories.

Figure 8-4 Sitting erect. (Photo by Erik Peper)

3. Now shift your position, and sit tall while looking upward (see figure 8.4). In this erect position, for the next thirty seconds think only of hopeless, helpless, powerless, or defeated memories.

4. Continue to sit tall while looking up, but change your mind-set, and for the next thirty seconds think only of empowering and optimistic memories.

Ask yourself, in which position was it easier to evoke the hopeless, helpless, powerless, and defeated memories, and in which position was it easier to evoke the empowering, positive memories? Additionally, in which position were you more captured by the memories?

You probably noticed responses similar to those we found in observations involving more than 200 participants (average age twenty-four). For the majority—175 of 200 of the respondents (87 percent), in an erect posture, it was easier to think positively and to recall positive mental images. In a collapsed posture, they felt more captured by negative memories, and it required greater mental effort to think of positive memories. (Our data are summarized in figure 8.5.)

Figure 8-5 Ease of accessing negative, powerless memories or positive, empowering memories. Respondents found it easier to recall positive memories and to think positively when seated with erect posture, rather than with collapsed posture. (Source: Peper, Lin, Harvey, and Perez, 2017

Slouching Can Drive Down Your Hormones

The work of the social psychologist Amy Cuddy while at Harvard found that just two minutes of standing in a collapsed or slouched position reduced testosterone and increased stress hormones (cortisol). In contrast, assuming erect posture, referred to as “power posture,” significantly increased testosterone and lowered stress hormones. As Cuddy pointed out in her 2012 TED Talk, “By changing posture, you not only present yourself differently to the world around you, you actually change your hormones.”

In the work of Cuddy and colleagues, findings regarding power posture match mammalian behavior of dominance and submission throughout the animal kingdom. Open (erect) posture is a dominant posture, in the sense of leadership and competition, whereas a compressed or closed posture (making oneself small) is a submissive posture. It’s not surprising that stress chemistry goes up in a submissive posture, reflecting increased stress. Chronic stress levels have been found to go down when one is in a dominant position of leadership.

The implication of Cuddy’s work is that standing tall can increase performance for both men and women. Astonishingly, short-term hormone levels can shift simply by changing to an upright body position of power and holding that position for two minutes, as a way to counteract a slouching position of powerlessness. (Moderate levels of testosterone benefit women as well as men, helping to support healthy bones and muscles, as well as libido, energy, and mood.) In Cuddy’s study, slouching postures reduced testosterone-competitiveness levels by about one-third, and increased a cortisol-stress effect by about a third, just in a matter of minutes. (So, when you’re on the phone and you’re slouching, remind yourself that you’re in a submissive or defeated position.)

Slouching Is a Low-Power Position

Figure 8-6 A depressed or collapsed posture is a universal symbol of constricted power in both humans and animals.

In nature, throughout the animal kingdom, collapsed posture indicates submission. This signifies a lower position in the hierarchy and correspondingly less access to food and social resources. On the other hand, erect posture universally indicates leadership. These patterns are likely millions of years old. Expanded, erect posture is associated with healthy (rather than destructive) competitiveness, leadership, and sexual prowess. Assuming the erect posture of leadership is good psychology, and it restores balance to your spine and nervous system.

Practical Things You Can Do About Your Posture

1. Get inspired. You may enjoy Amy Cuddy’s 2012 TED Talk, “Your Body Language Shapes Who You Are,” which describes the hormonal changes that her research team found associated with power posture versus collapsed posture. (At this point, Cuddy’s TED Talks on YouTube have attracted forty-six million views.)

2. Become more aware of your own posture. When you notice negative changes in your mood or energy, or tension in your neck and shoulders, use that as a cue to arch your back and look upward. Think of a positive memory, take another breath, wiggle, or shake out your shoulders if you’d like, and return to the task at hand.

3. Strengthen your core. If you find it difficult to maintain good posture, you may need to strengthen your core muscles. Fitness and sports that are beneficial for core strength include walking, sprinting, yoga, Pilates, swimming, and rowing. The most effective way to strengthen your core is through activities that you enjoy.

4. Organize the space where you live and work to “be uplifting.” Our research confirmed that when we look upward, a little above eye level, that increases positive energy and improves mood. To put this into action, if you have windows, when you take a break, look outside at the tops of the trees and notice details like how the leaves and branches are moving. You can hang art or photos slightly higher on the wall, so that you automatically have to look up just a little to see the pictures. You can also use the selections of art to evoke positive feelings.

5. Make an effort to get outside when you’re taking a break or on your lunch hour. Look up at the trees, the architecture, the hills, or at the clouds. If you work in an urban environment where you’re somewhat cut off from nature, you might want to become an expert on clouds. You can use that as inspiration to reconnect with positive energy and with the natural world, even in the heart of the busiest city.

Using Wearable Posture Biofeedback

This handy device consists of a small sensor, slightly larger than a quarter, placed on the back of your neck, which works with an app on your smartphone. After calibrating erect and slouched postures with your phone, the device will give you feedback whenever you slouch by vibrating lightly (as illustrated in Figure 8-7).

Figure 8-7 Wearing an UpRight Go to increase awareness of slouching and as a reminder to sit upright. (Photo courtesy of Erik Peper)

In our studies, clients, employees, and students wore a posture feedback device called the UpRight Go. This device provided a vibrational signal the moment the participant began to slouch, wherever they were, whether at work, at school, at home, while driving, or while walking. Almost all were unaware that they had been slouching. The most common triggers were (1) poor posture; (2) fatigue; (3) negative self-critical or depressive thoughts; (4) crossing their legs, shallow breathing; or (5) other factors.

When participants received the vibratory feedback, they were encouraged to identify what caused the slouching and then change their posture and behavior. They implemented some of the following strategies to optimize their health:

1. Poor posture. Head down when looking at their laptop, tablet, or cell phone. (See chapters 22 to 24 for more on ergonomics.)

- Change the ergonomics by using a laptop stand and an external keyboard to maintain a more upright posture while looking at the screen.

- Take more movement breaks to interrupt the static tension.

2. Feeling tired. (See chapter 11, “Thirty Hacks for Sleep,” and chapter 12, “Getting Off the Grid.”)

- Take a break or a nap to regenerate.

- Do some type of enjoyable physical activity, especially activities that involve looking upward to re-energize.

3. Negative self-critical, powerless, or depressive thoughts and feelings. (See chapters 16 to 18 on empowerment.)

- Reframe internal language to self-affirming thoughts.

- Look up and think of someone who loves you or makes you feel safe.

4. Sitting with legs crossed.

- Assume a power position and breathe diaphragmatically.

- Get up and do a few movements such as shoulder rolls or arm swings.

5. Other factors in slouching.

- Identify the trigger and explore strategies that enable you to sit erect without effort.

- Move, wiggle, or get up to interrupt static muscle tension.

- Stand up and look out the window at the far distance while breathing slowly.

Participants in our research study found benefit from using the feedback device (see figure 8.8).

As one participant reported, “I have been using the Upright device for a few weeks now while studying and during class. I have found that it helps me stay focused. Whenever I become frustrated or tired, or when my mind begins to wander, I slouch. The Upright vibrates, I realize that I’m slouching, and I immediately sit up straight. This device has improved my posture and helped me tune into what I’m thinking and feeling. It has also increased my overall study time!”

Figure 8-8 Changes after using posture feedback (reproduced from E. Peper, R. Harvey, and L. Mason, 2019).

9

Caught Up in the 24/7 Lifestyle?

For many people, the 24/7 lifestyle goes hand-in-hand with workplace stress and burnout. Many of us today feel as if we’re always “on.” A growing number of jobs require both management and staff to be on-call 24/7. Even on our time off, most of us feel compelled to keep our phones on and check work email. This leaves little time for total rest and repair, which helps to explain the astonishing fact that today one office worker in three develops a health problem or an injury. The 24/7 workstyle poses two major challenges. The first issue is disruption of biological rhythms that affect our sleep and energy. With little time for total relaxation, we lose other opportunities to recover from fatigue, stress, muscle strain, or injury.

The shopping mall and the seven-day workweek. This workstyle began in the 1960s with the introduction of the shopping mall, which meant that stores and businesses needed to stay open nine to nine, seven days a week. From an era in which almost all businesses were closed on Sunday, we shifted to a culture in which even hardware stores and grocery stores were expected to be open all day Sunday. This also evolved into around-the-clock diners, doughnut shops, laundromats, and big chain grocery stores that were open 365 days a year, morning, noon, and night. As the model of the megamall spread across the country, people who wanted work were willing to put up with the hours. You might be called into work any day of the week, from nine to nine. The longer work hours became disruptive to home life, as more and more family members found themselves working evening shifts or weekends, missing home-cooked meals and time together. For many, this shift work previewed the end of the nine-to-five workday. At this point, shift work no longer affected just first responders such as firefighters, police officers, emergency medical technicians, doctors, nurses, and factory workers.

How the personal computer raised the stakes. The early 1980s saw the introduction of computers in the home. More than half a million computers were in American households by 1982, selling for the equivalent of $1,350 today. Early models by Radio Shack, Commodore, Apple, and IBM led the field. With the addition of the home computer, this meant we had a second seductive screen in the home. By the 1990s, some people not only used their computers at work; they began doing additional work at home on the computer, expanding the opportunity to work longer hours. Unfortunately, everyone sat on the same awkward chair with awkward posture, because often the computer was on the kitchen table, and there was no ergonomically designed computer furniture available.

Fast-forward to the present. With the integration of laptops, tablets, and smartphones in the work site, time management has become more of a slippery slope. We are captured for more hours of the day, increasing the risk factors caused by our devices and how we use them, often with negative consequences to our mental and physical health. Gradually, our work life seems to have taken over our waking hours and become integrated into our entire existence. We have less time to connect with friends beyond coworkers and colleagues, and seldom have uninterrupted time for rest and repair.

The Importance of Biorhythms

A century of research on shift work and biorhythms has provided us with insight into the importance of day-night balance. It’s now widely known that light has an effect on our well-being. This is especially true of people in northern latitudes who suffer more from winter depression due to reduced sunlight. In the winter, a city like Fairbanks, Alaska, has fewer than three hours of daylight a day. Although low winter moods are now widely recognized, the fact that light has a significant effect on performance is still underappreciated.

Figure 9-1 Light pollution at night can have an effect on circadian rhythm and sleep patterns. Depicted here: Kobe, Japan. (Photo by Erik Peper)

Evolutionary Trap 7

We are wired to be active during daylight (with its blue-spectrum light), which is why blue-white light from our phones and computers can negatively affect the ability to fall sleep.

The blue light of sunrise stimulates the pineal gland deep in the brain to produce more cortisol, supporting a natural rise of energy in the morning. Cortisol, well-recognized as a stress hormone, is also central to energy production, promoting the release of glycogen from the liver to raise blood sugar. The production of cortisol follows circadian rhythm, and typically, more cortisol is released in the morning than in the evening. (Note that a number of factors can skew circadian rhythm, including shift work, jet lag, and the natural process of aging.)

When the sun sets, light in the blue spectrum decreases in intensity. As it becomes dark, production of melatonin increases, the hormonal signal for the body to gradually relax and sleep. The redder tone of evening light at sunset also stimulates the production of melatonin.

Mental function parallels biorhythm. Balanced hormone levels are crucial to performance. An early study of productivity by researcher Kleitman found that variations in performance on cognitive tasks throughout the day followed the same pattern as the cortisol curve. Cortisol rises rapidly in the morning and peaks around noon. It is gradually reduced throughout the rest of the day. Differences in hormone production over the course of the day have an effect on, among others, mood, memory, and internal circadian rhythm.

Experience It: Effects of Light Exposure at Night

Before the advent of electricity, people slept in the dark and were active during the day. The use of artificial light at night enables us—in theory—to be more productive, but it also interferes with our evolutionary patterns of sleep and regeneration. Light exposure at night often affects sleep, because it reduces melatonin levels (our self-produced sleep hormone). As a culture we now sleep fewer hours and often have more interrupted sleep, which negatively affects our physical and mental health. Given massive exposure to light both within the home and from the environment, it can be challenging to create a totally dark bedroom. If you are a light sleeper or if you periodically have insomnia, make an effort to eliminate all sources of light in your sleeping area. That might mean purchasing opaque window shades or an additional power strip. Then notice changes in your day-night patterns when you sleep in total darkness.

Consequences of Shift Work and Sleep Debt

What is the cost when our biological rhythm is out of balance? We know from the data that people who work nights or shift work have much higher accident rates. This type of data is tracked through large employee evaluations that involve thousands of workers such as the National Longitudinal Survey of Youth (NLSY). The data represent people working in a variety of jobs, with varying histories, work schedules, and different types of illness, injury, and accident rates.

Increases in injury and illness. In a survey of shift work, the frequency of illness and accidents among shift workers was compared with that of nine-to-five employees. After adjusting for age, gender, occupation, industry, and region, the researchers concluded that working long hours, late hours, overtime hours, and shift work were associated with increases in injury and illness. Rotating shifts or intermittent night shifts are even more harmful to our health. People who work night shifts and lack quality sleep, have broken sleep, or sleep deficit have greater health risks.

Higher accident rates. For instance, working more than sixty hours per week was associated with an increased hazard rate, and working in jobs with regular overtime schedules was associated with a 60 percent higher injury rate compared to jobs without overtime expectations. Shift work and jobs that entail a workday longer than eight hours increased the risk of illness and injury.

Science journalist Linda Geddes points out that just nineteen hours without sleep—equivalent to waking at 7:30 a.m. and driving home from a party at 2:30 a.m.—puts our cognitive abilities on par with an alcohol level over the drunk-driving limit.

Astronauts and the 24/7 Lifestyle

Tracking health, performance, and cognitive function of space shuttle astronauts, researchers Van Dijk and his team found that disruption of dark-light cycles and circadian rhythm was accompanied by a deterioration in mental performance. Scores on memory, math tasks, and psychomotor activities declined during space travel. Correlating circadian rhythm with hormone levels, they concluded that the changes in these biorhythms caused by unpredictable light-dark cycles in space affected quality of sleep. As a result of compromised sleep, the mental performance of the astronauts deteriorated.

Many office employees work in an environment comparable in one sense to that of the astronauts, lacking the natural light that maintains day-night rhythms and circadian balance. Living and working indoors all day, our bodies are deprived of natural light and are confused by the artificial environment. The light absorbed through our eyes rarely comes from the sun. Artificial lighting, smartphones, computer monitors, and TV screens have become our primary sources of light exposure. When we absorb excessive blue light from the computer screen, it is harder to fall asleep at night. Long-term exposure disrupts hormone balance, leading to elevated cortisol levels and inhibiting the production of melatonin. Fluorescent static blue-white lighting is also disruptive. Although employers increasingly invest in office improvements, innovative lighting remains uncharted territory for many organizations. Exposure to both sunlight and dynamic interior lighting is vital for sustainable productivity.

Virtual Binging

Today, it’s not just shift workers, and those working two jobs who are affected. We’re a nation of night owls. To some degree, these trends also apply to anybody who has developed a lifestyle of staying up late on social media, gaming, hanging out on their phone, or binge-watching. When we use media to relax, there may be an unintended consequence: the relaxation strategy may deprive us of quality sleep, with the aftereffect that we need more time out to regenerate and restore ourselves.

Gaming. Another major driver of the 24/7 lifestyle is the introduction of highly addictive computer games and binge entertainment. Gaming is a multibillion-dollar global phenomenon that attracts both kids and adults and is seen as a major sport in countries such as Korea, where people play hour after hour after hour. Gaming is primarily gender biased to males, with proportionally fewer females. Researchers Lynch and colleagues reviewed more than five hundred different video games introduced between 1984 and 2014. They observed that female characters usually had a secondary role compared with male characters, and female characters were more sexualized, making the games more attractive to male players.

Computer games are designed to be addictive. The games involve some type of reward as mastery increases, triggering the release of dopamine in the brain, a classic pattern of addiction formation. As any mother knows, if you have a boy playing computer games and you let him know it’s time to stop for dinner, you still may not see him for an hour or two because the game may be more desirable than food.

With gaming, the rewards occur second to second in a cascading series. There is a moment of tension and then you are either rewarded or dragged farther into the dynamic. This is a classic dopamine fix. Accessible 24/7, just as a casino would be, one can game any time of the day or night. The conditioned cues from this gaming world become another aspect of the addiction, similar to that which gamblers experience. Clearly other forms of digital entertainment also entice us to stay up late on social media or binge-watching, thanks to Netflix, Amazon Prime, Hulu, cable, and other streaming media providers.

Jet Lag, Sleep Lag, and Life Lag

Some jobs now involve a great deal of international travel. Anyone who travels between continents experiences significant jet lag. If you’ve done this, you know how disruptive that gradually becomes. You arrive out of sorts, your brain does not work as well, your body is out of rhythm, and your biological system just is not functioning. Even simple social jet lag from staying up late on weekends, or turning the clock forward or backward during daylight saving time, increases death rates and accident rates the next day. Experiencing various types of lag frequently is associated with increased morbidity and mortality.

Depression and mood. The brain runs on various neurotransmitters and nutrients. Adenosine, for example, is a primary constituent of ATP (adenosine triphosphate), the basic building block of energy that powers every cell in our bodies. In the brain and central nervous system, adenosine provides the energy for the cells involved with productive thought. When sleep, rest, and relaxation are disrupted—when there’s no time-out—our bodies do not replenish this type of important biochemistry, and then we run low on nutrients and energy, missing the opportunity to restore them. As a result, the quality of thought, creative activity, and intellectual property produced when we are exhausted often declines.

Figure 9-2 Eyes wide open: Sleep debt is a side effect of modern urban lifestyle and global travel. (Photo by Erik Peper)

Wired and tired. When we push ourselves with caffeine or energy drinks, we may become wired. However, we are at risk of a rebound effect, becoming more tired than when we listen to our body’s needs and take a time-out. The brain doesn’t have time to synthesize and release growth hormones, neurotransmitters, and nutrients that make it possible to get a fresh perspective on things. Being wired and tired, we may get caught up, living in crisis mode, always under pressure, continually putting out fires, whether the situations involve economics, workplace politics, or family crises (see chapter 19).

Burnout. Escalating chronic exhaustion and eventual burnout often lead to biological harm. In a sense, mental fatigue can be likened to overdoing physical exercise. Obviously, if you run a marathon, you will need time off afterward to regenerate. When all you do is work hard, then eventually your system will crash. If this resonates with you, think of your job as a weekly marathon. Build in time off just as you would after a race.

Typically, recovering from burnout requires several stages. For example, Bernier suggests six stages of recovery: “Admitting the problem, distancing oneself from work, restoring health, questioning values and building new values, exploring work possibilities, and finally, making a break or making a change.” Finding meaning in your work and making time for rest and renewal will help you avoid burnout on the job.

What You Can Do

Counteracting the digital demands of modern technology means paying attention to your reactions to physical and mental strain. Often this requires deliberate, conscious effort. Ultimately, to master Tech Stress you need to identify and master the triggers that seduce you into a 24/7 lifestyle, triggers that are specific to you.

Getting enough natural light. Outdoor breaks have a positive effect on biorhythm and should be promoted. No artificial light is as powerful as natural sunlight; the intensity of office lighting is 300 to 500 lux on average, while natural daylight on a clear day can reach an intensity of 125,000 lux. Increasing your daily exposure to natural light gives your biorhythm an indication of the time of day, which promotes more balanced hormone production. Whenever possible, favor workstations with natural light over those that only have artificial lighting.

Minimizing the effects of blue-spectrum light from your devices. There are currently a range of solutions for preventing disruptions to biorhythm caused by light from monitors. There is an app named F.lux that can be downloaded for free. The app asks you to enter your location and then adjusts the F.lux application on your computer screen to the time of day in your latitude and longitude. The natural variation of blue light to red light is adjusted gradually in tandem with changes in natural light.

Restoring your circadian rhythm. Sleep tends to be more disturbed when we keep irregular hours. On weekends if we stay up late and party or binge-watch, that creates a form of social jet lag. Generally speaking, it’s healthier if we tend to go to sleep at about the same time and wake up at the same time. That said, some people chafe under too much routine, so we each need to factor our own lifestyle into the mix of ideal circadian rhythm. If your schedule tends to be erratic, you might find the work of elite sports and sleep coach Nick Littlehales of interest. He has developed a system for managing erratic sleep schedules that he applies in coaching world-class athletes.

Coping with jet lag. Here are a few tips for traveling when the destination is more than three time zones away. Set your clock to the destination time as soon as you get on the plane. Arrive in the new time zone as early in the day as possible, eating foods that are typical for the new time zone, and forcing yourself to be as physically active as possible, preferably by walking in bright sunlight before going about your normal day, eventually sleeping at your normal bedtime in the new time zone. Avoid hypnotic sleeping pills. If you must take pills, then consider nutritional supplements or homeopathic jet-lag remedies. Also consider consulting with a physician for the appropriate dosage of melatonin, which is available over-the-counter in a range of strengths, from 0.5 mg to 5.0 mg and above. These sublingual tablets (which dissolve under your tongue) are typically taken one hour before you want to go to sleep. GABA (gamma-amino-butyric acid) can be taken in doses that range from 100 to 500 mg, spread throughout the day and/or around the time of sleep in the new time zone. Note also that once your biological clock has shifted, if you initially took supplements to help you adjust, then stop taking the supplements, simply letting your body produce this natural chemistry.

Rest and relaxation. Create unstructured time without stimulation that allows the opportunity for self-reflection and regeneration. As journalist Daniel Gross points out, “Freedom from noise and goal-directed tasks, it appears, unites the quiet without and within, allowing our conscious work space to do its thing, to weave ourselves into the world, to discover where we fit in. That’s the power of silence.”

10

Living a Virtual Life?

In 1900, about 90 percent of Americans lived on farms or in rural areas. By 1980, 90 percent of us lived in cities or suburbs. Today a metropolis of a million people is considered a small city, with megalopolises of fifteen million or more becoming commonplace.

Modern Times

During the commute home tonight on the subway, we were standing the whole time packed into the train like sardines, just inches away from dozens of strangers that we’ll probably never see again. The Muni was packed too. Exhausted, we got off half a block from our place, grabbed a quick dinner in front of the TV, answered work emails, checked WhatsApp and Facebook, and went off to bed.

Sometimes there’s a sense of social isolation in our lives. Even when we are physically surrounded by people, they may be strangers to us, and we do not feel socially connected to them. Social media, in a sense, gives us the feeling that we are still connected and less isolated, even though we’re in a city with millions of people. When I’m on my phone, I’m back with the group again, with my people. (Remind yourself that we evolved over the past five hundred thousand years living in extended family groups and clans of no more than 150 people.)

Using the phone or being on social media connects us to family, friends, and colleagues across the country. Clearly there are tremendous advantages to these nonphysical connections—the ability to conduct business, professional activity, and personal life around the globe.

Figure 10-1 Family dining, Newark Airport. (Photo by Erik Peper)

Farmer to Office Worker in Just Eighty Years

Although we’re hardwired for life in the bush, we now spend the majority of our lives indoors. In an urban environment, we may not only suffer from stress and social remoteness, but also from lack of physical activity and isolation from the natural world. What’s more, our environment has changed as well. The North American landscape has been transformed drastically in less than a century. After World War II, new housing starts averaged 1.5 million new houses a year, developed primarily in suburban areas. As a result, open space and natural habitats were often destroyed—forests, grassland, wetlands, and farm fields—areas that had served as a vast natural wonderland for Americans since the country’s founding. This trend was evident across the United States:

- Chicago. In the Chicago area, urban migration after World War II reduced farmland around the city by 40 percent.

- South Florida. Urban areas more than doubled in South Florida after 1960. With the development of large suburban-style cities, natural habitats in ecosystems such as the Everglades were reduced by 30 percent.

- Los Angeles. The population of the LA metro area increased more than twentyfold from 1900 to 1950, and has more than doubled since then to about ten million. Orange groves and farmland have become vast suburbs.

By 2010, more than half the U.S. population was suburban—the largest suburban population in history. Living indoors, we are more likely to live virtual lives, in contrast to lives connected to the natural world.

Social Life in the New Economy

At this point, fewer of us have time to socialize, likely a reflection of the economy. Fewer people participate in their local parent-teacher association. Church attendance is down, and there are far fewer church events. We volunteer less and donate less. The premise is that because we all work longer hours and commute farther, we simply don’t have as much time for these community and social occasions. Harvard health researcher Robert D. Putnam, author of Bowling Alone, makes the point that since the 1960s, slowly and surely our level of social commitment, social connectedness, and social capital has decreased.

Social capital reflects the networks and relationships among people who live and work in a particular society that enable it to function effectively. Building and maintaining social networks in the flesh is more involved than virtually accessing social media. Meeting in person often means arranging for child care, setting aside time to shower and dress, and dealing with the expense and effort of driving and parking or taking public transit.

Since the time and money required by social media are low, there is now a preference for convenient virtual connections versus the higher costs associated with face-to-face social networks. However, the question is raised: is the cost savings of a virtual life worth it in terms of social isolation and separation from real people and human interaction? Unfortunately, there is the loss of social capital that is built when you invest time and effort beyond merely using a virtual social media site. Further, we know there is a high cost to reduced social connections, reflected in increases in illness and early mortality. In cultures where people are highly socially connected, there are eight times as many centenarians as compared with the United States.

The Global “Village”

Historically, we are accustomed to living in small groups, so that’s our comfort zone. We believe that Neanderthals traveled in family groups of ten to fifteen individuals. In rural America a hundred years ago, a community might have centered around a few stores, a church, or a rail stop. Today, social media sites like Facebook are designed to recreate the small-group setting. That is an illusion that is effective in capturing and holding our interest, since in reality billions of people are on the site simultaneously.

The apparent digital world is deep, broad, and very attractive because of its fascinating visual and auditory nature. Online we may view media of someone traveling to Nepal, another person eating at a very expensive restaurant, a friend sharing the experience of a concert, and the potentially unlimited flow of pictures and video clips from time zones and events around the world. For some, the constant availability of media creates images of possibilities and desires for the future, with thoughts such as next year we may want to visit Kathmandu, attend the Burning Man festival, or eat at that new sushi place everyone recommends. For many others, it covertly amplifies dissatisfaction with the life they are now living. They may come to feel they do not have the skills or money to do those things; they may assume that they are boring compared with their friends. In fact, they may conclude that they are doing very little and feel worthless. That makes it a temptation to turn to Netflix and fill or kill time by binge-watching. Instead of creating, we have become consumers of other peoples’ images and thoughts—a process that encourages inactivity, undermines self-worth, and feeds depression.

The trap occurs when we allow social media to hijack our attention, replacing real social life with virtual experience. When I want a good conversation, I want to sit down for coffee with a friend, rather than hanging out with my phone.

This is not a new phenomenon. In a seminal book, Four Arguments for the Elimination of Television, American activist and writer Jerry Mander points out that before the Inuit people in northern Canada got TV, they were perfectly happy. Once they immersed themselves in television, their social connections and their happiness began to decline. Suddenly, they were comparing themselves to what they saw on television, the comfortable houses in Montreal with central heating, the abundance of food in the supermarkets, the apparent affluence of the people. By comparing themselves to the scenes on television, which they perceived as the reality for the rest of Canada, they felt diminished.

Social comparisons tend to make us less happy, especially when comparing ourselves to someone who has what we want or feel we should have. Olympic Silver medalists are significantly less happy with their medals compared to Bronze medalists. Silver medalists are more likely to compare themselves to the gold medalist and see themselves as a failure. The bronze medalists compare themselves to all the people who did not win a medal and experience more happiness and success. The happiness and joy are, in part, how you frame your own experience.

Figures 10-2 and 10-3. How technology has transformed social interaction. Digital immigrants talk to each other, while social media natives reduce in-person face time and connect digitally. (Photo by Erik Peper)

Our Kids Living Virtual Lives

In the decade after World War II, American children enjoyed a great deal of freedom. Kids played in the streets everywhere, all the time, even after dark. This was true in the toughest neighborhoods of the inner cities, as well as the suburbs and the country. Generally, nobody worried.

If you are a reader born before the internet, think back to times when there were no demands. As kids we were on our own, allowed to make our way in the world, to find friends, and to explore. The only thing required by parents was to come back by dinnertime. However, until dinner, that was free time, and no one ever had to tell us what to do. In many places there were wooded areas where we could hike and build forts; lakes and creeks for skipping stones and studying frogs; fields, empty lots, or streets where we could play baseball, kickball, or football. If you grew up in the country, or spent time there, that might have meant raising animals, riding horses, hiking, swimming, fishing, hunting, or camping. We were never bored.

So, what changed? As family size decreased, mothers opted to work outside the home. There was also an increased perception of urban crime and high-profile violence and kidnapping. The TV news cycle amplified the dangers. Parents now “helicoptered” over their children, attentively watching for danger. The perception that safety was disappearing motivated parents to begin keeping their kids at home after school. Since almost every American home had a TV, television served as a built-in (inexpensive) babysitter. Kids started coming home and watching cartoons instead of playing ball in the streets. The switch from TV to social media has been a logical next step.

What’s Changed?

American kids went from freedom to roam in a natural environment to being locked in the house with nothing to do but watch TV. What happened?

- Loss of the natural environment as the suburbs were built up in the 1950s to house veterans and their young families.

- Middle class flight to the suburbs—in 1990, the United States became the first nation in history with a suburban population larger than that of the cities.

- A rise in crime with the predominance of poverty in the cities.

- Increases in crime amplified by the media—in the morning papers and the evening news.

- Sensational news stories of a few high-profile cases of child runaways and kidnappings, increasing the belief that the world around us was unsafe.

- Following the example of women during the war, women entered the workforce in unprecedented numbers.

- The introduction of television in the 1950s, with afternoon programming designed specifically for kids, to meet this need, and the development of a vast array of commercial products marketed specifically to kids.

This was a sea change in American life, and the beginning of life glued to a screen instead of being out in the real world, with friends, in nature.

Figure 10-4 Are we losing emotional connection? (Photo by Eric Pickersgill)

That trend continues today. At most university campuses, you will see students using the phone more for texting and less for talking. They sit on buses glued to their phones, trading pictures of friends rather than interacting with those around them. In airports, one can observe whole families sitting together, all texting or surfing the web on their smartphones. Even couples may both be talking on the phone, each to someone else, sometimes to the extreme, agreeing only to limit access to their phones when in bed. Sometimes, even the bedroom is a place where we cannot detach from our phones. The sophistication of our technology seems to parallel an increase in social isolation and disconnection.

The hard data. Isolation and depression are not easy to measure. What do the data tell us about the well-being of young people in the U.S.? Tragically, over the past ten years, the incidence of suicide has tripled among girls and doubled among boys, when comparing the data from 2005 to that of 2015. Here are the leading causes of death (in round numbers, 2018) among fifteen- to twenty-four-year-olds:

- accidents: 34 percent

- homicides: 32 percent

- suicides: 10 percent

- cancer: 6 percent

This is significant, because unlike adults, kids are not usually responding directly to the pressures of the economy. What’s behind the increase in suicides, loneliness, depression, anxieties, and chronic illness? And what is the seduction of social media? Is there a connection between the lack of human communication at a deeper level? A researcher at San Diego State University, Jean Twenge, has compared the lifestyle of iGen (high school–age students) with that of prior generations. She found a decline in adolescent social interaction compared with Millennials and Baby Boomers of the same age. Twenge reported a sharp rise in responses by high school–age iGens about feeling left out or lonely. Twenge noted the attraction of simply interacting on social media rather than having to be chauffeured by one’s parents, needing to spend money, or being stuck at a friend’s house. One can simply hang out at home and text or post.

Twenge’s work with high school students found a correlation between increased time spent texting or on social media and psychiatric disorders. In contrast, she found that more time engaged in physical activities like sports and in interacting directly with others reduced the risk of depression and anxiety.

Research by Ethan Kross and colleagues of the University of Michigan reported that the more people in their study used Facebook, the more their life satisfaction levels declined over time. In contrast, interacting with others in person rather than virtually was not associated with a decline in life satisfaction. This dissatisfaction seemed to occur regardless of the size of people’s Facebook network, the perceived supportiveness of their network, or their motivation for using Facebook, and regardless of gender, loneliness, self-esteem, or depression.

With earlier forms of media, there was still the potential for a group experience—watching TV as a family, catching a movie with your partner, or listening to music with a friend. In contrast, when I’m captured by my phone, I become isolated, interacting with the media in a virtual experience. The suggestion here is that using technology as a style of relating could be a contributor to the development of extreme loneliness (“phone-liness”) and depression in our culture. Certainly, the data suggest there is a great deal more of that.

What do you experience? Although the researchers report correlations between high phone use and negative outcomes, your own experience may be more positive or more negative. The take-away message here is to begin paying attention to the relationship between your own phone use and a sense of anxiety, depression, or loneliness.

Story: I Want Something Real

The phone has a quality of unreality, an artificial environment. Even if I’m alone, I want to experience my life—I want contact with the world around me—the weather, the air, the sky, the people. When I’m on my phone, that’s all gone. The world just stops.

At the end of my life, I’m not going to wish I had spent more time on my phone. I’m going to wish I had spent more time in the world—appreciated more sunsets, more moons, and spent more time with the people I care about.

PART 2

COPING STRATEGIES

11

Thirty Hacks for Sleep

For the people who lived twenty thousand years ago in the wilderness, life revolved around the natural rhythms of sunlight and darkness. Later in farming cultures, the pattern of life was still defined by sunup and sunset. People awoke with the light and went to sleep when the light disappeared.

Fear of the Dark

Our fear of the dark is primordial because, the argument goes, in the dark we were the prey. For hundreds of thousands of years, night was a time of total darkness, as we hid in caves to avoid predators. During those prehistoric times, our fears of being eaten by wild animals were reduced by huddling together for warmth and safety as we slept.

Today we are often unaware of many of the motivations and impulses that lie deep within the human subconscious mind. Although our present life is far removed from our evolutionary past, that past is embedded within us, guiding, shaping, influencing, and otherwise controlling many of our biological and psychological behaviors, night and day.

Too much light at night. For many of us, darkness still feels unsafe. Total darkness is a rarity. Industrial nations illuminate their cities and suburbs 24/7/365 with artificial electric lighting of such intensity it is visible from space. Around 93 percent of Americans and 99 percent of Europeans experience an artificial glow in the night sky that makes the stars invisible at night and brings disarray to circadian rhythm.

Not enough sunlight. Light from the sun increases our sense of safety, warms us, and nourishes our bodies through vitamin D production. Natural light influences our biological pattern, the internal clock that coordinates our bodies—circadian rhythm. However, today most of us work indoors, and our exposure to full sunlight is limited. As a result, we may lack vitamin D, leaving us more vulnerable to infection, fatigue, or depression.

The Downside of Artificial Light

Exposure to artificial lighting after the sun goes down is another recent development in evolutionary terms. Only in the last ten thousand years have oil lamps and candles illuminated the darkness. Like fire, they provide light primarily in the yellow and red spectrum. However, with widespread electrical illumination little more than a hundred years ago, we now use intense light sources in the blue-white spectrum of light. Day and night, our offices and homes are constantly illuminated by blue-white light from incandescent, fluorescent, and LED light sources. Unfortunately, the advantage of having ready access to artificial light in the evening has a consequence for our evolutionary biology. The brain interprets blue light as blue sky and daylight.

Blue light exposure delays sleep. Before going to sleep, most all of us watch TV, surf the web, read email, connect with our friends on social media, and check our phone for the latest texts and notifications—all bathing us in blue light. Exposure to light on the blue-white spectrum (from phone, computer, Kindle, TV, or other artificial light sources) within thirty minutes before sleep can stimulate the retina in a manner similar to natural sunlight. In effect, the light tends to wake us up and energizes us as if it were morning. Unfortunately, blue light skews two hormones vital for sleep.

Light suppresses melatonin. Produced deep in the brain, melatonin is intended to prepare us for sleep and helps to regulate our circadian rhythms. This particular hormone is low in the day and rises with the onset of darkness, making us sleepy. However, blue light, more than any other spectrum of light, suppresses melatonin production. Lack of melatonin can keep us awake, delaying sleep onset, and making sleep more disrupted.

Cortisol can act as a stimulant, just when we’re trying to go to sleep. Less well recognized as contributing to insomnia, cortisol release is also triggered by blue light. In the morning, as the sky becomes blue, cortisol levels rise, signaling the release of glucose to raise blood sugar, which energizes and nourishes us for the day. Blue light exposure at night stimulates cortisol production, a signal to raise blood sugar, energizing us as if it were morning and revving us up at the very time we want to sleep.

Light exposure later at night further interrupts sleep. While sleeping, we may keep a light on in the room to feel safer or to allow us to see in case we have to get up. Even when we close the shades of the bedroom window, there is the soft glow of the alarm clock, the streetlights, or the flashing headlights of cars leaking around the edges of the blinds and curtains. Light exposure during the night suppresses melatonin production, so checking your phone for messages when you get up to go to the bathroom can further disrupt sleep patterns, making it difficult to get back to sleep.

The more our circadian rhythms are disturbed, the more our sleep is disrupted, and the greater the risk of illness. A complex set of interactions can contribute to poor-quality disrupted sleep, insomnia, fatigue, chronic fatigue, exhaustion, or burnout. The result is varying degrees of disruption to our biological rhythms that can affect our health and even increase the risk of cancer (see the work of D. B. Blask on this topic).

Restorative Sleep

Sleep functions in a broad sense as a time for the body to synthesize and restore the body chemistry that was used during the day. Sleep is also a period of maintenance and housekeeping for the body, when our ancient protective immune cells, the macrophages, roam the bloodstream, consuming microbes and cancer cells. The macrophages engulf these rogue cells and digest them whole. Elsewhere, natural killer cells on search-and-destroy missions identify viruses embedded in our cells and blast them with chemicals manufactured by the immune system. Without adequate sleep, this essential maintenance does not occur.

The more our circadian rhythms are disturbed, the more our sleep is disrupted, and the greater the risk of illness. A complex set of interactions can contribute to poor-quality sleep, insomnia, fatigue, chronic fatigue, exhaustion, or burnout. The result is varying degrees of disruption to our biological rhythms that can affect our health. We know from the research that shift workers have an increased incidence of illnesses such as cancer, due in part to disruptions in regular sleep patterns. Not only humans, but also many species of mammals, are negatively affected by sleep interruptions. For example, animal studies have found that cancer cells proliferated significantly in rats when lights were kept on during the night, compared with the health of animals in the control group who slept in darkness.

Experience It: Are You Getting Enough Sleep? And How Much Sleep Do You Need?

To learn more about your own sleep patterns, try an experiment. On a weekend, go to bed at about the same time, but do not use an alarm clock to wake up. Then simply notice whether you awaken without an alarm. What is your normal time to wake up?

If you always need an alarm clock to wake up, you probably don’t get enough sleep. In that case, try adding another thirty minutes or an hour to your sleeping time, either by going to bed earlier or getting up later, whichever is more realistic. See if that brings you to a point where you feel rested when you wake up. Continue the experiment until you awaken refreshed and well rested.

Do you need more sleep? Research studies suggest that in the United States, many people don’t get enough sleep. And some of us need more sleep. Teens and kids in a growth phase require more sleep. Yet the data suggest that currently, young people in elementary school, junior high, high school, and college are shortchanging their sleep. Anyone recovering from surgery, an accident, a heart attack, cancer, or chronic illness should plan on extra sleep, using the exercise above to determine an optimal sleep pattern. Obviously, pregnant moms, tikes, and elders also need extra sleep for optimal health. Although sleeping less seems like a shortcut to doing more, losing sleep can be destructive to health.

Still waking up tired? There is a symptom associated with chronic fatigue referred to as nonrestorative sleep. People with this condition awaken tired, exhausted, or in pain. If you experience these symptoms, consider seeking out a practitioner of functional medicine—either a medical doctor (MD) or naturopathic doctor (ND), one with experience in treating chronic fatigue syndrome, fibromyalgia, adrenal insufficiency (HPA dysfunction), or Lyme disease.

Honoring your own unique needs. Some people do very nicely on four to five hours of sleep, and others report that they feel sluggish if they get more than eight hours of sleep. Folks who are dealing with illness (whether that’s the flu or some form of chronic condition) need nine or more hours of sleep. Some young children require twelve hours or more. Young infants often need closer to sixteen hours of sleep, possibly because sleep is a time when the body synthesizes and releases various growth hormones. The more we need to grow, during infancy, our teens, or a period of repair or healing, the more sleep the body needs. Sleep is also a time when memory consolidation occurs. Although we’re inactive when we sleep, apparently there is a tremendous amount of activity occurring behind the scenes.

Enhancing health with sleep cycles. There are also various characteristic slow-wave and fast-wave elements reflecting deeper and shallower degrees of sleep that occur in cycles. There is agreement that a typical time frame needed for a sleep cycle is about ninety minutes, and humans on average need about five of those ninety-minute cycles (about 7.5 hours). During sleep time, synthesis and release of chemicals that are required for normal waking activities can occur to differing degrees. Some people have shorter or fewer cycles, implying that a way to define a “healthy insomniac” includes people who only need a few cycles of sleep (for example, 4.5 hours) in order to synthesize and replenish the chemicals that were used during the day.

An unhealthy insomniac includes people who don’t get enough sleep cycles to replenish what they need. When we miss essential sleep cycles, the body forces itself into a sleep state more easily in order to regenerate more quickly. Moreover, there are critical periods for sleep phases when the body releases restorative chemicals. Sometimes you can take an hour-long nap and not feel refreshed, while at other times you may close your eyes for a few minutes and feel great, because during those few minutes your body released what was necessary to function better.

Avoid comparing yourself to anyone else, because it doesn’t usually work to base your needs on what others need. Knowing the average sleep requirement among a group of people tells us very little about our individual needs. Knowing yourself and what you need is the key to protecting those times of day when your body requires a critical period of regeneration and restoration. For more extensive reviews of sleep cycles, refer to Matthew Walker’s book Why We Sleep and Nick Littlehale’s book Sleep.

Thirty Things You Can Do to Get to Sleep

Good Sleep Hygiene

Chronic insomnia typically takes one of three forms: (1) having trouble falling asleep; (2) waking up in the middle of the night; or (3) early morning awakening. The solutions for addressing various kinds of insomnia are slightly different. The first step is to practice good sleep hygiene. Optimizing your sleep hygiene includes fostering conditions of total darkness, which reduces retinal and optic nerve stimulation; maintaining a cool room, which supports the hypothalamic temperature regulators of sleep (when our bodies are too hot, it is more difficult to sleep); and reducing noises, including the noise pollution of sirens and honking cars.

Sleep as sanctuary. In terms of behavior and habits, experts recommend keeping the bedroom just for sleeping and relaxing, although not everyone has that luxury. Yet even in the most basic circumstances, you can make your bed or sleeping area a sanctuary.

Slumbering in total darkness. It’s helpful to have a routine for dealing with light pollution at bedtime, including the elimination of artificial light from electronic devices. For example, we may be tempted to check the phone or watch TV around bedtime, or we may be exposed to devices that give off light, like routers, glowing alarm clocks, smoke detectors, or night lights. Consider connecting all devices to one or two power strips in each room and then turn them all off at bedtime, to reduce both the light and energy use.

Sleeping in a cool room. Many people sleep in rooms that are too hot. To have a slightly cooler sleep, change your blanket with the change of seasons, and also explore bed linens such as sheets and pillow cases made from materials that help cool the body (cotton, linen, or silk).

Freshening the air. Good ventilation can make a difference. If the ventilation is too strong, or you are sensitive to drafts, you always have the option of airing the room out before you go to bed.

Avoiding overstimulation at bedtime. You want to minimize negative or violent imagery before going to sleep. That means avoiding last-minute news, videos, emotion-packed media, or chatting on your phone about emotionally charged topics. Nurture yourself with positive thoughts at bedtime, being selective about what you talk about, watch, or read. In general, you want to let your mind and body slow down.

Developing a bedtime ritual. Consider meditating, doing yoga, snuggling, or reading before you go to sleep. If insomnia is an issue, develop a short-list of how you want to spend your time once you’re ready to go to sleep. This is an opportunity to create a haven within the rhythm of your day.

Optimizing Light

Computers, TVs, cell phones, and artificial light have a strong peak in the blue range of the light spectrum. Rather than waking yourself up with the light, it’s helpful to put media aside and begin dimming the light in the room at least thirty minutes before sleep.

Glasses that block blue light. If you must work at night, or if you're a night owl or a movie buff, consider trying tinted glasses such as amber-tinted lenses that reduce the blue spectrum of light. If you wear glasses, clip-ons with a pale tint are also available. These tinted lenses are easy on the eyes and can be quite relaxing for computer use or reading.

Reading in bed. A good book is a classic relaxation technique if you use an actual book rather than an electronic device.

Circadian rhythm. Depending on the season of the year, some people find that their innate biological clock runs a little longer than twenty-four hours—perhaps twenty-four hours and thirty minutes or so. (It varies.) The quickest way to reset your biological clock is with light exposure in the morning.

- Consistent bedtime. Go to bed at about the same time every night.

- Bright morning light. In the morning, get exposure to direct, natural sunlight for an average of thirty minutes.

- Therapeutic indoor lighting. If that is not practical, try some form of light therapy (see below).

Light therapy. If it is too foggy or overcast where you live to reset your circadian rhythm, as it often is in the San Francisco Bay Area and in Seattle, you may want to try light therapy.

- Combination light and alarm clock. One can also use a special alarm clock that slowly increases the brightness of the light over a period of fifteen minutes, simulating sunrise.

- A light therapy lamp. These small, bright lamps can be placed on the breakfast table or on your desk at work. The goal is to be near the lamp for about thirty minutes each morning.

- Light visor. If you are highly active in the morning with no time to sit for thirty minutes in front of a therapy lamp, you can purchase a light that clips onto a hat or visor, available from Northern Light.

This therapy can also be helpful for people who live in an area with limited sunlight in the winter, such as the mountains or northern latitudes. Seasonal affective disorder (SAD) can result not only in blue moods and depression, but also in low energy during winter months. (Amazon.com offers lighting solutions that range from $30 to $300.)

Napping

Coffee and a nap. The 2018 book Sleep by Nick Littlehales provides an intriguing system for maximizing sleep. Littlehales has sleep down to a science. When deadlines loom, one of his simple strategies is a well-timed cup of coffee followed by a ninety-minute afternoon snooze. The trick is determining the best duration and time for that power nap and pick-me-up beverage.

A Royal Air Force lifesaver. It is said that the British did some fancy sleep research during World War II to ascertain the shortest nap that would provide restorative sleep for their pilots. Their conclusion was twenty minutes as a minimum for an effective nap. If you’re pushing deadlines, consider closing the door to reduce noise and light and setting your phone alarm for approximately twenty to thirty minutes (according to Allebach, who reported on the RAF Institute of Aviation Medicine findings for pilots). Your optimum nap time is possible with some trial-and-error self-experiments.

Catnapping. Littlehales offers the suggestion that we learn to catch a quick nap anytime, anywhere. Littlehales coaches champion footballers, who are often on the road, sleeping in hotels, and playing night games, yet must perform at their highest potential. The system he has developed to achieve optimum sleep is described in his book Sleep.

Delicious Sleep

Consider Cassie. The owner of a popular bookstore, after a day on her feet she still had the accounts to do, including complicated credit card billing. Once the doors were locked, she had a quick bite to eat, cleared the big table in her workroom, and stretched out for a nap. When she woke up, her energy was back, and she was ready to finish the accounting and head out for the evening.

Sound

Be sure to turn off all the notifications on your computer and your smartphone so they don’t beep or vibrate in the middle of the night.

White noise. One solution for noise is to run a white-noise machine in the background with a pleasing rhythmic sound such as the ocean, rain, or other lulling sounds.

Soothing music. Audio can be a good way to drift off to sleep. You’ll want to get the volume just right, not too stimulating, and effortless to hear. Avoid recordings with dramatic transitions or changes in volume.

Bedtime stories. An audiobook can be a pleasant alternative to a good read. If you sleep with a partner, use earbuds. You want something that will engage you and put you in a positive frame of mind for sleep, without being too overstimulating (avoid a page-turner).

Industrial-strength earphones. Ear plugs are always worth a try, although some can be uncomfortable and others simply don’t work. If you ever find yourself in a dire situation in which you are besieged by noise, you might try this rather zany solution. Step 1 is to purchase industrial-strength ear protectors rated to at least 36 to 40 decibels of sound reduction. Use the ear protectors in tandem with a neck pillow shaped like the letter C, like those used for air travel. When you’re lying on your side, the ear protector fits right into the pillow.

Relaxants

Some of us find that our body doesn’t slow down easily without some type of gentle nudge toward sleep.

Showers and soaks. For some, a nice hot shower, soak, or hot tub is ideal, especially if there is any neck or shoulder pain. For others, a hot (or cold) shower is too stimulating, because that can increase the heart rate. Finding the optimum way to relax your muscles, such as hydrotherapy, can help your sleep.

Detox soaks. The Japanese shower first, and then soak in a tub, so you are soaking in nice clean water. If you want to add a detoxifying oil or bath salts, start at a moderate dosage. Epsom salts are a good detox soak, as is crystalline vitamin C. Try half a cup and work up to a whole cup. If you have access to an indoor or outdoor hot tub, that is definitely a pleasant way to unwind.

Foot warmers and night caps. If you have trouble getting to sleep. warming your feet and your head can be a relaxing way to get cozy. If you have cold feet, first do a warm soak, with a cup of warm, uncaffeinated tea, and then don some socks and cover your head with a cap.

Aroma therapy. Relaxing essential oils include lavender, orange, lemon, and lemon balm, which are useful in promoting or maintaining sleep. There is extensive literature about the kinds of aroma therapies that promote sleep; however, it will be left to the reader to explore more on their own the wide range of aromatherapy techniques that may support sleep.

Progressive muscle relaxation (PMR). This technique involves systematically tightening and releasing any given muscle group and is beneficial because PMR is semi-active and principally under your control.

Traveling

As if jet lag weren’t enough, when we travel, we also have to deal with hotel room lighting. Recently at a conference overseas, we found that the hotel rooms were filled with a variety of electronic devices with little flashing lights. It’s shocking sometimes how much light these devices produce. Unfortunately, for better sleep, you need darkness. The strategy we use is to cover (or unplug) as many of the lights as possible, whether that’s a smoke alarm, a television, or a microwave. (Consider packing a roll of masking tape for this very purpose.) You can use a newspaper, a magazine, or a piece of clothing, being careful that you do not create a potential fire hazard. Another source of distraction is the light that leaks in underneath the door from the hallway. Roll up two towels and place them against the bottom of the door to block the light. If you are in a situation in which you cannot control all the light, consider using a soft fabric sleep mask.

Nutrition and Supplements

At bedtime, avoid food high in sugar, to minimize sleep disruptions. Reduce heavy, rich fatty foods that are difficult to digest to support restorative sleep.

Protein. People who wake up in the middle of the night and can’t get back to sleep may find that they need a little more food that’s rich in protein. Note how much protein you’re getting at dinner and either increase that a little or plan on a light snack at bedtime, to sustain your blood sugar through the night. Some people find foods containing the natural amino acid tryptophan to be helpful, so for example, try a small turkey sandwich close to bedtime. (Remind yourself that many aspects of nutrition differ from person to person. Honor your own experience.)

Calcium, magnesium, or a cal-mag supplement. Cal-mag capsules can be useful if the issue is waking up at 3 or 4 a.m. and not being able to get back to sleep. In other cases, two calcium citrate capsules may do the trick if you occasionally awaken in the middle of the night or early in the morning before it’s time to get up. A third option is a magnesium supplement made by a reputable vendor.

Melatonin. These sublingual tablets mimic a hormone made by the body once the sun sets. Melatonin could be worth a try, but check with your physician about trying a lower dosage such as 0.5 mg. Higher dosage forms of melatonin may have a negative effect.

Herbs. There are a number of botanicals available with a long history of use as relaxants or calmatives, with very mild sedative effects. Valerian, hops, and chamomile are among the most popular. Products such as Revitalizing Sleep, formulated by physician Jacob Teitelbaum and described in his work with fibromyalgia patients, can be helpful. There are also botanical teas such as golden tea made with turmeric and aromatic spices. Commercial blends like Sleepytime Tea by Celestial Seasonings and Well Rested by Trader Joe’s contain chamomile and mint.

Bioidentical progesterone. Sleep can become more difficult for women once there are symptoms of perimenopause or menopause. Bioidentical hormones can be useful in restoring sleep and general functionality. Estrogen and progesterone, prescribed by a physician, are molecularly identical to those found in a woman’s body and have demonstrated a very good history of safety and effectiveness in the world medical literature.

Medication. The data on sleeping medication are not very favorable and suggest the potential for harm. In general, avoid hypnotic sleep medications, but always consult your physician, depending on your individual circumstances.

Integrative Therapies and Devices

Yoga. This lovely yoga book from North Atlantic Books features a series of asanas that serve as gentle stretches and relaxing postures: Yoga for Better Sleep by Mark Stephens.

Meditation. Meditation or some form of spiritual practice can be a good way to unwind at bedtime.

Acupuncture. For some people, insomnia is an issue with the flow of energy in the body, and improving energetic exchange can make a major difference. Acupuncture can also be quite helpful in cases of exhaustion or burnout. If you are on a budget, you might try community acupuncture.

A check-in with your doctor. If sleep has become an issue that is impacting your health, do consider checking in with your health care provider. Sleep deprivation, over months or years, can erode health to a surprising degree. A history of poor sleep is often an aspect of chronic illness. In complementary medicine, testing body chemistry is often combined with other integrative health therapies related to sleep improvement.

If all else fails … If you find that you’ve awakened and can’t get back to sleep no matter what, think of this moment of quiet as a gift. Many spiritual traditions involve awakening at 4 a.m. for prayers. Within the Christian monastic tradition, and in sects within the Muslim faith, Judaic practices, Zen Buddhism, and Indian Vedanta, prayer and contemplation are scheduled at specific times throughout the day to achieve states of awareness or consciousness. It is a practice within many meditative and monastic traditions to awaken very early in the morning at a time when the world is quiet. The intention is to experience a state of dreamlike wakefulness, an openness to spiritual experience, a mental state of thankfulness, the opportunity for mindfulness and meditation, and the cultivation of a positive attitude. If you awaken at such an early hour and find that you can’t get back to sleep, remind yourself gently that you always have the option of spending the time well—resting, relaxing, reading, meditating, or doing something else that is satisfying or productive.

In combination or separately, these strategies to facilitate better sleep can be explored as a form of self-study. One of our primary points is to pay attention to the influences of excessive screen exposure on sleep quality, and then shift your intention to reduce the negative effects of Tech Stress.

12

Getting Off the Grid

Unplugging is all about quality of life, however you define it. Is that an afternoon of delicious unbroken sleep or an hour of yoga, windsurfing, or basketball? This chapter explores time off the grid as an opportunity to more fully engage in our lives on the one hand and to achieve deeper relaxation on the other. You are encouraged to schedule downtime right on your calendar, so you can periodically unplug and refresh. What do you want from your day off?

- the chance to slow down and relax

- unstructured time to catch up with yourself

- a space where relationships can flourish

- replenishing energy for peak performance and productivity

- embarking on an adventure

- studying something new, like learning a language

- being creative, doing something you love

The risks of always being “on.” The new 24/7 connectivity to coworkers and to our personal social networks means that there is little time out to reflect, to digress, to concentrate, or to integrate our thoughts. Information is continuously being flooded through our visual and auditory world. Life becomes similar to the news cycle. Each news item replaces the previous one. Temporary memory is continuously updated and replaced by new information. Much of that information is temporary and is never stored in long-term memory. The more information we sequentially experience, the less integrated it becomes. Instead of depth, the rapid surface flow of information and experience replaces the deeper analytical and emotional meanings.

Taking One Day Off a Week Changed My Life

Matthew was an extremely successful clinician with a full teaching load at the university, a research grant, and twin boys at home. Ultimately, his schedule caught up with him, and he was downed by a series of stress-related illnesses. Once he recovered, he made a commitment to himself and to his family to take one day off a week, regardless of circumstances. Usually this meant no plans and no scheduled activities. In retrospect, he feels that this not only changed his life, it became the foundation of his spectacular success. The benefits were so dramatic that he now teaches this strategy to all his medical students.

A chance to catch your breath. Modern life can be complicated, so complicated at times that it’s almost painful. Having a calm inner life allows a smoother navigation of the demands and expectations placed on us. Taking time for your own life provides the opportunity to problem solve, to think through important issues, and to develop strategies for coping. We need time to engage with the people we care about, to tune in to reality, to the world around us, without our devices. We can use time off the grid to hold onto what’s best about being human.

Increased energy. Time off reduces the drain on your energy from overstimulation. Since the human brain is incapable of shutting out various stimuli, in order to rest we have to create those opportunities. On the most basic level, our responses are based on our available energy. Relaxation and regeneration strategies are key to our energy and our quality of life. When work demands more energy than we have at the moment, we may become exhausted and our moods are negatively affected. We need time for rest and renewal, to heal aching muscles from physical wear and tear. We also need the opportunity to recover from emotional stress and mental exertion.

Digital media seems like the ultimate escape, but in reality, it is virtual. What you need is a real escape.

Better sleep. Checking in with digital media just before sleep increases our arousal. Instead of slowing down and drifting toward sleep, we may become intellectually and emotionally excited by the emails, texts, or social media updates—it could remind us of past or upcoming conflicts and challenges, personally, professionally, or culturally. (See chapter 11 for more suggestions.)

The normal process of consolidating and storing memory takes place during sleep, so when we’re short on sleep, there’s less opportunity to store memory. We need the opportunity to free flow, in order to integrate our experiences. Relaxation supports quality of life and quality sleep. As the Spanish proverb says, “How delicious it is to sleep after resting.”

Time for movement and exercise. Although you may not think of walking, yoga, or tai chi as exercise, these practices can effectively strengthen and nourish the body and clear the mind. In addition, recent research has shown that regular exercise is absolutely critical to maintain good health. Unplugging will give you the time to enjoy physical activity without feeling rushed or pressured.

Opportunity to gain a clearer sense of yourself. Time off the grid provides a chance to tune in to your own inner life and appreciate yourself, to be comfortable in your own mind, in your skin, and to value yourself. In a sense this time can be a form of energetic detox. This is a chance to reclaim your mind and body, and reclaim your own personal boundaries.

Being present in your most important relationships. There is value in having the time to nurture the relationships that are most vital to you. Being fully present with those you love is one of the most meaningful gifts you can give. Similarly, when you spend time with your dog, truly be with them. Animals profoundly sense whether you are present or not. This is the underlying source of joy and richness in your relationships.

Reduced exposure to EMF. Electromagnetic fields (EMF) from Wi-Fi, phones, computers, television sets, microwave ovens, and smoke detectors are all sources of nonionizing electromagnetic energy. The risk is higher the closer the device is to the body and the higher the intensity of the source. We’re also exposed to electromagnetic radiation via high-voltage power lines, power company smart meters, cell phone towers, and automobile dashboards (as well as traveling by air). Higher levels of EMF have been associated with oxidative stress, a factor implicated in the development of cancer. Reducing EMF exposure lowers the drain on your energy and reduces the risks associated with radiation damage. (See chapter 25 for more on minimizing EMF exposure.)

Creativity. Scheduling a block of unstructured time provides the space for unexpected insight and creativity; this can enable you to tap deep inner resources. That’s when the creative flashes, the moments of genius and joy can occur. Surprisingly, true creativity is a learned skill. Like a meditation practice, if you don’t allow the space for it, it may not occur. Create the openness, the opportunity for your creativity to emerge and flourish.

How Observing the Sabbath Saved Me from a Coronary

David was a gifted lawyer with a background in public policy and constitutional law. He was thrilled when President Kennedy tapped him as a key member of his transition team soon after the election. Growing up in a Jewish family in New York, he observed Shabbat at home, and attended temple services periodically, but had never been strictly observant. However, knowing the incredible demands a job in the White House would place on him, he joined an orthodox temple in Washington, DC. Being observant meant no use of machinery on Saturday, which translated into no phone calls from sunset on Friday to sunset on Saturday, and no driving into the office at 8 a.m. Saturday morning. Ultimately, he benefited in a number of ways. His faith deepened, he was able to avoid the coronary that had taken his father’s life, and he only had to work ninety-hour weeks.

What You Can Do for Rest and Repair

Ideally, you want a series of strategies to restore your energy, to nurture your attention, and to create a sense of mindfulness.

Unplug daily.

- Be unplugged while you’re driving to be able to attend to the road.

- Unplug when you’re walking. Be alert and aware of your surroundings; that means periodically looking over your shoulder, and walking purposefully. That way you can respond quicker to any sign of mischief, and you are less likely to be a victim of crime. Clearly, that also means staying off your phone.

- Go off the grid when you go out to dinner, or spend time with family or friends. Plan unplugged time with your kids.

Get off the grid nightly. Turn off all electronic displays about thirty minutes to an hour before going to bed to allow your normal sleep cycle to occur. As an anecdotal note about students in class, when asked for a show of hands about media use before bed, we have observed some general patterns: More than a third of students spend one to three hours watching media in some form before going to sleep. The majority use their smartphone in bed before sleeping, which they report affects their sleep negatively.

Take one day off each week.

- Many of the world’s great religions stipulate a day of peace, when one abstains from work. Whatever your belief system, schedule one day each week to totally disconnect.

- Take kids outside without access to any screen time as a way to facilitate creativity and self-sufficiency instead of dependence on technology.

Up your productivity.

- The goal throughout the book is to work smarter rather than harder.

- While working on a specific task, shut off all electronic media not needed for that task. Turn off email and your smartphone. This allows in-depth focus and greater productivity.

- Schedule specific times to read and answer emails, voicemail, and text messages.

Maximize quality time.

- Hold face-to-face meetings while taking a walk.

- Disconnect while spending time with friends or dining out. Be completely present to the person you are with. Put all emails, texts, and phone calls on hold unless needed in case of emergency. Sit over dinner or walk with friends and share your experiences in depth with each other. Share stories.

Go for balance. If your job is sedentary, your R&R may begin with exercise that relaxes you. If your job is physically demanding, you’ll want to be less active and use your downtime for relaxation and rest. If you experience mental stress in your job, consider quiet techniques such as meditation. On the other hand, if you experience emotional stress (for example, overwhelming time pressures or the challenges of customer service), consider physical activity.

Set limits. In many parts of Europe such as Holland, the weekends are considered family time, and people honor that time together. Employers are not allowed to contact workers during their personal time. The tendency to live longer is associated with having more cohesive family life, whether the family is a biological family or an assumed family. Setting limits and carving out family time can be challenging and often require a supportive network to reinforce those limits. However, creating quality home life or family time is ultimately worth the effort.

Participate in religious worship and family gatherings. In the past, religion and family provided many of the opportunities for personal regeneration. If either of these resources is available in your life, consider those times possible opportunities to restore your energy.

Schedule break time. Enter your breaks right into your calendar.

Track how you use your time. Inventory your schedule to gain a sense of what’s working. You may also want to begin by establishing a baseline—where does your time actually go? What did you do, how, where, and when? And what do you want to do differently? Also remember to build in vacations when possible.

Catch up on sleep. When changing habits, think strategically. If you move your TV, tablet, and laptop out of the bedroom, you’re less tempted to stay up watching the late show (see chapter 11).

Deepen your quality of life. Drawing inspiration from the lifestyle of the ancients, the hunters and gatherers:

- Spending time outdoors. This could mean walking in the woods, by a creek, or by the ocean, or walking, period. Stargazing, watching the sunrise or the sunset, watching the sky. Observing birds or wildlife, foraging. Hiking, climbing, camping, fishing, hunting, canoeing, kayaking, rafting, sailing, swimming.

- Working with wood, stone, or soil. Gardening, chopping wood, or landscaping, all with hand tools rather than power tools. Ancient crafts: making pottery, weaving, the dyer’s art, building things with wood, making clothing, working with leather or fiber.

- Gatherings. Community can encompass anything from communal cooking to festivals, drumming, singing with or without accompaniment, or playing instruments.

- Touch. Bathing, giving or receiving a massage, dancing.

- Caregiving. Caring for the very young, the very old, those who are homeless or ill, and for animals.

- Escaping into silence. For a day, turning off the media. Just for twenty-four hours, attuning yourself to the day. You even have the option, if you wish, of arising and going to bed with the sun.

Experience It: Explore the Effect of Setting Time Limits on Media Use

This exercise explores quality of life. Stop social media interruptions, reduce cell phone calls, and observe what happens. What happens when you reduce your cell phone use?

1. For a few days, begin by observing how you use your cell phone and how much you watch media.

2. Keep a record of each time you use your phone for texting and calling, how often you look at your phone for social media updates (WhatsApp, Signal, Facebook, Instagram, Twitter, Snapchat, TikTok, Slack, Reddit, LinkedIn, and so on), and how often you feel the desire to check your phone during other activities. For example, do you think about your phone while you’re working, at dinner, or when you’re with friends? Also, rate your energy level, productivity, and the level of emotional connection you feel with (1) friends, (2) family, and (3) coworkers when you are distracted by media.

3. Begin the experiment by creating time periods off the grid when you don’t use your phone to text, email, or read notifications—in other words, media-free time. This also means reducing the amount of time you spend watching films and other media. Let all your colleagues, friends, and family know that you are not available to respond to emails, text messages, social media updates, or tweets during specific time periods.

4. Let them know that you will be available between specific time periods such as 4 p.m. to 6 p.m., or whatever time periods you decide, and you will respond then to emails and texts.

5. In addition, when you are with people face-to-face having lunch, sitting down to dinner, or taking a walk, turn off your cell phone so you can really be truly present.

6. Rate your energy level, productivity, and the level of emotional connection when you’re with friends, family, and coworkers.

7. Implement this plan for one week and observe how you feel compared to how you felt earlier.

Response from a study participant: Initially I felt lonely and wanted to keep checking my phone; however, by the third day, I found myself feeling more connected to my friends. When we talked, I was really with them, really present, instead of continuously trying to check my phone for messages. I had so much more time, and I was much more productive, and I think my sleep was also better too.

Observations from Erik and Rick: In our experience, most people found that their coworkers respected their decision and contacted them during the time period they had requested. Many people report that initially, they wanted to keep checking their phone to see what was going on. However, this urgency was rapidly reduced because they knew there was a prearranged time when they could check in on media.

13

Hangry? Low Blood Sugar?

Hangry (HAN-gree) adj. a state of anger caused by low blood sugar.

Hangry, a combination of hungry and angry, is just one of the moods that people experience when their blood sugar drops. Hangry describes the interaction between stress, low blood sugar, and mood, reducing our ability to cope. Blood sugar has an impact on many of the systems in the body, including the adrenals, so drastic drops in blood glucose can trigger a form of stress response and all the chemistry that goes with it. In the extreme, low blood sugar can stop you in your tracks, reflected in a broad range of possible symptoms:

- loss of concentration or focus

- brain fog

- a sudden drop in energy

- wired and tired

- impatience or anger

- depression or tearfulness

- nausea

- sweating

- wooziness or blurry vision

- sensitivity to sound or touch

- allergic-type reactions: congestion and sensitivity to pollen, animal dander, perfumes, cigarette smoke, chemicals

If blood sugar drops drastically, it can take hours to come back to normal, to feel better, and to be fully functional. In the workplace, this matters—it’s not as if you can take half an hour off, have a good meal, and go lie down, much as you’d like to. A good strategy here is to learn prevention. We don’t need to wait until our system crashes. Rather, the goal is to intervene before it’s a major issue, before we crash. Coping in real time means intervening when you still feel good. This bears repeating—once blood sugar and energy plummet, accompanied by anger or depression, it becomes more difficult to get back into balance.

Approaches such as psychotherapy tend to underestimate the role of factors such as diet, physical exhaustion, or lack of exercise on emotional coping.

When blood sugar is dropping, we tend to react automatically. Even routine daily tasks and interactions become difficult, and it’s harder to solve problems or resolve conflict. Despite our best efforts, it can be difficult to change our emotional reactions, especially when we are hungry, tired, and/or stressed.

Managing blood sugar makes it easier to manage moods. This is an important way in which you can show compassion for yourself. Treat yourself as you would your best friend—take time out, have some food, and get some rest. If you crashed and got involved in conflict, do take time out, with the promise to revisit the issue within twenty-four hours. Then in the clear light of the next day, after having eaten a nutritious breakfast, deal with any unresolved issues. Discuss and resolve what happened the day before that triggered the outburst. Similarly, when the other person is out of control, do not take it personally.

Chronic low blood sugar. When blood sugar is unstable, that can be a sign of hypoglycemia, which could mean

- blood sugar drops too quickly after a meal, which can be improved by eating periodic snacks rich in protein

- blood sugar drops after consuming sugar or other high carbohydrate foods, so it’s vital to avoid simple carbs and sugars

- blood sugar drops too low, resulting in extreme or emotional mood swings or physical symptoms

Hypoglycemia can develop from poor diet choices, skipping meals, chronic exhaustion, or prediabetes (metabolic syndrome). If your health is generally good, avoid sugar and other simple carbs, and include a healthy snack midmorning and midafternoon. (Working really late? Don’t skip dinner, and later on, do have a snack.) When diabetes is a potential issue, seek guidance from your physician.

Stressed? In some cases, we may need nourishment, but we’re not the slightest bit hungry. Being hangry can lead to excessive release of stress chemistry such as adrenaline, a stimulant. According to researchers Waller and colleagues, stress chemistry can suppress appetite and in extreme circumstances could lead to eating disorders.

Acid stomach? In other cases, when we’re hangry, we may develop an acidic stomach. When we skip a meal, our stomach still produces the acid that is vital to digestion, but there is no food there to dilute these acids. The result can be a sense of discomfort or nausea. At the very time one needs food, it is unappealing. As a result, one of the greatest challenges is that when blood sugar drops, we may not feel hungry and may not even want to eat.

Mood swings. If the goal is to remain rational in the face of stress, remind yourself that the brain is a glucose hog and requires much more energy than any other organ in the body. When blood sugar drops, not only do other systems go out of balance, but we are also lacking the fuel to think rationally.

- Depression. Low blood sugar can amplify depression as an issue. Some people find that when their blood sugar crashes, they become depressed and may even burst into tears or experience an emotional crash with massive depression. For others, it’s a sudden feeling of the loss of emotional control.

- Anger. Dropping blood sugar lowers the threshold for extremes in emotion, and we become more reactive. When pushed to the limit, we’re more likely to lash out in anger or withdraw in depression.

Fatigue, exhaustion, and hydration. Low blood sugar is associated with a sudden sense of physiological exhaustion and lack of energy. Some people find that if they’re crashing a lot, they may simply be working too long without food or water. In certain cases, hunger feelings may also be due to a lack of water. Remember, all these patterns tend to be somewhat individual.

Blood sugar spikes from carbs. People who prefer simple, refined carbs or junk food tend to experience sudden spikes in blood sugar and then insulin. The high insulin then causes a rapid drop in blood sugar, which leads to a drop in energy about twenty to thirty minutes later. This results in the drop in blood sugar levels we associate with hypoglycemic symptoms, which leaves us feeling like we are running on empty. Furthermore, spikes of insulin that are released to deal with high blood sugar can affect the brain negatively.

Prediabetes. When insulin resistance develops, it becomes more difficult to maintain stable blood sugar. If you experience frequent blood sugar crashes or find that you feel sleepy or foggy after a big meal with lots of hidden sugars, that could be a sign that you have insulin resistance, hypoglycemia, a yeast infection, or dysbiosis. That discussion is beyond the scope of this book, so you will want to be sure to discuss insulin issues with your doctor.

Alcohol and blood sugar. Hypoglycemia can be a factor in some forms of alcoholism. Alcohol is a simple sugar. Beer is made from grain and is high in carbs. Mixed drinks often contain a great deal of sugar. People with blood sugar issues who drink find that they feel much better within a few minutes. The addictive aspect is not only the alcohol, it’s also the sugar. For someone with a tendency to alcoholism, as their blood sugar drops, that’s a cue that it’s time for another drink. That next drink will raise their blood sugar again, but simple sugars only sustain energy for about twenty to thirty minutes, so the result is another crash.

Slow carbs. In contrast to this pattern, when we eat a whole grain such as brown rice, it requires quite a bit of digestion. The grain has a husk that is broken down slowly. That’s good news for our body, because it means that the glucose (a primary source of energy) is released gradually over at least two hours. Proteins are another food that are digested more slowly and are less likely to cause weight gain. Fish, chicken, and beef require even more effort to digest and can take up to four hours to be fully broken down and absorbed.

Burnout. Another cause of crashing is related to burnout. People who experience burnout may have depleted deep stores of nutrients, misguided signaling from key hormone systems in the brain, and exhausted adrenal glands. The dynamics that underlie adrenal issues are complex, but often respond to an approach using functional and lifestyle medicine. Burnout is often associated with a heavy workload, characteristic of lawyers, physicians who work around the clock, entrepreneurs, people with more than one job, parents with new babies or sick kids, and those who care for a family member with chronic illness. In most cases, our bodies can only overperform under these circumstances for so long. Eventually, our nutrient reserves and our adrenals wear down, and we become more subject to fluctuations in blood sugar and in mood. Clearly, everyone has a different constitution, but we all need time to regenerate. If we don’t have that, we are potentially at increased risk of illness or injury.

What You Can Do About It

Notice your own patterns and responses. Most people find that once they include regular snacks and clean up their diet (eliminating sugars and fast carbs), their body begins to stabilize. When you are irritated and hangry, pause, and have a snack such as a low carb protein bar or fruit and nuts. Take time out to relax and catch your breath.

For more information on good nutrition, read the outstanding books by professor Michael Pollan, The Omnivore’s Dilemma: A Natural History of Four Meals and In Defense of Food: An Eater’s Manifesto, as well as physician Mark Hyman’s The Blood Sugar Solution 10-Day Detox Diet, and physician and researcher Terry Wahls’s The Wahls Protocol.

Use common sense to make food choices. Eat only those foods that in the course of evolution have been identified as food. Explore the Mediterranean diet, which means eating a variety of plant-based foods (fruits, leafy greens, fresh vegetables, nuts). Eat like your great-great-grandparents. They were not exposed to the seductive products or advertising of agribusiness.

1. As much as possible, avoid processed foods. While they can be convenient, prepackaged and processed foods almost always contain a wide range of fillers, texturizers, and additives with questionable health benefits. High levels of carbohydrates are also very common in processed or fast foods. It does take a bit more time to prepare foods from basic ingredients of vegetables and proteins, but the benefits are well worth a little extra planning and effort.

In the warm months of the year, quick simple meals can be put together by serving large salads and protein (salmon, burgers from turkey or beef, grilled chicken). The fixings can simply be set out for each member of the household to fix their own salad, a chance to be creative and suit their own tastes.

2. Whenever possible, eat organically grown or raised foods. Nonorganic foods can contain unhealthy levels of pesticides, insecticides, antibiotics, hormones, and genetically modified grains that increase the risk of cancer and numerous other health issues. Factory-farmed, industrially harvested, and processed foods also contain fewer essential minerals, vitamins, and antioxidants. The beneficial effects of organic foods have been clearly demonstrated by measuring the vitamin and mineral levels in foods grown in nutrient-rich soil. Preliminary data strongly suggest that the higher nutrient levels in organic foods increase longevity and improve fertility.

3. 3. Include some form of protein and healthy fat in your diet. We need to consume some protein, because our bodies can’t make nine of the twenty amino acids found in quality protein (referred to as essential amino acids). These are necessary to create bones, muscles, and healthy tissues, healthy brain chemistry (neurotransmitters are created directly from protein), and immune factors (antibodies are made of proteins as well). Many people are afraid of consuming fatty foods, but we need some healthy fat in our diet to repair the myelin that protects our nerves (myelin is 70 to 85 percent fat).

4. Consider adding organ meat from healthy animals to your diet. Organically raised animals produce proteins and fats that are better quality than those from animals exposed to hormones and antibiotics. When animals are raised in feedlots, industrial chemicals can accumulate in their meats and organs. In contrast, animals that are grass-fed or barnyard-raised are most similar to the diet of indigenous and agrarian people, before the era of factory farming. The researcher Weston Price, who studied nutrition among aboriginal peoples, noted the inclusion of organ meat as a staple in many traditional diets. Similarly, carnivorous animals in nature usually eat the internal organs first because they are the richest source of nutrients and will often leave the muscle meat for scavengers.

5. If you cannot pronounce it, don’t eat it. Adapt the precautionary principle and assume that any new and artificially produced additives or chemically processed foods contain novel materials that have not been part of our historical diet. These are the foods in boxes and cans in the central section of the supermarket. Highly processed foods may be harmful over the long term, and our bodies do not yet know how to process commercially produced foods such as trans fats and high-fructose corn syrup.

6. Reduce sugar and all forms of sweeteners. Simple carbs are used by the body so rapidly that they quickly raise blood sugar, and just as quickly drop it. Energy plummets in that same moment. A diet high in simple carbs, over time, can result in obesity, a major risk factor for diabetes, heart disease, and stroke. What is less well known is that some cancers and Alzheimer’s disease have also been directly linked to simple carbs in the diet. For a medical page-turner, see the book by Travis Christofferson, Tripping over the Truth, on the connection between carbs and cancer.

7. Do your own research. Be cautious about dietary recommendations, especially if you know of counter-examples and exceptions. When evaluating a study, ask who has funded the research, who decides how a food can be labeled, and who will benefit if more of this food is sold. Maintain healthy skepticism. For example, low-fat foods are often high in sugar. The French or Swiss paradox refers to a diet that sometimes has high butter and cheese intake, found in a number of European cultures with low heart disease rates. This phenomenon is explained in part by a more relaxed approach to mealtime (i.e., eating slowly) and the inclusion of foods that balance the fats.

8. Takeaways. Morning slumps? Be sure you’ve had a good breakfast that includes quality protein or slow carbs and healthy fats. Afternoon blahs? Take a mid-afternoon break and have a nourishing snack that includes some protein or slow carbs to support your energy until dinner time.

14

Taking Microbreaks

In the modern workplace, most of us find ourselves working indoors, in small office spaces, often sitting at a computer for hours at a time. Yet we’re still genetically programmed to be physically active and to be outside in the sunlight most of the day, like the nomadic hunters and gatherers of forty thousand years ago.

Our workstyle puts us out of sync with our genetic heritage. Whether hunting and gathering or building and harvesting, our ancestors alternated periods of inactivity with physical tasks that required walking, running, jumping, climbing, digging, lifting, and carrying, to name a few activities. In contrast, today many of us have a workstyle that is so immobile we may not even leave our desk for lunch.

Story of Success: I Used to Have a Headache by 11 Every Morning

I needed an aspirin just to get through the morning! And by 3 in the afternoon, my headache was back and I’d have to take another aspirin. I thought it was due to job stress, but I discovered that working at the computer was the source of the headaches.

Now I take a little break every twenty minutes and get away from the computer and do some movement exercises. (They’re wonderful.) It only takes a few minutes, but I’m amazed at the difference! My headaches are gone—I no longer need to take aspirin constantly, and I have much more energy at the end of the day. I only wish I’d done this sooner. I’ve always loved my job, and it’s even better without the headaches!

As health researchers, we have had the chance to study workstyles all over the world. Back pain and strain injuries now affect a large proportion of office workers in the U.S. and in high-tech firms worldwide. The vast majority of these jobs are sedentary, so one focus of the research is on how to achieve a more balanced way of working.

A recent study on exercise looked at blood flow to the brain. Researchers Carter and colleagues found that if people sit for four hours on the job, there’s a significant decrease in blood flow to the brain. However, if every thirty or forty minutes you get up and move around for just two minutes, then brain blood flow remains steady. The more often you interrupt sitting with movement, the better.

It may seem obvious that to stay healthy, it’s important to take breaks and be physically active from time to time throughout the day. Building more activity into your workstyle raises several questions: how often, for how long, and at what intensity level? Additionally, periods of rest are also essential. Alternating activity and rest recreates the pattern of our ancestors’ daily lives. The goal is to alternate sedentary tasks with physical activity, and follow work with relaxation. When we keep this type of balance going, most people find that they have more energy, are more productive, and can be more effective.

Tracking Your Progress

The typical way to compare improvement or decline in either physical activity or rest breaks is by measuring the FIT statistics of Frequency, Intensity, and Time or duration. For example, when building muscle mass, you may repeat a given frequency of repetitions for a given type of weightlifting exercises (intensity), over a specified time duration measured in minutes, or over days, weeks, or months. One of the ways you know progress (or regress) is by the degree to which you have been increasing (or decreasing) the frequency, intensity, and time duration of physical activity. The same measurement of FIT applies to rest and regeneration activities by observing how you feel after increasing the amount of time you engage in restorative, restful activities, whether that means relaxing, sleeping, meditating, doing yoga, stretching, or some other form of activity that has restorative benefits.

Select the better times of day to rest and regenerate, paced to your body rhythms. For example, if you are typically getting tired after lunch, then it is probably better to start building in a short rest break following lunch, before engaging in difficult tasks. If you push your system with coffee or an energy drink to stay alert when you are tired after lunch, then you may unintentionally create a vicious cycle of using stimulants to keep going, and then suppressants to slow down. Only you can know the exact or precise effects of substances in terms of the frequency, intensity (or dose), and duration of substances that stimulate or suppress your system.

Building breaks into your schedule means paying attention to your rest cycles as well as activity cycles, and to the effects of substances, both produced within or consumed from outside the body (for example, a double-shot espresso venti organic soy chocolate brownie iced vanilla Frappuccino with whipped cream) during any rest or activity cycles. Again, only you can know the effects of this chemistry on your body, for a given frequency, intensity (dosage), and time or duration of exposure.

Almost everyone is surprised by how quickly tension can build up in a muscle, and how painful it can become. Working at the computer for hours without a break can lead to fatigue in various muscles. For example, we tend to hover our hands over the keyboard without providing a chance for them to relax. Similarly, we may tighten some of the big muscles of our body, such as bracing or crossing our legs. What’s needed is a chance to move a little every few minutes—we can achieve this right where we sit by developing the habit of microbreaks. Without regular movement, our muscles can become stiff and uncomfortable. When we don’t take breaks from static muscle tension, our muscles don’t have a chance to regenerate and circulate oxygen and necessary nutrients. (Also see chapters 21 to 24 on the role that good ergonomics can play in a workstyle with more freedom of movement.)

Experience It: How Tension Builds Up in Your Muscles

The following is an exercise to help you tune into how quickly tension builds in your muscles:

Position yourself comfortably near a wall or table to help you keep your balance. While standing against the wall, raise one foot. Now, move your raised foot forward as if you were going to take a step. However, hold the raised foot in the air about twelve inches in front of you. Maintain that position while you stand on the other foot.

Continue to stand like this until you begin to get tired—usually this happens within a few minutes. Notice the fatigue and discomfort that start to develop. Before you get too uncomfortable, put your foot down and relax. How long were you able to stand with your foot in the air before the muscle fatigue became too intense?

The muscles we use for movement come in two main types, generally referred to as slow-twitch (type I) and fast-twitch (type II) muscle fibers because they require “refueling” on a slow basis (measured in minutes to hours) or a fast basis (measured in seconds to minutes), respectively. Note that most of us have no problem walking for hours, because our muscles are alternately tightening and relaxing. However, in contrast, if we stand on one leg without moving (as in the exercise above), the muscle begins to fatigue after just a few minutes because there is much less circulating blood to refuel those muscles and remove waste products such as lactic acid. The ultimate message is that regular movement leads to happy, healthy muscles. Static tension from sitting all day with little movement leads to sore, unhappy, unhealthy muscles.

Create Your Own Break Program

Many people are surprised that some health problems and injuries can be eliminated just by changing workstyle. For example, when we observed university employees with computer-related pain, we found major improvement in their symptoms of discomfort after only three training sessions. The observations compared their progress with that of other employees who had similar conditions, who were on a waiting list and had not yet taken the training. Employees in the training program reported improvement in symptoms that included neck, shoulder, back, arm, wrist, or hand pain. Participants in the training also reported less fatigue and fewer headaches, whereas those on the waiting list experienced no improvement.

We’ve included a number of break programs that we recommend. It’s a practical approach that involves a modest commitment of time. Breaks come in different sizes and are useful in different ways. Build a variety of breaks into your workday:

- Alternate work tasks.

- Use key commands.

- Take brief, one-second microbreaks.

- Take one-minute stretch breaks.

- Get up and move around.

- Change your environment.

- Get thirty to forty minutes of exercise a day.

Alternate Work Tasks

You can become a little bit more physically active at work by having your phone on the other side of the desk, situating the printer across the room, and perhaps using a standing desk for part of the day. Even a few minutes away from the desk makes a difference, whether you’re hand-delivering some papers in the building (take the stairs), going down for coffee, or running a quick errand. When you alternate the types of movement you do, that gives specific muscles a chance to relax and regenerate. Try any of these strategies:

- Alternate computer work with other activities, like opening the mail.

- Schedule your meetings periodically throughout the day to build in breaks whenever possible.

- Avoid long hours at the computer whenever feasible.

- Vary keyboarding and hand movements.

If you have a job that enables you to set your own schedule, you can intentionally build variety into your day. People who have less control over their schedule might consider meeting with their supervisor to discuss strategies for incorporating more task variation in their job.

Use Key Commands

If your job requires intense concentration, key commands can help you avoid repetitive strain injury (RSI). Although this shortcut has been around a while, if you’re not using them, check it out. Key commands for both PCs (such as the Windows operating system) and Macs (MacOS) are available online.

Adopt Brief, One-Second Microbreaks

If you’ve developed an injury—or have a lot of aches and pains—you’ll probably find split-second microbreaks invaluable. They’re especially important for people who do any type of high-pressure or production work, whether they’re working on the floor of a stock exchange or employed in a typing pool.

A microbreak means taking brief periods of time that last just a few seconds to relax the tension in your wrists, shoulders, and neck. For example, when typing, simply letting your wrists drop to your lap for a second or so will allow the circulation to return fully to help regenerate the muscles. The goal is to develop a habit that is part of your routine and becomes automatic, like driving a car. To make the habit of microbreaks practical, think about how you can build the breaks into your workstyle. That could mean a brief pause after you’ve completed a task, entered a column of data, or finished a page.

To take a microbreak, simply relax or stretch for a second or so, without getting out of your chair. In general, a microbreak may be defined as lasting one to thirty seconds. A minibreak may last roughly thirty seconds to a few minutes, and longer large-movement breaks are usually greater than a few minutes. Popular microbreaks:

- Relax for a second or more.

- Take a few deep breaths.

- Pause to take a sip of water.

- Rest your hands in your lap.

- Stretch.

- Let your arms drop to your sides.

- Drop your arms and shake your hands.

- Do a quick shoulder or neck roll.

Often, we don’t realize how much tension we’ve been carrying until we experience it. But we can raise our awareness of excess tension—this is a learned skill. And we can train ourselves to let go of excess muscle tension. As we increase our awareness, we’re able to develop a new, more dynamic workstyle that better fits who we are.

Take One-Minute Stretch Breaks

The typical mini stretch break lasts from thirty to sixty seconds to a few minutes. Ideally you want to take them several times an hour. Like the microbreaks, mini stretch breaks are especially important for people with an injury. They’re also a priority for anyone at risk of injury, in a fast-paced job involving a great deal of computer work. Taking breaks is important, especially if you have symptoms related to computer stress or whenever you’re working long hours at the computer. To take a stretch break:

- Begin with a big stretch, for example, by reaching high over your head.

- Then drop your hands in your lap or to your sides.

- Inhale and exhale deeply, and check in with your body.

- Look away from the monitor, do a neck roll or shoulder roll, and blink several times.

- Straighten your back and stretch your entire backbone by lifting your head and neck gently, as if there were an invisible string attached to the crown of your head. Now go back to work.

Figure 14-1 We all benefit from a brief break, even with the best of posture (left). One approach is to totally release your muscles (middle). That release can be paired with a series of brief stretches (right).

Wiggle breaks. Wiggling exercises are especially good for muscle tension or wrist pain. When you take a momentary break, shake your hands and wiggle. Wiggle all over, as much as possible. It feels good, and it’s also a great way to improve circulation.

Zen moments. Create moments of peacefulness throughout the day by assuming a meditative mind-set. You may want to have reminders in your office of this contented state—fresh flowers, calligraphy, or a favorite picture—anything that evokes mindfulness, peacefulness, and thoughts of joy.

Sensory awareness breaks. Sitting with both feet flat on the floor, close your eyes and listen to the sounds outside your body, including the sounds of the building, the fan on the computer, or the sounds in the street. Breathe in and out over ten seconds (breathe in for four or five seconds and breathe out for five or six seconds), making the exhale slightly longer than the inhale. Feel your jaw, mouth, and tongue muscles relax. Feel the back and bottom of the chair as your body breathes all around you. See someone in your mind’s eye who is kind and reassuring, who makes you feel safe and loved, and who can bring a smile to your face inwardly or outwardly. Wiggle your fingers and toes after the mini sensory awareness break, while opening your eyes.

Get Up and Move Around

Once we become conscious of muscle tension, we may be able to reverse it simply by getting away from the office for a few minutes, and also by taking brief breaks more often. Building breaks into our schedule permits both mental and physical regeneration (which, arguably, is the original intent of the coffee break).

- Take a break for coffee (or green tea, or any hydrating beverage), a bathroom break, or run an errand in your building.

- Use the stairs whenever possible for added exercise.

- Remember the healing power of laughter: share a light thought with a coworker for a moment.

- Include as much walking and physical activity as you can in your workday, especially after meals—by walking briefly after lunch.

Change Your Environment

More and more of us eat lunch at the computer. Many of us spend our entire workday in the office. If we don’t get away from the desk and change our environment, we miss an opportunity to regenerate from deadlines and stress. Fresh air can have an amazing and restorative effect, even on a rainy day. Here are some tried-and-true strategies:

- Develop the habit of time away from the desk for meals and relaxation.

- Run errands in an area that you can walk to, rather than having to drive.

- Work out at the gym, take an exercise class at lunch, or go for a brisk walk.

To observe the effect on productivity and energy level, do your own experiment. For a few days, take short breaks every fifteen or twenty minutes, and rate your energy level. At the end of the day, make note of your productivity and mood. Compare this to days when you don’t take breaks. If you are like most people, you will be shocked by how much more energy you have during the day and how much more productive you are when you take breaks.

The research makes it clear that intermittent exercise, such as brief, frequent physical activity throughout the day, is more beneficial than long-term efforts such as spending hours at a gym on the weekend. This explains why small changes can have such a big impact—it’s simply a matter of reminding yourself that it’s worth the effort.

Success Story: There’s Life after 5!

As management, I didn’t see any reason to take the Tech Stress Program. I didn’t have any health issues and my energy has always been good. I felt I really couldn’t spare the time away from the office, but I agreed to take the program anyway. To my surprise, I’ve found that I have much more energy at the end of the day. That’s added a whole new dimension to my life.

15

Dynamic Movement (a.k.a. Exercise)

How can you integrate dynamic movement into your lifestyle? It’s useful to think of physical activity in a broader sense. Obviously, exercise can mean going to the gym, but it could also mean taking a brisk walk, going dancing, playing soccer with your friends, or playing softball with your family. Think of exercise as any form of dynamic movement. Even people who hate to exercise may find that something as simple as getting a puppy and taking it for a walk will fulfill that need.

The Ideal Workout

Creating your own routine means figuring out what you want. What nurtures you, what makes you feel complete? Do you want more time with friends, or do you need a little time to yourself? Would you enjoy swimming laps, long-distance running, or high-intensity aerobics—or would qigong, yoga, or walking with a partner be your first choice? The goal is to do things you find appealing, rather than doing things you think you should do. You’re encouraged to take a new look at exercise, workouts, and sports, and get involved.

Are you a sprinter or a long-distance runner? Adjust your exercise to your own natural rhythms. Are you capable of intense bursts of energy like an Arabian racehorse, or is stamina your strong suit, like a Belgian draft horse? If you’re a sprinter, great—work very intensely, then take a break and regenerate. Ultimately, you want to know how to pace yourself. Factor in your personality, energy level, and body type. Consider a broad range of options, so you can develop a program that fits the amount of time you have available. You don’t want to have to overthink this too much.

Are you a creature of habit or do you crave variety? Is predictability comforting or do you chafe under routine? Are you a night owl or an early bird? These are broad questions, but they’re relevant here because they reflect your basic needs and the kind of routine that will be most satisfying to you.

Is exercise a good opportunity to socialize? If you enjoy one-on-one, having made a commitment to your friend, the other person will pull you in and keep you motivated to continue. If you enjoy the social piece, then that’s a great way to start and maintain an exercise practice because it becomes a social event.

Do you like doing things in a group? Some people enjoy lots of social stimulation and are happiest playing volleyball with friends or working out in a class with music and lots of action. Consider this a chance to expand your social network. In many cases, the more others are involved, the easier it is to maintain your practice. Consider encouraging everyone in your office to take breaks and exercise together. You’ll probably find that even when you don’t feel like exercising, others will encourage your practice.

Do you prefer to exercise outdoors? If you live in an urban area and commute to work, it may be possible to park your car a bit farther from where you work or get off the train or bus one stop earlier and walk that distance each day. If you work from home, it could mean doing your errands by bike or on foot. Being active outdoors can range from running or cycling or hiking in the hills to doing yoga or tai chi in an outside setting. These outside activities give you the benefit of exercise plus the soothing effects of connecting with your natural environment.

Experience It: Feeling More Alert and Centered

If you haven’t done much exercise lately, do some form of physical activity for twenty or thirty minutes, and then check in with yourself. Afterward, you will probably feel more tired, which is normal. But after allowing yourself time for recovery, do you feel more alert and more centered? Are you now convinced that regular physical movement is important for you? Most people find that when they are physically active, they feel better, more alive. If you find that to be true, then it becomes very pragmatic. How can you incorporate regular physical activity into your week?

How Often Do I Need to Exercise?

If you haven’t been exercising on a regular basis, getting started could be daunting. When you’re beginning, have compassion for yourself. Understand that it will take awhile to build up strength and develop new habits. If you stick with it, you’ll become more consistent.

Twice a day for twenty minutes. Recent research suggests that two shorter workouts may be better than one longer session. Explore ways to walk in the morning, during lunch break, or right after work. Ideally, you also want to get up and move around for about five minutes every hour while you’re at work.

Once a day for thirty to forty minutes. Physical activity for half an hour such as taking a walk five or six times a week provides a solid basis for good circulation and heart health. Readers who don’t get this much exercise will want to gradually work toward this goal. One strategy is to walk for exercise and increase the time by one or two minutes a day. That puts the goal within reach in about a month’s time.

Extra credit. For added benefit, you can include other forms of exercise in your schedule, like a yoga class, Pilates, workouts at the gym, or aerobic exercise such as running or spinning.

Working out in the morning. Statistically, people who exercise in the morning tend to stick with it more than people who exercise in the afternoon because in the afternoon, for many of us, responsibilities pile up, our willpower decreases (we’ve already used it up for other tasks), and it’s easier to say exercise is not as important as getting work done.

Mixing it up. You may want more than one approach to fitness. Consider: Mark walks part of the way to work every day, swims several nights a week, and periodically does weeklong hikes. Bill has a three-day routine, alternating yoga, martial arts, and weight training. Sarah stops at the gym on her way home to swim or work out and goes running on the weekends. Generate your own options.

Story: Spontaneous Exercise

For folks who dislike structure or routine, there can be a sense of pleasure in spontaneous exercise. Brad is a carpenter, very physically fit, a free spirit who loves spending time outdoors. He likes sports and enjoys walking. He makes it a point to get outside every day and be active, whether that means a game of pickup basketball or a long detour on his usual walk home.

Getting Started

You may be tempted to dive into a new exercise program with both feet; however, beware of too much intensity in the beginning. Don’t push too hard the first day, the first week, or even the second. Better to build and sustain your practice:

- If pain or discomfort occurs, stop! Pain is not gain. Pain discourages training. Pain and the anticipation of pain usually induce bracing and tension, which increase the risk of injury.

- Practice strengthening and stretching exercises, and while practicing, remember to breathe. Many exercises should be performed slowly and gently.

- Perform the practices in a playful, exploratory manner. Practice with awareness and attention. Ask yourself: “Do I feel different when I exercise and afterward?”

- Check with your physician first. Consult your health care provider if you have any medical condition that could be affected by exercise. Inquire as to whether you have any special precautions or limitations relative to exercise.

- Keep a log of your exercise. After a few weeks, analyze your log. What were the situations that helped you to exercise or that interfered?

Easy does it. Sometimes people dive into exercise, bringing too much intensity to their practice, and then they become worn out or sore and don’t want to continue. There is also the risk of injury. Don’t push too hard in the beginning. Take it easy and build up the frequency, intensity, and time duration (FIT) of your exercise session. Be gentle with yourself, gradually increasing the level of intensity. If you have not exercised for a while, have been ill, or are jet-lagged, restart your exercise practice slowly at lower intensity and time duration. Although it may feel like you can engage in exercise as intensely as before the break, most people find that they have lost some of their strength and endurance. Give yourself time to get back into condition.

Approach exercise with a fresh perspective. At times, it’s a temptation to exercise on automatic pilot, falling back on sequences of movement that are habitual and conditioned. Without knowing it, when we exercise, we may be holding our breath and tightening our shoulders. To counter this, the goal is to make sure your breath is natural and relaxed. As you perform an exercise, continually check your body and relax any muscles that are not needed for the actual posture or sequence of movements. Become your own instructor—when doing yoga, for example, keep reminding yourself to breathe deeply as you do each posture (asana). Become aware of any habitual muscle tightening or tension associated with your workouts. Bring this level of awareness to any type of physical activity. This is an opportunity to train your attention and self-awareness that will benefit you in many other areas of your life.

Staying Motivated

When Max decided to start running, he was totally motivated. He would jump in the car, drive to the track, and run for two miles. After a couple of weeks, his motivation began to wane, and he fell off the wagon. When he connected with a new friend who loved running, that reignited his interest, and this time he stuck with it. However, eight months later, Raoul moved away, and the motivation to run was replaced by sheer willpower. That lasted about two weeks, and then the running stopped. At that point, Max realized that running was effortless with a friend. Instead of using willpower to force himself to exercise, he arranged running dates for the week with different friends and had no trouble sticking with it from then on.

High-Intensity Interval Training (HIIT)

The best data on physical fitness and exercise currently favor interval training, the latest breakthrough in exercise physiology. The advantage of high-intensity interval training is that it takes much less time and provides better results than conventional endurance training. Researchers have found that fifteen minutes of HIIT three times a week is equal to or better than forty-five minutes of exercise five times a week. HIIT uses short bursts of high-energy exercise with cool-down periods between each high-intensity interval. The intervals place extra demands on the heart, followed by a period of recovery. This makes it imperative that you consult with your doctor first to find out if you have any special limitations. The workout can be tailored to a lower maximal rate if your physician recommends it.

Whatever exercise you choose to do, consider structuring the activity using the principles of interval training. That means pushing yourself for a little while, recovering, pushing yourself again, and recovering. You can approach almost any type of activity in intervals, whether that means alternating walking at a brisk pace and then a normal pace, cycling quickly or slowly, or dancing at a swing pace alternated with a gentle pace. With interval training the goal is to perform the activity intensely for one minute—for example, walking very quickly up the stairs so your heart rate increases to over 120. Then walk slowly until your heart rate is less than 100, and then repeat. You will want to increase and decrease your heart rate three times in a row. A sample session consists of

- three-minute warm-up walk

- thirty-second sprint and sixty-second walk

- repeat six times, at 80 to 95 percent of maximum target heart rate (above 100 beats per minute)

- three-minute cool-down walk

Once you build your stamina, you may want to include an aerobic interval in every workout, increasing your heart rate a little for about one minute. This is a good way to train your body and the heart to respond to brief, intense physical demands.

High-Level Fitness

A deeper commitment to fitness provides benefits that go far beyond physical capabilities. The effects have a positive impact on our health, on the presence we project, our appearance, and our stamina. High fitness also has positive effects on poise and equanimity, our sense of calm, our ability to focus, to listen closely, and to tune into other people.

Training. Being truly fit often involves more than one type of exercise or physical activity. Taking fitness seriously means being genuinely present as you train with an increased awareness of your own body.

High-level nutrition. A high-quality diet is basic to high-level fitness. That means low consumption of sugar and simple carbs. The emphasis is on an abundant intake of nutrient-dense vegetables, quality protein, and selective consumption of fruit such as berries.

Nutraceuticals. High-level fitness almost always includes the intake of nutritional supplements. Some are aimed at maximizing the benefit and recovery from training sessions; others help with stress resistance and support cognitive function and focus.

The Beauty of Weight Training

Bill is a nutritionist and a weightlifter. Working in the nutrition booth at a bodybuilding championship, he had the opportunity for in-depth discussions with some of the country’s top bodybuilders. Not only were they gorgeous; what struck him was the sense of relaxed confidence in their physical presence. This was not an egocentric or dominating kind of energy—he found them very grounded with a quality of focused attention that put Bill at ease. He experienced this with person after person the entire afternoon. By the end of the day, it occurred to him that the benefits of their high-level fitness extended far beyond the physical, reflecting qualities that would be extremely valuable in any business or professional situation.

Rock climbing as an elegant workout. Rock wall climbing in a gym (or top rope climbing outdoors) provides an opportunity to work a wide range of muscles, along with various parts of your brain. Unlike using a treadmill or an elliptical trainer, climbing a rock wall combines strength training and stretching. None of the movements are ever repetitive, which is excellent for brain health. Additionally, the movements and posture when you climb encourage you to open your chest and keep a very outward extension pattern. (See chapter 8 for more on the practice and benefits of power posture.) This has the added benefit of using the rib-cage muscles that aid in moving fluids throughout the body.

Walking the dog. Having a dog sometimes feels like getting exercise without doing exercise. It’s easy to fit a dog into your lifestyle even with small children, with a child in a stroller or in a backpack. You can walk the dog and take care of the child at the same time. Consider getting a medium-weight dog, one that’s very social and attractive. There are even hypoallergenic breeds that are appropriate for people who have allergies to dogs. For example, a sheepdog-poodle mix creates a friendly companion, so everyone is always in a positive mood. As a result, one experiences the world as a much friendlier place.

Go outside and play. Make it a point to give your body as much experience of varied movement as possible. For example, if you like to hike in hills or woodland, when possible, get off the paved trail. Take the unpaved trail where you must step over roots, where the ground is uneven, ideally with hilly terrain. (If you’ve been hiking on manicured trails, make this transition slowly to avoid injury.) If you’re lucky enough to be near a beach, walk on the dunes or barefoot in the soft sand. Where possible, make it a point to include walking up and down hills, whether in an urban or in a natural environment. The idea is to stimulate not only different areas of the body, but also different areas of the brain. Varied routines range from hiking, swimming, or biking regularly, to climbing, canoeing, skiing, or kayaking. The message is not that expensive sports are recommended for everyone, but rather that there is some type of activity that is good for everyone.

Parenting: Finding the Time to Exercise

In some cultures, partners rearing children are encouraged to be as selfless as possible. This may be a form of evolutionary trap. The idea is that the better a caregiver is at caring for others, the more selfless they must be—and by extension, the more likely their children are to survive. Balancing parenting with self-care is essential to reduce chronic stress.

When there’s a young baby in the house, for example, it may seem difficult logistically or even extravagant to say, “I need some time out to exercise, so I’ll have more energy to give for the rest of the day.” The trap is that if the caregiver continually gives to others, eventually there will be nothing left for themselves. Making time for activity and exercise, such as a stop at the gym on the way home from work, can be one way to take care of ourselves physically, but also to regenerate personally and emotionally from work and family stress. Granted, this scenario is not easy to imagine in all situations. Kids want their parents to be there regardless of how much stress or strain parents may be experiencing. By and large, kids spell love time, so spending time with kids and caring for one’s own needs mean negotiating as a family, and being really secure in your decision that making time for yourself is important.

In a parenting situation in which you have no support, it may be possible to find a friend with whom to trade care or start a mothers’ group and share the care. “I’ll take your child on Tuesday for two hours if you take both the kids on Thursday for two hours.” In these arrangements, you alternate being the caregiver. In some ways, it’s comparable to a nanny share. Whenever possible, negotiate with your own family to share care. Taking good care of yourself by sharing responsibilities with others is one of the essential elements of being healthy.

These situations often challenge us to devise a clever workaround. Someone who is caring for a parent with Alzheimer’s may find that their parent can no longer be left alone. In that case, it becomes important to redefine what it means to exercise. Ultimately, exercise could be any kind of movement that you enjoy: practicing yoga or tai chi at home, or using a rowing machine or a StairMaster. If one’s family member requires monitoring, that might even mean staying in the same room with them while exercising. If you are confined to home, one of the benefits is that you can be really uninhibited in a way you wouldn’t dream of at the gym. Turn up the volume on your workout and “dance like nobody is watching, sing like nobody is listening.”

Make Yourself a Priority

We’ve all made New Year’s resolutions. We all know we should exercise, just as we know we should stick to a good diet, go easy on junk food, and get enough sleep. But it’s remarkably challenging. People who start going to the gym in January often find that by March their gym bag stays in the closet.

It is up to each of us to adapt the techniques to our particular situation. Learning and growing from new information can increase the ability to influence our world, making better choices that will keep us safe and healthy, committed to improving our lives. A hardy, resilient, and courageous set of attitudes is possible through the practice of positive health habits.

To have the greatest chance of success at creating an exercise program in your life, you have to make it a priority. Ask yourself if it’s worthwhile, and if it is, if you feel it will prolong your life and give you a better quality of life, then acknowledge that you deserve it. You deserve the chance to take care of yourself. You’ve earned it. In the end, life is always about making priorities. That means making yourself a priority. It means, for example, consciously setting aside time every day to take good care of your body. Then the next step is simply a matter of figuring out the details and putting together the pieces of the puzzle.

This means acknowledging that you’re really important. You don’t want to continually be giving yourself away until there’s nothing left of you. It’s essential to regenerate, and exercise is one very effective way to achieve that.

Benefit, Benefit, Benefit

When we are more active, we also think more clearly. Dynamic movement not only provides circulation to the brain, but also unstructured time to reduce mental activity and inflammation. Research over the past several decades has found that when we exercise, we develop new neurons in many areas of the brain, an important aspect of neurogenesis and neuroplasticity (the ability of the brain to achieve a certain amount of self-healing).

Intense training may even make us younger. When healthy individuals trained for and competed in a marathon, even at relatively low exercise intensity, their bodies became younger by about four years, indicated by a reduction of central blood pressure and aortic stiffness. Most impressively, older, slower individuals had greater rejuvenation.

Improving your total health. Exercise has been found to reduce high blood pressure, to modulate weight gain, prediabetes, and metabolic disease, and support good immune function by moving lymph and blood throughout the body to clear infection and toxins.

Reducing physical tension. Every movement we make alternately tightens and then relaxes our muscles. Whenever we move, we’re releasing the tension that builds up while we’re sitting still. A key point is that exercise remains one of the most effective ways to reduce tension held in our muscles, and also to release tension in the muscle memory of our body.

Turning off the stress response. Physical activity following a distressing situation helps filter out excess adrenaline and cortisol. When life’s stressful circumstances kick in, and the situation becomes undermining and overwhelming, having a regular habit of exercise can be an effective way to counter stress. Similarly, after a challenging day at work, build in the habit of hitting the gym on the way home or have equipment in your home so you can work out and work off the stress.

Breathing more deeply. When we concentrate, our breathing may become shallow. Shallow and rapid breathing causes carbon dioxide to decrease, which increases muscle reactivity and the risk of injury. The effects of shallow breathing can be countered with aerobic exercise or yoga, which require us to breathe more fully, diaphragmatically, lower, and slower.

Lowering the risk of back pain. The most commonly reported work-related complaint is backache. This is especially true for many people who work at the computer. The best treatment for back pain is prevention through correct ergonomics at the work site and at home, dealing with emotional stress, getting enough sleep, finding time for R&R, and making physical fitness a priority. In short, physical activity is one of the basic elements of a workstyle that is dynamic and satisfying.

16

Coping with Chronic Stress

Humans are equipped to adapt to stress in the short term. Almost all of us must respond to deadlines or seasonal workload—retailers at Christmas, accountants at tax time. The ability to adapt to stress means we can push ourselves when we need to and then take time to relax, rest, and repair.

Comparing modern workstyle with that of the ancient hunters, we know that periodically they needed to make a tremendous effort to secure food. Archaeologists in Europe have found evidence, for example, that forty thousand years ago, a band of humanoids happened on a herd of wild bison, ran the animals off a high cliff, and then set up camp to smoke the meat. Evidence from the tools and discarded bones suggest that they worked feverishly for several days to preserve the meat before it spoiled.

One hundred years ago, when most of our ancestors were farmers, the annual harvest required a similar push. Everyone worked from sunup to sundown and beyond to harvest the corn and hay before it could be destroyed by storms. We are genetically hardwired with the ability to push ourselves, to make this extra effort, when the situation demands it.

Since the push is fueled by adrenaline, there is a sense of exhilaration and often an awareness of our own strength. As a result, if life makes additional long-term demands, we have the sense that we’ll be able to meet those demands as well—whether that’s the opportunities of a start-up, the challenge of a special project, the joy of a new baby, or the responsibilities when there is a serious illness in the family.

We’re Hardwired to Respond to Stress, but Not 24/7/365

Since we are hardwired to respond to extra demands in the short term, it is a temptation to assume that we can sustain that pace. This is what they do in the movies, right? That kind of magical thinking becomes a seduction, and over time, possibly a trap.

Researchers have linked stress to almost every form of nonhereditary illness.

What happens when stress continues unabated? The research makes it clear that stress—left unmanaged—can lead to major psychological and physical problems. Once stress becomes chronic, almost all of us experience a similar pattern of physical and emotional distress that reflects profound imbalances in our body chemistry. When those imbalances persist, they cause inflammation. A racing heart, vital during the stress response, can develop into a chronic condition (rapid heartbeat, referred to as tachycardia), and eventually manifest as cardiovascular disease. Little by little, cells and then tissues are damaged. Eventually we develop a recognizable condition that can be named, but long before we are diagnosed with a specific illness, when we live with chronic stress, we may struggle with profound fatigue and mental torment.

How Chronic Stress Differs from Crisis Stress

When stress is short-term (like running away from an angry dog), adrenaline is the primary hormone, released at the center of the adrenal glands. However, if the sources of stress are frequent, constant, or long-term, cortisol is the hormone released in elevated levels by the outer layer of the adrenal glands. When stress moves from a crisis response to a long-term chronic situation, cortisol is continually released. Then excess cortisol accumulates, eventually diminishing digestion, reproduction, and immune function.

The Toxic Effects of Chronic Stress

cortisol up

sleep down

DHEA down

slower  tissue healing

testosterone down

less  vitality, poorer health

estrogen down

poorer  reproductive health & well-being

dopamine down

pleasure down

oxytocin down

bonding down

serotonin down

depression worse

Figure 16-1 Chronic stress is characterized by depressed immune function and appears to be a precursor and an underlying factor in many forms of chronic illness. (Source: Nancy Faass © 2020; clinical insight: Steve Amoils, MD, and Sandi Amoils, MD)

Toxic to brain cells. The brain’s neurons are extremely sensitive to the effects of cortisol, so when stress hormones continue to circulate at chronically high levels, they contribute to the death of brain cells. The neurons in the hippocampus are especially sensitive to the toxic effects of high cortisol levels. Alzheimer’s disease begins in the hippocampus and a number of researchers such as Ouanes and Popp have suggested that chronically high cortisol contributes to Alzheimer’s pathology.

Compromised immune function. The body conserves energy in a time of crisis by limiting the immune response. Why bother with immune function when we’re running for our life, at risk of becoming someone else’s lunch? We need to use all our energy to survive—to run or fight. Only when we are safe do we use our resources for repair and regeneration, but in the thick of the fight, the body shuts down immune function. However, when stress becomes chronic, that has the potential for ongoing immune suppression. (For more on this topic, see the work of Stanford University researcher Robert Sapolsky, who explains the elegant logic of this response in the book Why Zebras Don’t Get Ulcers and on YouTube.com.)

Under chronic stress, your hormones may become skewed or depleted. Symptoms of low cortisol include low energy, slower healing from infections, and less ability to deal with stress. (These are the same types of symptoms that the researcher Hans Selye observed when he first studied and defined chronic stress.)

Health at risk. When do periodic spikes in blood pressure become hypertension? How long does it take for tensed muscles to become inflamed tissue and, over time, carpal tunnel syndrome? When does chronic indigestion become an ulcer? And at what point does immune suppression begin to manifest as frequent or chronic infections? (Our thanks to Michael Harris, MD, of St. Charles Memorial Hospital in Bend, Oregon, for these insights.)

How long does it take for stress to catch up with us? This is totally individual and can vary tremendously. It’s smart to intervene before damage is done.

Effects on our mojo. People who live in a constant state of stress will want to know that this reduces both healing hormones such as DHEA (dehydroepiandrosterone) and the hormones that define our sexuality and reproductive health. The hormones that underlie our gender don’t just keep us sexy. Testosterone maintains our strength and energy, and builds strong bones and muscles. Estrogen reduces inflammation and keeps us trim. Don’t believe it? Look at what happens when people hit their forties and fifties and their hormones begin to drop. Chronic stress also ages us more quickly. (Based on the work of Paul Lynn, MD, of the San Francisco Preventive Medical Group.)

Unwanted weight gain. Researchers Miller and O’Callaghan describe how Cushing’s disease, marked by excessive production of cortisol, influences the accumulation of body fat, stating: “The relationship between abdominal obesity and excess cortisol in this disease has fueled speculation that chronic stress or dysregulation of the HPA axis with excessive glucocorticoid production may also lead to central adiposity with its attendant adverse health consequences.” The fact that elevated cortisol parallels abdominal weight gain (one of the first signs of prediabetes) reflects the vital importance of reducing stress.

Dwindling energy. One of the cruel double-binds of chronic stress is that the effects reduce our ability to cope—and our ability to climb out of crisis mode. The effect can be devastating. Just when we desperately need extra energy to deal with problems, it’s not there. Don’t brush off chronic stress. Take it seriously.

Gender Differences in Stress

The stress response is common to all of humanity, in every culture throughout history, but it tends to be expressed differently in women than in men. Estrogen and testosterone turn out to be major influences on how we deal with stress. Understanding these differences can provide insight into your own response to stress, and the responses of those you work with. This is an important aspect of coping in the workplace.

In men, testosterone amplifies the effects of adrenaline and raises cortisol levels, intensifying aggression, described by Bateup and colleagues. Testosterone can significantly increase negative responses to stress, particularly in men with inherently higher testosterone levels. This is reflected in physical, behavioral, and psychological responses. Patterson and colleagues labeled these coping strategies “silence or violence.” It is worth considering that in the United States men are responsible for approximately 96 percent of domestic violence, 88 percent of homicides, and 76 percent of felonies. Global data from the New York Times reported that 97 percent of military combatants worldwide are male.

For women, estrogen and oxytocin are associated with a style of stress response referred to as “tend and befriend,” a tendency to more prosocial, cooperative behavior under stress, to some degree. The research of McEwen, and of Gao and others, has confirmed that oxytocin has different effects on women than on men. In stressful situations, women are more likely to participate in prosocial compromise such as acts of “sharing and caring.” Women may fight less and may make initial attempts at appeasement, friendship, or cooperation.

Yet estrogen comes with its own set of problems. Animal studies show that high levels of estrogen increase female sensitivity and vulnerability to stress and susceptibility to conditions such as depression, anxiety, and post-traumatic stress disorder. This may explain maladaptive responses such as tolerance of sexual harassment in the workplace and battering in the home. Estrogen was found to amplify the stress response in areas of the brain associated with the development of depression, which women are twice as likely to experience as men.

However, it can be misleading to characterize a “tend and befriend” style of responding as feminine or “female only.” For example, females with offspring of any species can be extraordinarily hypervigilant and aggressive. Both men and women employ different styles of stress reactions to varying degrees, depending on social or physical types of stress, their personality, physiology, culture, and situation.

Know Your Coping Style: Fight or Flight?

When we hear the phrase “fight or flight,” we tend to think of a paleo hunter confronting a saber-toothed tiger. Yet these same tendencies surface today, in any conflict between any two human beings, occurring across a spectrum that ranges from constructive and helpful to short-sighted and destructive. Almost all conflict involves elements of approach-avoidance, passive-aggressive, and dominance-submission.

Experience Your Coping Style

The fight or flight response occurs in both genders across a range of responses.

“Fight” or Approach

- proactive

- self-protective

- assertive tone of voice

- dominant posture

- shouting

- physical aggression

- escalation to combat

“Flight” or Avoidance

- tactful

- pulling away

- shutting down

- becoming silent and withdrawn

- the freeze response

- physically leaving the situation

- severing the relationship

Figure 16-2 A broad range of coping strategies is associated with the fight or flight response. (Source: Nancy Faass © 2020)

We all employ a number of different reactions to stressful life circumstances, but most of us tend to express reactions to stress through a few key behaviors. When you are extremely stressed, do you become more assertive, or step back to minimize conflict? Whatever your nature, knowing your habitual response strengthens your ability to cope, particularly if your preferred or typical response is not working for you. We can learn to become more attuned to our own patterns of reactivity:

- Do you confront things head on or quickly lash out? When people react defensively, often they are attempting to protect themselves.

- Do you tend to back off, pull away, or totally withdraw? Going blank and becoming numb are also forms of withdrawal. Shutting down completely is a form of dissociation.

- Note that in the extreme, neither passive nor aggressive styles are effective in resolving conflict.

- It can be helpful to consider how conflict was handled in your family of origin and how your response is similar or different.

Tuning into Stress Earlier

It’s useful (and important) to determine whether the stress is external—time pressure, too many things to do, lack of money—or our own thoughts, anticipations, or emotions.

- Thought patterns. Deepen your awareness of your thought patterns. What stresses you the most? What are deal breakers for you? Learning to recognize the stressors that are most likely to trigger you is an incredibly powerful tool for managing the stress response.

- Physical signs of stress. Most of us find that when we become stressed, we can feel ourselves beginning to tense up. How do you experience emotional tension? A clenched jaw? A tension headache? Tightening your abdomen (a “gut reaction”) or feeling like there is a weight on your chest? Do you have less patience, become irritated by interruptions, or speak faster? Does your style of handling conflict reflect the approach to stress in your family, your culture, or your profession? Knowing your own characteristic response could enhance your ability to cope under pressure.

What You Can Do

We usually know Big Stress when we see it—but not always. Sometimes stress sneaks up on us. When stress is frequent, intense, or long-lasting, it can gradually wear us down and become insidiously harmful.

1. R&R (Recharge and Regenerate)

Ask yourself what you need to do to be able to take a day off just to recharge your batteries and regenerate your energy? If you are employed full time, can you take time off on the weekend, even just a few hours? You want to remind yourself that, “For these few hours, I am putting all my worries in the background and just taking care of myself.” Without taking care of yourself, there’s nothing left to give to your job, to others, or to yourself.

Bulldoze your calendar. Imagine all of the grid lines on a monthly calendar that identify days and times for various tasks. Then imagine a bulldozer coming along and clearing all of the tasks off your calendar on one particular day. The bulldozer only works once a month, and written on the side of the bulldozer is a phrase: “Don’t be sick on your sick day,” implying that you can opt to take at least one day off per month, guilt-free. However, make sure you are taking a health day, rather than a sick day, to recharge and renew your health.

2. Writing It Down, Sorting It Out

For many people, the act of writing permits the chance to reframe, build perspective, and make new choices. Putting stress aside, and then reviewing it, gives one the sense of witness to self. People often think that they’re in touch with their situation, and that they can simply talk their way through it. However, the act of writing serves to externalize the details in a way that talking may not. In the act of writing it down, you get a momentary distance from yourself. For that moment, the writer is no longer the person who is experiencing the stress, making the act of writing objective and freeing.

For simple stressors, it’s helpful to make a list throughout the day of how you feel and what’s stressing you. For example, write down: “Tues. 2 p.m. late finishing the report—feeling embarrassed, worried about the impact on my next review.” The initial step is to make a long list of stressors, particularly those associated with work, money, family, and relationships.

3. Identifying the Source of the Stress

The next step involves asking some key questions: Did I wake up this morning feeling great and looking forward to the day, or did I wake up dreading it? Is my job a source of stress? If so, what are the particular and specific triggers that I can influence? Is the problem a lack of control or frustration with a supervisor that I cannot influence? Are there aspects of the job that I can shape or guide in my favor? Do my problems begin at home? Are there other major issues in my life that are triggering stress?

To focus your problem solving, it can be helpful to think like an investigative journalist asking questions such as what, who, when, where, why, how? For example, you could start by asking “what.” “What are the specifics—the particular aspects of the situation that are most difficult?” Also ask, “Which aspects of the situation could be changed to move things in a more positive direction?” For example, “What seems to cause the stress (a triggering event) and why?” There are other categories of questions, such as “How can I make progress in reducing my overall stress and reactivity?” or “What do I need to do to shift out of a constant crisis mode?” Identify a series of “if-then” scenarios to consider as thought experiments or actual explorations.

Internal stress or external circumstances? Identify the specific stressors and how you are responding to them. Does it involve your emotions or your health? If it is external, is it due to a specific situation or broader issues? Regardless of the nature of the stressors, we have to recognize that if we are too captured by the stress, too fearful, too overwhelmed, fatigued, or burned out, then it becomes difficult to imagine the future clearly, to plan ahead, or to make decisions. The process of reflecting on stressful circumstances and reframing them helps to address some of these questions.

Respect and support. There is consensus in the research literature on the importance of respect and support from your supervisors and your coworkers. People who have that support do much better at handling stress. Similarly, within any living situation, mutual respect and support are essential.

The workload. Is the workload too high? For many people, that is an ongoing issue. If one is in a law firm, for example, working sixty to eighty hours a week or more, the question becomes, “Is this worthwhile?” If the situation is extreme, that raises a simple question, although horrible to contemplate: “Is the job worth dying for?” Yes, a mother will give her life to save her child. A lover will give their life to save the one they love. However, work, in most cases, is not worth dying for. If we identify the level of stress as extreme, an obvious question becomes, “Is this situation worth the effort?”

Light at the end of the tunnel. If you do not see a light at the end of the tunnel, that intensifies the stress. You need to ask yourself if there is anything you can do to identify an end to the struggles. Can you set up targets that can be achieved by certain dates? Can you gain additional perspective or insight from a friend or professional? What resources can you bring to bear?

4. Defining Your Strengths

An inventory of assets involves another set of questions.

Workstyle. What is my workstyle? Am I a Belgian draft horse or an Arabian racehorse? How can I pace myself to suit the demands of my job, my workstyle, and my life? If my workload goes up, can I work more hours each day, or can I learn to work faster? Ideally, I want to work smarter to produce more, with less energy. Are there seasonal demands in my job … a crunch time at Christmas or tax time … a lull in August or January? How can I anticipate the next deadline or crisis? What are my own rhythms over the course of a day, a week, or a year? Are there other factors in my life, like buying a house, expecting a child, or coping with a divorce? Finding the balance is a challenge, because the balance point is different for each of us. Balance in life is dynamic and ever changing.

What is my ideal pace? Am I overperforming and headed for burnout—or underperforming and not reaching my potential? How can I find my own optimum pace and sustain it? What gives me energy? What gives me peace? What is my bliss?

Peak performance. The research shows that if we stay at maximum performance effort indefinitely, we’re more likely to get injured or become ill. Athletes get stress fractures, executives may develop high blood pressure, students tend to get sick at the end of finals. These are often stress-related illnesses.

Developing new skills. Do I need more skills to cope in the present situation? Am I delegating responsibility effectively? Is this a matter of assertiveness training, better time management, or overcoming perfectionism? Do I need to work with my moods and emotions (anxiety, anger, or frustration), or reframe the situation?

We may want to identify new resources: meditating, doing yoga, taking up qigong, walking for meditation, beginning to work out, exercising, or doing sports. We also want to allow ourselves sufficient rest and regeneration to shift out of the stress response. This phase of the process also involves self-evaluation to identify training or coaching that could be helpful in dealing with stress. Gaining a new skill set can enhance one’s coping ability.

5. Expanding Your Resources

The next step is to identify the areas in which we do have some control. It’s important to recognize what is working. Is there a simple solution? Could our concerns be resolved by talking with a supervisor about ergonomics, workflow, or workload? Once we define our options, we can decide how much we want change and what it is worth to us. The next step is to develop a plan of action. To increase our options, we may have to make some tough lifestyle choices, in terms of income, housing, or possessions. This process may seem daunting, but if we stick with it, and work through the issues step by step, that can make an enormous difference.

Leverage points. The next step is to list the areas in which we do have control. Is it possible that we have more leverage than we realize, or are the options limited at the moment? At that point, we can develop a plan of action.

Getting support. Sources of strength and assistance may include a partner or spouse, a trusted friend (especially those who will tell us the truth), a coworker, a support group, a self-help or faith-based group, peer counseling, counseling, therapy, or coaching.

6. Putting the Solutions into Action

At this stage, the goal is to take specific steps to improve the situation, to help you define where you are, where you want to be, and the resources you need to get there.

Communication. This step may involve talking with coworkers to determine what is actually possible and what is realistic. Ultimately it may involve talking with the supervisor.

Recovering from injury. Employees who have sustained a serious injury must consider whether they need to transfer to another department, another company, or another line of work. Working in the same situation, with the same people, doing the same tasks has a high likelihood of causing reinjury.

More Productive Than Ever

The journalist Shankar Vedantam relates the example of a superbly brilliant woman who goes to medical school, works very hard all the time, becomes an outstanding professional, and works, works, works, becoming the top chief of staff in her field. Suddenly she finds herself making mistakes. Medicine is her life. She agrees to take time out to save her career, and when she does, she realizes that she’s been under massive stress, not enough sleep, working insane hours. The only thing she does is medicine. Finally, she decides that she needs to take off half a day a week, no work, no social connections, basically no responsibilities, nothing. This absolutely goes against her grain—six hours of wasted time. But what she finds after going through a rehab program is that she has become a better physician. She is, in fact, now more productive than ever.

17

Skills for Sanity

One of our goals in this book is to offer a range of practical tools and resources for dealing with stress. Some of these skills, such as cultivating gratitude, are already widely recognized. Others, such as pivoting, are a variation on this theme. (To pivot means to ask for what you need, rather than focusing on what you don’t want.) These are skill sets that support effective coping and quality of life, and on occasion, they can be life-changing.

17.1. Identifying Energy Drains and Gains

17.2. The Importance of Choice

17.3. Knowing Who You Are

17.4. Asking for What You Need

17.5. Sharing Gratitude

17.1. Identifying Energy Drains and Gains—Reclaiming Lost Energy

Are you full of energy, ready to do more? Or do you feel drained and exhausted? After giving at the office, is there nothing left to give at home? Do you feel as if you’re on a treadmill, that more things in your life are draining than energizing?

Often, we live our lives on autopilot and forget to notice when we feel more tired or when we feel energized. After an illness, for example, we may think that we have recovered until all of a sudden, one day we wake up and actually do feel much better. At that point, we realize how lousy we felt until now. Experiences of feeling chronically drained are often a precursor to illness. In contrast, feeling energized enhances productivity, seems to expand the possibilities in our life, and is a crucial aspect of health. This raises the question: What contributes to energy drains and gains for any one of us, specifically?

What gives you joy? There is a lovely set of exercises that go to the heart of experiencing how joy improves health. This practice involves identifying the skill sets, activities, situations, and people in your life that give you energy and those that decrease it. The more people, activities, and events that tend to increase your energy, the more likely you are to do better and remain healthier. There are many things in our lives that we must do that drain our energy, situations in which little choice is involved. Yet there are others that we can choose to do. Bringing conscious awareness to our choices provides us with some leverage—the opportunity to create positive energy.

Energy defined. Energy in this context is a subjective sense of feeling alive and vibrant. An energy gain can be any thought, activity, or person that makes us feel better and more alive. An energy drain is the opposite: it leaves us feeling less alive and perhaps a little depressed.

Drains and gains are individual. Situations, tasks, and people that energize us are always unique to the individual. What is a gain for one person can be a drain for another. An energy drain, for example, might be doing the dishes and feeling resentful that your partner or kids are not helping. To someone else, doing the dishes may be interpreted as a gain because you are being helpful and contributing to the well-being of the household. Energy gains (or drains) can vary by degree as well. For some people, doing dishes is actually celebratory. Preparing to cook for Thanksgiving, for example, in some households means washing every pot, pan, and dish in the house, so the cooking occurs in a gleaming fresh kitchen. That level of preparation can invoke a great sense of accomplishment. For other people, doing the dishes is surprisingly draining. They may see this as just another task to do in a long line of tasks. In the case of someone who was criticized as a child for the way they did dishes, they now associate doing the dishes with being criticized unfairly, and feel exhausted at the mere thought of dirty dishes.

Increasing Your Mental and Emotional Energy

Explore strategies to identify and increase energy gains and decrease drains on your energy.

Week 1. Find your baseline. For one week, monitor situations that affect your energy. Notice events, activities, people, thoughts, and emotions that could increase or decrease energy. Track your responses at home and at work. Be honest. Simply note the events that change your energy level.

Week 2. Increase one gain. After you’ve identified and categorized drains and gains for a week, look back over your list and identify one gain you’d like to increase. Then work out a behavioral strategy to increase that gain. Your solution can be very pragmatic. Make only one change at a time, by increasing one aspect of your life that enhances your energy. Each day, implement that behavior or experience and then observe what happens.

Week 3. Decrease one drain. The following week, develop a strategy to decrease one of the energy drains. Be very specific about how, where, when, with whom, and in which situations you will decrease a task that drains your energy. For example, if doing the dishes is a drain, how can you solve that? Does that mean working out a trade with your partner or kids, in terms of who does the chores? Would each person be willing to wash their own dishes, as they do in the Zen monasteries in Japan? Would it mean using paper plates, hiring housekeeping help, or saving up for a dishwasher? The important aspect of the exercise is to observe your response, how you feel about the situation, and then developing a new way to deal with it. Anticipate any obstacles that may interfere with reducing your drains and develop new ways to overcome these obstacles: trading tasks with others, setting time limits, giving yourself a positive reward after finishing the task—a cup of tea, a text or phone message to a close friend, or watching a video in the evening.

Week 4. Assess your experience. Once a month, set time aside to reflect on gains and drains, the opportunity for an ongoing reassessment. Taking time for reflection can be useful in a number of ways. If you see patterns of drains in your life that continue to reoccur, that may lead you to a point where you’re wondering, “Do I want to keep living this way? What kind of changes do I need to make?” These are behavioral choices. We cannot make these choices unless we clearly see what’s going on, unless we see the data for ourselves, and we’re actually aware of the impact. Then, we have the option to do some problem solving.

Week 5. Track your progress. If you make just one change at a time (for example, one a week, or even one change every two weeks), it becomes clearer whether the new behavior makes you feel more energetic and joyful, and if it’s worth the effort.

17.2. The Importance of Choice

As you increase your awareness of the things that give you energy and joy, it’s useful to consider how you want to spend your time. Ultimately, the question is: What is your intention when it comes to engaging in the things that you really want to do?

When you wake up in the morning, it can be helpful to check in with yourself: “How do I feel?” “What am I looking forward to today?” If your response is negative, explore what may be stopping you from feeling okay with your choices. Shifting intention and making optimal choices, given your circumstances, will lead to energy gains and help you reduce drains on your energy.

Awareness that you have a choice. Our research observations suggest that when people lack a conscious awareness that they have a choice about a task, they may experience depression, futility, or hopelessness. On the other hand, if you feel optimistic and look forward to the day, that can enhance your health and immune function. Rather than saying, “I have to do this,” identify tasks that reflect positive choices you are consciously making. The goal here is to bring your choices to full conscious attention so that you can come to some kind of acceptance of your life, while making changes that are intentional and essential.

Accentuate positive choices. Simply, whenever you have a choice, choose something positive.

Story: Focusing on What’s Working

After five years as a freelance graphic artist, Zoey had an established clientele and a distinctive style. She loved the work, but found herself bogged down with financial management and tax reporting. Given the work ethic she had inherited from her parents, she felt she should be able to handle everything on her own, but the accounting was making her miserable. Once she realized how conflicted and overwhelmed she was, she gave herself permission to hire a bookkeeper. Knowing that her business was handled freed her to do more of the work she loved.

The Caregiver

At some point in our lives, most of us will go out on leave to care for our partner, a child, or a parent. This is not a new role for human beings. Evidence from the Paleolithic era and earlier makes it clear that we have been taking care of one another since time out of mind. Archaeologists have found that thousands of years ago, obviously long before modern health care, people were able to recover from very serious injuries, an indication that they had received good care. Today, being there for our partner, our kids, and our parents when they need us is an important aspect of our humanity.

Reframing. When caregiving involves hope of eventual recovery or resolution of pain and suffering, we see light at the end of the tunnel, and are more likely to have the energy to keep going with a positive attitude. Knowing that our partner or our child will get better enables us to deal with the physical, mental, and emotional demands. What happens when caring for a parent, for example, with a chronic, degenerative condition such as Alzheimer’s? That tends to be more demanding, and may leave us feeling more drained. Here too there is the opportunity for reframing, for building perspective. If we see our role as providing our family member with quality of life, that can become surprisingly positive, in contrast to focusing on either their disability or the short life span they may have left.

Looking for energy gains. If you are in a challenging role such as caregiver, the exercise involving energy gains and drains can be applied to specific tasks in your life, to aspects of caring for a loved one who is ill. Within the tremendous challenge and the demands of caregiving, are there times in the day, or events, however large or small, that are energizing? For example, playing music for your loved one, they may suddenly recognize a song from their past, and be enlightened. Seeing the moments of joy and the quality of life that they experience will enrich you as well.

Where do you have leverage? What are the options you could influence, while realistically acknowledging the difficult circumstances you are experiencing? Does your situation serve a higher purpose, with meaning and relevance to some greater goal? In that context, it is useful to be pragmatic, take a proactive stance, and ask, “What can I do about it?” (You may find it helpful to review the steps in problem solving outlined in chapter 16 on chronic stress. Create the time you need to define your situation and identify strengths and resources. You want to have enough mental space to think outside the box. At times it is helpful to go on a long walk without any distractions and let your mind roam. Sometimes new ideas emerge, almost effortlessly.)

Building perspective. When there seem to be no solutions or work-arounds, can we reframe the situation, or work toward some level of acceptance, rather than pitying ourself or blaming others? Sometimes the outcome is not in changing the tasks, but rather in making the effort to think about our circumstances in new ways. You will notice the emphasis on “effort” and “work” because redirecting negative emotions requires a good deal of emotional energy, although it does become easier. Building perspective is one of the central goals of mindfulness, making choices intentional with the potential to gain energy and live a happier life.

Emphasis on quality of life. The work of Dr. Lawrence LeShan in his remarkable book Cancer as a Turning Point reveals the importance of this perspective. LeShan observed that when patients with cancer began paying attention to what they truly wanted to do with their lives, exploring options available to them, and intentionally acting on their unfulfilled dreams, some found that their health actually improved.

Reframing the internal dialogue. Often our lives are filled with things that we feel we should do versus want to do. In some cases, the life we find ourself in may not be the one we wanted. Our life may reflect our all too human doubts and fears. Over time, we can make the effort to reframe our internal dialogue, shifting it from self-doubt and worry to ideas filled with possibilities and choices. We now know that these mental shifts are realistically possible. In contemporary science, the term neuroplasticity refers to the fact that gradual changes can be achieved in brain circuitry, reflecting mental growth. Confirming the work of pioneers such as Jon Kabat-Zinn, researchers Garland and colleagues observed that practices such as meditation and mindfulness can increase a sense of perspective, gradually changing brain and body, just as one would increase physical strength by working out at the gym over a period of months or years.

17.3. Knowing Who You Are

Temperament theory offers insight into familiar personality types, drawn from the Myers-Briggs Type Indicator (MBTI), the most widely used career tool on the planet. Based on the ideas of the psychologist Carl Jung, the MBTI has been validated for decades through a database at the University of Florida that contains hundreds of thousands of Myers-Briggs profiles. Temperament theory is a variation on the MBTI that simplifies this system into four primary temperaments that are easy to understand and to apply.

The ancient Greeks evolved similar classifications, which they described as the four humors. Since that time, the idea of four basic personality types or temperaments has been reflected in philosophy, medicine, and literature. Hippocrates, Plato, and Aristotle proposed them, and Shakespeare included those ideas in his cosmology. The psychologist Carl Jung applied the concept of four temperaments in his own work, and felt that his theories offered a realistic reflection of human psychology.

Psychologists David Keirsey and Marilyn Bates reframed the four temperaments for modern readers in 1978 in their seminal work Please Understand Me. Most recently, different variations of these same four temperaments have been effectively applied in the work of psychologists Helen Fisher, in her book on relationships, Why Him? Why Her?, and Loretta Graziano Breuning, in her book on neurotransmitters, Habits of a Happy Brain. Temperament is linked to lifestyle in Diet Right for Your Personality Type by the health and fitness expert Jen Widerstrom.

The temperaments are easy to understand and remember; once you know them, you will see them everywhere in the people around you, and in yourself. (Note: Spontaneous Adventurer types are put off by the idea of categorizing people, but for the rest of us, the temperaments help us get a little clearer on what makes people tick.) The four temperaments can be useful in defining your own personality and core values to help you sort out the things that are most important to you. This will also help you recognize the people with whom you share your highest values, whether they be family by blood or by choice, friends, or coworkers.

The Four Temperaments

CITIZEN / TRADITIONALIST / WORKER

These people are the doers of the world, and they tend to be highly organized, focused, hardworking, and punctual. They love order and understand its value in providing harmony and stability. Data from the Temperament Research Institute suggest that these folks are in the majority, making up more than 40 percent of the U.S. population. They are managers, businesspeople, and accountants, visible in administration, the PTA, government, and industry. In the corporate world, research shows that more than 85 percent of leadership has this temperament. Men and women almost equally identify with these values (about 8 percent more women than men). Ultimately, for these people order is the highest value, and they appreciate how easily order can be lost.

FREE SPIRIT / ADVENTURER / SENSUALIST

Folks with this hardwiring live in the moment, tend to be spontaneous, and are attuned to the pleasure of experience. They have been described as inventive, pragmatic, and self-reliant, and are attracted to jobs that range from firefighter, paramedic, or pilot to investor, entrepreneur, or salesperson. They make up about one-third of the population and are found almost equally among men and women (15 percent more men identify as Free Spirits).

STRATEGIC THINKER / RESEARCHER / VISIONARY

The world of ideas is the realm of these people. They tend to be analytical, rational, focused, and inventive thinkers who are found among writers, entrepreneurs, analysts, engineers, professors, researchers, and scientists. Thinkers tend to be pragmatic and strategic, and they value a logical, realistic world view. About 10 percent of Americans have this temperament, which is found about twice as frequently among men.

NURTURER / HUMANIST / DEVOTEE

These are the helpers of the world, who serve humanity—nurses, teachers, psychologists, and social workers. People who share the emotions and thought patterns of a Nurturer also include those drawn to spirituality or religion, so their number includes ministers, nuns, and devotees of every faith. For Nurturers, fairness is the highest value, so they are found in greater numbers on the liberal side of the spectrum. People with this temperament tend to be imaginative, intuitive, and idealistic. Generally speaking, this temperament is found in a little more than 10 percent of Americans, and about twice as many women identify as nurturers.

You can delve more deeply into these ideas through any of the books we’ve mentioned. Most people tend to be a combination of two temperaments, and some highly evolved souls have all the bases covered. If a temperament rings true to you, use it as a bit of a compass to get greater clarity in your own life.

Citizen

Free Spirit

Workstyle

Lifestyle

Workstyle

Lifestyle

organized

factual

dependable

logical

orderly

punctual

reliable

industrious

efficient

conscientious

practical

realistic

traditional

steadfast

cooperative

loyal

responsible

painstaking

prepared

decisive

independent

creative

skillful

inventive

adaptable

energetic

alert

observant

pragmatic

easygoing

adventurous

spontaneous

charismatic

impulsive

fun-loving

playful

entertaining

outgoing

self-reliant

tolerant

Thinker

Nurturer

Workstyle

Lifestyle

Workstyle

Lifestyle

analytical

knowledgeable

theoretical

objective

intellectual

competitive

focused

strategic

inventive

competent

independent

decisive

pragmatic

inquisitive

intelligent

rational

reserved

truthful

perfectionist

complex

humanistic

empathic

harmonious

fair-minded

nurturing

progressive

protective

creative

verbal

persuasive

compassionate

affectionate

open

idealistic

altruistic

imaginative

intuitive

introspective

authentic

devotional

Figure 17-1 The Four Temperaments. Put a check by all the qualities that describe your personality, workstyle, and lifestyle. Know that most people are a combination of two primary modes, or sometimes three. (Source: Nancy Faass © 2020, with thanks to a number of innovators in temperament theory)

We can use temperament to better understand the people we’re working with and how to best interact with them. In the digital world, where we often have fewer face-to-face connections, it’s a temptation to forget that other people have different temperaments, values, biases, and personal goals. Various temperament theories can be particularly useful when we’re working on virtual teams, to deepen our empathy. Understanding more about our own style and the style of others can make it easier to work collaboratively on teams and to connect with others.

17.4. Asking for What You Need

This handy little skill works by turning our complaints or concerns into positive requests. We are hardwired to pay attention to the negative rather than the positive, so if we’re mindful, we may catch ourselves complaining. The value of this skill, referred to as pivoting, is that we are more likely to get what we want if we ask for it specifically, framing it as a positive rather than a negative.

Complaining focuses our attention—and that of our listener—on what we don’t want. When we communicate what we do want in clear, actionable terms, others are more likely to support us. For example, if we’re worn out and running on empty, rather than complaining about how tired we are, the strategy is to stop and think about what we need (rest!) and then express that in order to negotiate what we want. That might mean asking our boss for a day off from work, or having our partner handle our chores while we take a nap or catch a movie.

The trick in pivoting is to identify what we need. That requires experiencing the negative emotions that underlie our discontent. To a degree, that means being willing to experience the emotional discomfort in order to get to a solution.

Imagine this scenario: two friends with the same ultimate need, companionship. One friend is fond of complaining. He tends to get a little sunk in negativity, so his train of thought is something like: It’s such a drag since my girlfriend left. What a witch. You just can’t trust women. Yeah, I know I should get out more, start hiking again, but I hate going alone; it’s so boring.

Our second friend is also lonesome, but is being more proactive. Man, my apartment feels so empty since my girlfriend cut out. I’m bouncing off the walls.… Maybe I should get a dog. Had a great dog as a kid, Max.…

He is willing to look at his experience and connect with something that worked for him in the past. When we find ourselves complaining, it’s time to figure out what we need, pivot, and express that to those in a position to get us what we want. (This exercise is based on the work of Esther and Jerry Hicks.)

17.5. Sharing Gratitude

It was late in the afternoon and I was tired. A knock on my office door. One of my students came in and made a little speech she had memorized: “I want to thank you so much for all your help on my project. Thank you for encouraging and supporting me. I’m making new discoveries about myself and finding more happiness and fulfillment. Thank you.”

I was deeply touched, and my eyes started to fill with tears. At that moment, I felt so appreciated. We hugged. My fatigue disappeared, and I felt at peace.

—Erik Peper

The gift of gratitude is that it makes others feel appreciated, worthwhile, and recognized for the contributions they have made. In a sense, it gives meaning to life. This experience evokes the positive emotions that support regeneration. Most interestingly, the person sharing the gratitude benefits equally. In the act of giving to others, we mobilize our own self-healing and experience a deepening connection. This is a form of selfless caring referred to by the Greeks as agape, which encompasses unconditional love, universal love, charity, and love without expectation.

Showing gratitude is so powerful that you might consider making it part of your personal style, to express gratitude in every situation in which someone provides you a service or does something good for you. Expressing gratitude even for small or routine favors shows appreciation and recognizes the presence and service of the other person. When we express sincere gratitude, people tend to feel deeply touched, and both our hearts open.

18

Reframing

Reframing the choices that we make is a valuable skill that not only helps build perspective, but also can preserve our poise and sense of sanity. As the saying goes, “Hindsight is 20-20.” If you are tempted to look back on events with regret, try reframing a perceived failure or an unfortunate situation into possibilities of success. This chapter offers several perspectives on the technique of reframing.

18.1. Turning Failure into Success

18.2. Using Imagery to Change a Habit

18.3. Overcoming Negative Self-Talk

18.4. Rethinking Traumas from the Past

18.5. Celebrating What You’ve Done Right

18.1. Turning Failure into Success

During the slalom race, I was going too fast. I was thrown by a bump and exploded on the slope at fifty miles an hour. The ski patrol came and got me, put me on the toboggan, and took me down the slope to the hospital. All the time, I kept asking myself, “How could this have happened? Why me?” Whenever anyone came to visit me, they also asked, “What happened? How did you get hurt?” I found myself describing the accident over and over—my failure, how I screwed up, and how I got injured.

The experience. When I got back to competitive skiing, I had lost my edge. Whenever I went fast or hit a bump, I tensed up and got scared. I felt just like I had right before I was injured. Then I realized that when I described the accident, I was rehearsing how to ski with failure. I had relived the accident hundreds of times, each time focusing on what I did wrong. In my attempts to figure out where things had gone south, and then in the retelling of the experience, I had overlearned the bad habit of stiffening when I was going too fast.

Once I realized this, I asked myself, “How could I ski differently so that I don’t get hurt?” The answer was obvious: the moment I began going too fast, I needed to exhale, flex my knees, and retract my legs as I hit the bump. That would help me slow down while staying balanced and in control. Realizing that, I started to rehearse this new image. Whenever I thought of skiing or the accident, I imagined this new scene, exhaling, relaxing, flexing my knees and retracting my legs. I continued this process even when friends ask me about the accident. Instead of telling them what I did wrong, I now answered, “It’s true, I got injured, but let me tell you how I’m going to approach that situation next time.”

The payoff. After practicing this for a few weeks, my skiing improved remarkably. It taught me an important lesson. Instead of revisiting failure, I now ask, “What can I learn from it? How can I do this differently?” So, I now spend my time rehearsing how I would like to do things instead of how not to do them.

Here are the steps the athlete took to reframe his experience, learn from his mistake, and succeed. You can become skilled in using this type of practice:

1. Acknowledge your error when you make a mistake.

2. Figure out what caused the problem. In the case of the skier, he was able to analyze his form and develop a new approach. If the problem involves another person, that may mean opening a discussion with them. In other cases, assessing the problem might involve doing some research. If the issue is vital, do whatever it takes.

3. Identify what needs to be done differently to succeed.

4. Develop imagery in which you see and feel yourself reliving the experience successfully, step by step.

To apply this process in your own life:

5. Use this imagery daily, at a time when you are relaxed and comfortable, so it becomes a form of self-hypnosis.

6. Act. Apply your step-by-step approach in a real-life situation.

7. Assess how that worked, and course-correct if necessary.

8. Acknowledge and celebrate your success. This is one of the best ways to free yourself from failure and achieve quality of life.

This step-by-step process may feel somewhat artificial, initially. As with many of the exercises here, with repeated practice, this approach becomes more and more natural. Applying this process is especially encouraging when you start seeing results.

Reframing in Action

In one of our studies, a group of 142 participants used imagery to explore the impact on their productivity. The participants’ average age was twenty-three and included 42 males and 100 females. Those who applied the intervention were coached on self-care and stress management for a period of four months. The practice involved problem solving and the development of new strategies to achieve different behavior or outcomes, like that described in the vignette of the skier. The coaching also encouraged participants to minimize negative self-talk. At the end of four months, participants reported:

- Procrastination decreased more than two-fold.

- Productivity increased three-fold.

- Energy improved four-fold.

Practices that contributed to these successes included developing greater compassion, self-acceptance, mastery, and coping skills.

18.2. Using Imagery to Change a Habit

Before you tackle a habit that you would like to change, consider the surprisingly powerful effects of imagery and how it can impact your physiology.

Experience It: The Power of Thought

Gently close your eyes and imagine a lemon. Notice the deep yellow color and the two stubby ends. Imagine placing the lemon on a cutting board and cutting it in half with your favorite kitchen knife. Notice the pressure of the knife in your hand as you cut the lemon. Feel a drop of lemon juice against your skin. After cutting the lemon in half, put the knife down and pick up one half of the lemon. As you look at it, notice the drops of juice glistening in the light, the half-cut seeds, the outer yellow rind, and the pale inner rind. Now get a glass, and squeeze this piece of lemon so the juice goes into the glass. As you squeeze, notice the pressure in your fingers and forearm. Feel droplets of lemon juice squirting against your skin. Smell the pungent, sharp fragrance. Now take the other half of the lemon and squeeze the juice of that piece into the glass as well. Take the glass in your hand. Feel the coolness of the glass and bring it to your lips. Feel the juice against your lips, and then sip the lemon juice. Taste the tart juice, and slowly swallow it. Observe the pulp and any seeds as you swallow.

What did you notice? As you imagined this, did you experience an increase in salivation, or did your mouth pucker? Almost everyone who does this exercise experiences some of these physical changes. The increase in salivation demonstrates that these thoughts and images have a direct effect on our thoughts and physiology.

We may be tempted to dismiss our experience when we used the imagery of a lemon—it was only an imaginary lemon, after all. However, consciously experiencing the impact of imagery raises a fundamentally important point. Every minute, every hour, every day, our bodies are subtly affected by thoughts, emotions, and images.

This insight can be extended to many other aspects of our emotional experience. When we have thoughts of anxiety, resentment, frustration, or anger, they also affect us physically. These responses interfere with our ability to relax and heal. If this kind of tension is a constant habit, it reduces the body’s ability to regenerate.

Just as the image of the lemon was so powerful it caused us to salivate, our thoughts and emotions can also gradually result in imperceptible changes that can be compared to water rushing down a riverbed. At any given moment, there is almost no apparent effect. However, as the stream grows, it becomes wider and deeper. Year in, year out, the water will scour the ground, carving a deeper and deeper riverbed. Eventually, the river changes the landscape.

In a similar way, over time, our patterns of thinking influence every aspect of our lives. Our thoughts, moment to moment, have an impact on our thought patterns and on the types of experiences on which we choose to focus. This includes the friends we make, the career opportunities that come to us, and the lifestyle that we live. There are also effects on our internal health, which are imperceptible at first. Just as drops of water over the years can create a streambed where there was none, so our thoughts ultimately shape our lives.

By managing thought patterns, we can enhance our health and well-being and the quality of our life.

Fortunately, we are capable of learning. We can reverse patterns in our life, learn new behaviors, and be thankful for the opportunity. Reframing provides us with the opportunity to pay attention, to focus on the positive, and to move forward intentionally toward more successful and satisfying behaviors.

Use visualization to transform your experience. Imagery will enable you to reframe and elaborate on your new approach or habit. Every day, observe an action you currently experience as going wrong or as an error, however small, and at that moment mentally rewrite how you would like to have behaved. Although it is usually possible to generate a new pattern to change the undesired behavior, some people report that when they rehearse the new pattern, it feels like a lie. If you feel like a fraud when you use the new approach, just say, “I have learned from this past behavior, and now I am going to imagine a situation in the future where I can rehearse new, preferable behavior.” Use the following five-step process:

1. Think of a past behavior with which you are dissatisfied.

2. Ask, “How could I have done this differently?” Take the time to analyze the problem, breaking into smaller parts the various aspects of the problem in order to identify new solutions to each aspect of the situation. Then, taking one small part at a time, write out the new behavior pattern that you would like to rehearse.

3. Now create a visualization in which you respond as you wish you had in the past.

4. See yourself in that same situation but behaving differently, using the wisdom of hindsight you now have. (You might want to rehearse this step a number of times.)

5. Picture a possible future situation in which you might be tempted to react in the old pattern and see yourself doing it differently, with the desired behavior. Practice the visualization each day in a relaxed and meditative frame of mind. Now take action, and try out the new behavior.

Imagine the situation in total detail. See and feel the experience. Imagine every small step, sensation, and thought—everything that would occur when you actually do the task. How you imagine the task is not important. Some people see it in living color, while others only have a sense of it. Just take yourself through the new activity. Rewriting the past takes practice. During the mental rehearsal, the old pattern often reasserts itself. Just let it go and practice again. If it continues to recur, ask yourself, “What do I need to learn from this? What is my lesson?”

The following is an example of someone on a diet, trying to eat better, who is tempted to resort to their old pattern of coming home at night and pigging out on chips and beer:

As I left the office, I realized that I was running on empty—low blood sugar, for sure. As soon as I got home, I headed to the fridge to pop open a cold beer and claim the big bag of chips my buddy had left the other night. Suddenly, I remembered my diet and visualized myself enjoying a fantastic salad. I stopped, paused, and took a deep breath. Then I pulled out my phone, and hit the number for my neighborhood Thai restaurant. I ordered their best stir-fry, and said “no thanks” to the starchy noodles. The stir-fry was great. Once my energy came back, I made a big salad to top off the meal and went to bed in much better shape.

Smile and congratulate yourself for taking charge of programming your own future. Remember, you strengthen your new behavior patterns when you practice them mentally, and also in real life.

18.3. Overcoming Negative Self-Talk: Thought Stopping

When we’re under stress, dark thoughts and old scripts from our past tend to bubble up (“woulda-shoulda-coulda”). If this type of thinking becomes habitual, projecting negative worst-case scenarios, we may come to believe that we have little control over our moods, although we may actually be generating the negative physical, behavioral, or psychological reactions ourselves. If we re-evoke those same dark thoughts again and again, instead of letting them go, that can create a self-perpetuating downward spiral of distress-related symptoms. (For more on reversing this pattern, see the pioneering work in this field by David Burns in Feeling Good.)

The human mind has no off switch. Sometimes referred to as the “monkey mind,” the restless human mind has gotten us into a world of trouble over the millennia, creating fabulous empires and then destroying them, making inroads on the human condition and then letting progress slip away. The monkey mind can also wreak havoc in our own individual lives. It is comforting to know that there are resources within both Western psychology and the Eastern meditative traditions that can help us find the off switch, or at least turn the volume down on noisy internal dialogue (the monkey mind).

For many of us, learning how to influence that dialogue, and then making it a habit to think more positively, can be life-changing. We actually do have the ability to stop rehashing negativity and rethinking dark thoughts. By actively changing our thoughts, we can interrupt negative thought and behavior cycles.

We almost always have the option of refocusing our attention. For example, simply shifting physical posture, taking a deep breath, and refocusing on the positive can help reduce the impact of a negative attitude. In our research on attitude, we found that a brief four-step process that included a change in posture was more effective than simply trying to change a thought pattern by thinking different thoughts. In our study, participants

1. changed their posture by sitting more erect and upright

2. focused their vision above eye-level

3. took a deep breath

4. then changed their thoughts

The challenge is to learn to observe our thoughts, identifying thoughts that evoke and maintain stress, and then learning strategies to change them. Mind and body, thoughts and feelings are not separate. Every thought has a corresponding physical counterpart and vice versa. The implication: it is much more effective to change posture and breathing first before simply trying to changing negative thoughts. By shifting body posture to a more upright position, a new perspective is more easily available.

The Powerful Effect of Awareness

At the young age of twenty-two, William was given a terminal diagnosis. Once he realized there was some small hope that he wasn’t going to die, and that he might be able to rebuild his life, he was still running dark thoughts, thousands of them. He felt stuck in a cycle of negative, repetitive patterns that kept coming around and around.

The first step for him was to become aware of the thoughts. He made a commitment to himself to recognize the pattern whenever it surfaced and to do something about it. Just that awareness alone, just recognizing the darkness of his thoughts, had a powerful effect, interrupting the loop and freeing him.

18.4. Rethinking Traumas from the Past

This next exercise is a kind of taking stock, a personal inventory that builds on energy drains and gains. The goal here is to identify burdens we carry from the past, consider them, and practice releasing them. Our history is not absolved in a single day or a single act like the burning of a message on a piece of paper, even though we may feel better. It’s not extinguished in a single wave of fury, boxing gloves pounding the bag, or crying when our heartstrings are touched by an emotional movie. However, we owe it to ourselves to release these burdens, over and over, as they bubble to the surface of our conscious mind.

Neglected, bullied, or assaulted. Memories of the past may nag at us. Former latchkey kids may think of their childhood with a kind of melancholy, reflecting the loneliness a child might feel walking into an empty house. Other kids experience hazing, bullying, being beaten up or assaulted. As children, we feel so helpless, and yet usually there is nothing we could have done. There are so many settings in which we had no control, and regardless of our behaviors, nothing would have been different. In those situations, the goal is to work toward acceptance. And remember, happiness is the best revenge.

You can’t change the past. Acknowledge that it happened. Often, we don’t understand why it happened. Consider that you have grown, and explore any learning that could be gained from the difficulties you experienced. Reaffirm that you are no longer the same person you were when the experience occurred; then take a deep breath, relax, and let it go, knowing that this personal experience has taught you a set of coping skills that have nurtured your growth and development. Periodically, these memories and feelings may resurface. Each time, acknowledge them, respect them, affirm your worth, and work on letting them go.

Divorce. We can use similar techniques to deal with memories that may haunt us from other episodes in our past. For example, in the United States, about 40 to 50 percent of all marriages end in divorce. Research from the field of biological anthropology suggests there are even biological reasons for divorce. However, despite the prevalence of divorce worldwide and across millennia, most people walk away from the experience with a certain amount of guilt.

Romantic love. Almost all species that practice monogamy practice serial monogamy, which lasts the time it takes to rear young. For birds, this is a season. For babies, this requires several years. When anthropologist Helen Fisher ran the data, she discovered that in every culture in which divorce was allowed, the average marriage lasted three to four years. That also seems to parallel the intoxicating chemistry of romantic love, which researchers found to closely resemble the chemistry of addiction. For more on this perspective, see the books of Helen Fisher: Anatomy of Love as well as Why We Love: The Nature and Chemistry of Romantic Love and Why Him? Why Her?

You can only change yourself. In dealing with the experience of divorce, remind yourself, “I can only control my own behavior. I have little or no control over the behavior of others.” Remember that others have the freedom and the right to react in their own way. Ultimately, that frees you. In your imagery, see yourself changing. Others may also change in their response to you. However, in the real world, they may or may not change, and have that right.

Everyone has done something wrong. There are also an endless number of ways that we can mess up. We did engage in that course of action. If we were a different person, we might have made a different choice. However, we did not. Whatever we did, acknowledge that it happened, and that we did our best at the time given our genetics, our life experience, our social training, our skills, and our emotions. Accept that there was no way you could have done it any differently given the skills you had at the time.

Experience It: Everyone Makes Mistakes

There is a wonderful song that Fred Rogers used to sing on Mister Rogers’ Neighborhood: “Everyone makes mistakes, oh, yes, they do / Big people, small people, matter of fact, all people / If everyone in the whole wide world makes mistakes, why can’t you?”

That is a premise worth testing. Is it really true that no one is perfect? Relax in your favorite chair or curl up on the couch (with a cat or dog if available) and get cozy. Begin thinking of all the people you’ve ever known: people you loved, people you admired, even people you may have envied a little. As you think of each person, ask yourself if they were perfect. It is definitely possible that the great avatars of humanity were indeed perfect—Buddha, Jesus, Mohammad. That was so noteworthy that people centuries later are still talking about them. The rest of us are works in progress. Imperfection is the nature of life on earth.

People and life in general are complicated and multifaceted. Realizing this on a fundamental level can be very freeing.

Fess up. Trust that you did the best you could have done, even though, looking back, you now see a better option. You may have engaged in some bad choices or made bad decisions, but at that moment, you did the only thing you felt you could have done. When a situation occurs in which you feel you were in error, acknowledge what happened and cut yourself some slack. If you feel you did your best, remind yourself of that. If you feel guilty, act on it. Reach out to the other person and ask, “What do I need to do to make it up?” and then do that. Be proactive.

If you’d have known better, you’d have done better. The next step is to take time for reflection. Ask yourself, “Given the wisdom I now have, because I’m a day older and smarter, how would I have done that differently?” Then, see yourself dealing with the situation in a new way. Every time you find yourself thinking back, thinking about what you feel you should have done, begin by saying, “Thank you for an opportunity for learning and growth,” and then mentally walk through the situation step by step. Visualize yourself coping differently, dealing with events in a different way. That establishes the beginning of a form of learning. It primes the brain, creating a kind of mental resilience, so that we don’t need to repeat the same behavior over and over. When you do that, you are training your brain to think in a better way.

18.5. Celebrating What You’ve Done Right

Having released grief, pain, and trauma, it’s time to begin taking stock of who you are and celebrate your strengths. What are your contributions? For example, are you

- loyal, hardworking, someone everyone relies on (the guy who comes in on their day off)?

- the brains of the operation, the one who figures out the problem, the fixer, the mastermind?

- the embodiment of excitement and adventure, the one who brings life to the party (or to a tedious project), who puts the joy in joie de vivre?

- big heart energy, the one who takes care of everyone else, and especially the very young, the very old, and those most fragile, be they human, canine, or feline?

Here’s the opportunity to create your “life list,” just as an avid bird-watcher might, of your most wonderful moments, greatest achievements, and proudest accomplishments, large and small.

19

Overcoming Burnout

STEVE AMOILS, MD, AND SANDI AMOILS, MD

People respond to stress in unique ways. One person will thrive in a situation that causes another to crumble. However, we all have our breaking point. Once stress becomes chronic and overwhelming, almost all of us tend to experience a similar pattern of physical and emotional responses that reflect profound changes in our body chemistry:

1. Stage 1. Feeling great

2. Stage 2. Wired and tired

3. Stage 3. Exhausted

4. Stage 4. Exhausted and inflamed

5. Stage 5. Depleted

This chapter is provided courtesy of Steve Amoils, MD, and Sandi Amoils, MD, medical codirectors of Alliance Integrative Medicine, www.myhealingpartner.com. This information can also be found in the book: Steve Amoils and Sandi Amoils, Get Well & Stay Well (Cincinnati: Integrative Medicine Foundation, 2011). For additional information, see www.integrativemedfoundation.org.

The Stress Curve

Our moods, our health, and our ability to fight off illness mirror where we are on the Stress Curve.

Stage 1. Feeling Great

Under mild or moderate stress, most of us typically respond well. If we have an exciting opportunity such as a new job, we’re likely to feel energized or exhilarated. If we’re asked to complete a rush job with an urgent deadline, or to study for an exam, usually we can push ourselves, respond to the stress, and meet the challenge. At this stage, problems are simply challenges to overcome. This is the optimum response.

What’s going on inside the body. Some of the chemicals produced by our bodies serve as natural stimulants. That’s how we’re able to pull an all-nighter or get the driveway shoveled after the first big snow. When we feel invigorated, these natural stimulants (such as adrenaline) have kicked in. This chemistry gives us the drive to respond to the task at hand. This same chemistry is present in all mammals and at the extreme is evident whenever they experience the stress response.

Stage 2. Wired and Tired

At what point does the sense of exhilaration become a drain? Let’s say that the stress, the pressure, long hours, lack of sleep, and deadlines continue day in and day out. You may be an emergency room nurse, a single parent working two (or three) jobs, the manager of a start-up, a student preparing for a big exam, someone grappling with an addiction, or the parent of a child with a chronic illness. In these circumstances, you may be able to meet the demands of the tasks facing you, but eventually you will no longer be able to respond as efficiently. Your ability to keep adapting to stress diminishes as your body chemistry begins to deplete. In this phase, adrenaline remains high, making you feel wired, while your cortisol level begins to drop, making you feel tired. The Stress Curve flattens out, producing the stage referred to as Wired and Tired. At this point in the Stress Curve, you may begin to experience unpleasant or unnerving physical symptoms:

- Emotions. Feeling stressed, hypersensitive, irritable, tense, anxious, and/or fatigued

- Possible physical symptoms. Restless sleep, hyperactivity, racing heartbeat at times, cold sweats, or high blood pressure

Inside the body. When we are wired and tired, our bodies are putting out too much of the stress hormone adrenaline, as well as other stimulating brain chemistry. This causes a racy yet anxious feeling. In this phase of the stress response, cortisol drops during the day, but then rises at night—so we feel tired during the day, but more alert and awake at night, just when we want to sleep. Over time, stress wears away at metabolic reserves, depletes vital nutrients, and puts a strain on different systems throughout the body. The body attempts to adapt. The mind tries to relax by secreting calming neurotransmitters such as GABA and serotonin, natural tranquilizers that act as brakes on a racing mind.

Stage 3. Exhausted

What happens when we feel we have to keep pushing despite the stress, when we go beyond the wired and tired phase? The body continues adapting to chronic stress. To do so, it slows metabolism, attempting to conserve energy. If we keep pressing on despite this, we become more depleted, and move more deeply into the stress response—exhaustion. Symptoms of chronic exhaustion include

- Fatigue. Extreme fatigue, nonrestorative sleep (fatigue is no longer improved by a good night’s sleep, so we wake up tired rather than refreshed), a sense of constantly dragging, feeling depressed, weak, worn down, with low libido

- Weight issues. Weight gain, difficulty losing weight, or difficulty gaining sufficient weight

- Health issues. Recurrent infections, indigestion, fertility issues (both men and women), cold hands and feet

Inside the body. When continued life demands are too high, our bodies can’t sustain the pace or the workload. Key stress hormones change. Adrenaline starts dropping while cortisol levels fluctuate, tending to drop as we become more fatigued. Unfortunately, the brain chemicals that would normally calm us, such as serotonin, also begin to drop. The result is that we feel depressed and anxious. Low serotonin levels can also be associated with other conditions such as PMS, irritable bowel syndrome, and fibromyalgia. Unfortunately, many people live in this state much of the time. Prediabetes (resulting from insulin resistance) also begins to increase under chronic stress. Muscle tone may be lost, and the body needs more time to recover from injuries. When stress is chronically high, we simply don’t have the energy for repair or the emotional stamina to change the pattern.

Stage 4. Exhausted and Inflamed

We are genetically hardwired to adapt to increased stress by turning on inflammation. For our ancestors, living in the wild thousands of years ago, this inflammatory cascade helped repair wounds more quickly and enabled them to better resist infection. However, chronic stress and inflammation are a different situation. When we reach the point of being exhausted and inflamed from chronic stress, health issues that are already present intensify. Asthma attacks become more frequent; migraines last a little longer. Everything becomes a little worse as the body seems to catch on fire, figuratively speaking. With chronic inflammation, the immune system is overstressed too, and as a result, we tend to get sick more often. We also have a sense of feeling progressively more out of sorts, that something is vaguely wrong.

Depletion, infection, and inflammation are common at this point. Low serotonin is associated with an overreactive immune system. We tend to get sick more easily, and infections and injuries may develop and then linger. The list of inflammatory conditions made worse by stress is seemingly endless: allergies; arthritis; asthma; autoimmune diseases; digestive disorders; eczema; high blood pressure; joint, shoulder, and back problems; and spikes in cholesterol. Debilitating symptoms at this point may include aching joints, plaque and blockage inside the arteries, high blood pressure, disorders of the heart muscle, worsening type 2 diabetes, diabetic complications, skin diseases such as psoriasis and eczema, asthma attacks, chronic obstructive pulmonary disease (COPD), worsening osteoporosis, allergy symptoms, heartburn or GERD, colitis, cancer initiation or aggravation, or a neurological disorder such as Alzheimer’s disease and Parkinson’s disease.

Inside the body. What happens when chronic stress leaves us exhausted and inflamed?

- Stress hormones. Cortisol levels remain low, so little of this hormone is available to dampen the inflammatory response. DHEA, our “well-being hormone,” also drops.

- Inflammation. At this point, the ongoing stress sounds an alarm for the inflammatory system. The body pours out pro-inflammatory chemistry (termed cytokines, such as the interleukins) to further ramp up the immune response.

- Insulin resistance and blood sugar issues. With increasing inflammation, the body becomes more insulin-resistant. This means that the hormone insulin (which controls blood sugar levels) has trouble carrying blood sugar into the cells. This causes blood sugar highs and crashing lows. At this point, it is a temptation to counter low energy with quick fixes—sugary snacks and junk food. Unfortunately, that just leads to more intense sugar highs and lows, as well as more cravings and more weight gain. Another vicious cycle.

THE TIPPING POINT AND THE LAST STRAW: EXHAUSTION

On the path to illness, exhaustion typically makes us more vulnerable. We may get sick more easily, have emotional crises and energy crashes, and are more susceptible to stress injuries and chronic health issues. When patients come to us with complex illnesses and a history of chronic stress and exhaustion, we trace back through their history to learn everything we can about the underlying causes of their condition.

As physicians, we often find that after a long period of chronic stress, when yet another stressful event occurs in a patient’s life, it becomes the last straw, pushing them over the edge of coping. At that point, they slip into the final phase of the stress response, developing a disease. On the Stress Curve, we call this phase Overwhelmed and Depleted.

Almost any kind of stressful event can become the final trigger for illness, particularly if it’s intense enough. It could be a physical stress, such as an accident, an infection, a surgery, or a toxic exposure in the workplace. It might be an emotional trauma, such as losing a job, a divorce, or the death of someone close. Sometimes a patient isn’t overstressed, but the stress itself is huge. However, most often the final straw is a single event for a system that is already exhausted—a system that has been overcompensating for far too long. It is after this tipping point or triggering factor that patients tend to develop serious illness. The time from the stressful event until the time of illness can range from a matter of days to about eighteen months or even longer.

Unfortunately, society tends to misinterpret the cause of the disease. Health care providers focus on the problem in front of them, viewing a single disorder as the issue and treating that alone. In reality, that particular illness or injury is simply the last straw. Our patients also tend to focus on one symptom or illness in their attempts to make sense of their lives. Unfortunately, the problem usually goes much deeper. These patients are suffering from a system-wide malfunction, precipitated by a triggering event. Often the deeper issue is severe depletion as a result of chronic stress that has developed over a period of months or years. Sometimes the final stressful event seems to be insignificant. This is because we become psychologically primed by previous stressors. A loss early in our lives that is repeated in some form later can trigger intense emotional reactions.

In Benita’s case, she felt abandoned at age thirteen when her mother died. She coped reasonably well, but when her husband ended the marriage and moved out, that triggered a sense of overwhelming loss that shut down her immune system and left her vulnerable to illness.

Stage 5. Depletion: An Invisible Illness

In the final phase of stress, we feel overwhelmed and depleted. We are usually depressed and apathetic, and it is at this point that disease or chronic illness sets in. This is the stage at which many of our chronically stressed patients were diagnosed with a degenerative disease such as cancer, an autoimmune disorder such as lupus, rheumatoid arthritis, or multiple sclerosis. Others struggled with emotional issues such as major depression. An experienced physician can diagnose any one of these illnesses without much trouble.

However, many chronically stressed people develop complex symptoms that elude diagnosis, such as frequently feeling out of sorts or ill at ease; drastic weight gain or loss; depression, apathy, or hopelessness; feeling drained, emotionless; difficulty with concentration; poor memory; weakness, clammy sweats, fever; or dizziness.

When we are under prolonged stress, the sympathetic nervous system (the mode of the stress response) stays turned on, effectively pushing us further along the Stress Curve.

If you are a patient whose system is in a state of overwhelm or exhaustion, you may go to the doctor and be diagnosed with an illness or with depression. However, in our experience, the majority of patients do not initially receive any diagnosis at all. They may even be told, “It’s all in your head.” Standard blood tests are usually normal, including the complete blood count (CBC), kidney and electrolyte testing, and liver function tests. Thyroid tests may be borderline or minimally abnormal, but nothing dramatic.

Inside the body. Our autonomic nervous system is the aspect of our nervous system that runs our bodies on automatic pilot, regulating unconscious actions such as breathing and heartbeat. It consists of two parts: the sympathetic and parasympathetic nervous systems. The sympathetic controls our stress response, ramping up the body in times of crisis. The parasympathetic does just the opposite, activating our relaxation response, slowing our heart rate, lowering blood pressure, and aiding digestion. These two systems are designed to be a check and balance against each other.

Sleep

In a healthy person with a normal day-night circadian rhythm, cortisol rises in the early morning, reminding the body to release glucose for energy. Gradually, over the course of the day, the cortisol level normally decreases, so we gradually run out of energy at night, allowing us to fall asleep easily and peacefully.

In the Wired and Tired phase, cortisol is low in the morning and starts rising in the late afternoon or evening. After feeling exhausted during the day, a person in this phase may have a spike of energy in the evening or at night. As a result, it becomes difficult to unwind and fall asleep.

In the Exhausted phase, cortisol levels dip even more, remaining low for most of the day, consistent with feelings of exhaustion. By the time we get to the Exhausted and Inflamed state, our cortisol levels can no longer combat inflammation. Additionally, neurotransmitters such as adrenaline and serotonin bottom out, leaving people feeling apathetic and overwhelmed. The important point here is that unless cortisol levels are extremely imbalanced, it is unlikely that a single test will pick up a problem. We recommend saliva testing for cortisol levels, taken four times over the course of a day—typically on awakening, at about 11 a.m., 4 p.m., and at bedtime.

Depression

Many of our patients feel depressed but refuse help, saying they just need to “pull themselves together.” They feel embarrassed to confide in anyone their sense of feeling overwhelmed. We want to assure you that this is nothing to feel embarrassed about. Depression is a condition with a physical basis. When your neurotransmitters are depleted, you cannot simply “pull yourself together.” However, depression is a condition that can be successfully treated by both holistic practitioners and mainstream physicians.

According to the diagnostic standards of the American Psychiatric Association, a major depressive episode may include depressed mood most of the day; feeling sad or empty, tearful; significant loss of interest or pleasure in activities that used to be enjoyable; changes in weight, appetite, sleep, or thought patterns; fatigue or loss of energy; feelings of worthlessness or inappropriate guilt; poor concentration or having difficulty making decisions; or thinking about death or suicide. The level of depression is considered significant if the symptoms have occurred nearly every day for at least two weeks (clearly some people struggle with depression for years before getting help). If you are suffering from any of these symptoms, don’t feel embarrassed to talk with your physician about them.

Anna’s stress started when her husband became sick. The physiological and physical deficits caused by caring for her husband as he succumbed to cancer, paired with the continued stress of being a single parent, pushed her to the point where she was totally exhausted and overwhelmed. After that, she developed recurrent infections and was diagnosed with an autoimmune thyroid disorder (Grave’s disease). Although she was probably genetically susceptible to this disease, since her mother had also had it, the frequent infections due to chronic stress ultimately triggered the illness.

Transforming Chronic Stress

The first step is to decide where you are on the Stress Curve. The goal is either to stay on the left side of the curve or to gradually and steadily work your way in that direction—to a state of health in which stress is invigorating.

Stage 1. Riding the Wave of Exhilarating Stress

In general, exhilarating or invigorating stress is the positive side of the stress response. We may have an exciting challenge in our lives—a new job, graduate school, or another child in the family. We are usually energized, motivated, and excited by these changes. At times like this, it’s important not to neglect yourself. Recognize that you can only sustain this level of effort for so long before you begin to become depleted and move toward the right side of the curve. Maintain a sense of balance and control over your life. Develop a strategy for the long term.

Stage 2. Transforming a Wired and Tired Profile

We know we have pushed too hard when we find ourselves Wired and Tired. Fortunately, we can usually reverse these early changes, quickly and easily. Start by examining your life. We do not suggest making big changes—in fact, just the opposite. A much more effective approach is to make small but meaningful changes to address the major causes of the stress. If the wrong job or a toxic relationship is driving the stress, now is the time to deal with it. You want to address the cause of your stress before it results in burnout.

- Lifestyle. Maintain a healthy lifestyle and keep your daily routine going. This is where exercise, especially aerobic exercise, can help burn off the extra adrenaline you are carrying around. Breath work will help you simultaneously revitalize and relax your body.

- Body chemistry. Consider nutritional supplements and adaptogenic herbs to prevent depletion.

- Nutritional supplements. These include vitamin C, zinc, and B-complex vitamins. If you are under a lot of stress, you may need up to 1,500 mg of vitamin B_5 (pantothenic acid) and 200 mg of vitamin B_6 (pyridoxine) daily. Increase your dosage in increments every other day, and monitor your symptoms, particularly if you have a history of Lyme disease. These vitamins help to metabolize stress hormones. Additionally, phosphatidylserine, L-theanine, and GABA can also be helpful for reducing anxiety and helping you relax.

- Adaptogenic herbs. These include Siberian ginseng or eleuthero; Panax ginseng (Korean, Asian or American ginseng) and Rhodiola. There are also a host of Chinese herbal adaptogens such as huang qi (Astragalus membranaceus), dang shen (Codonopsis pilosula), and reishi mushrooms (Ganoderma lucidum). We always suggest working with someone well trained in herbs and supplements, as these can have untoward effects, including interfering with the metabolism of medications.

- Healing therapies. Acupuncture, energy healing, and massage or other types of bodywork can be instrumental in helping you reduce bodily tension and achieve restorative sleep. The effects of one session can last for several weeks. These therapies promote deep relaxation and balance the sense of being wired by balancing stress hormones and calming the nervous system.

Stage 3. Transforming Fatigue and Exhaustion

The sense of exhaustion we are referring to here isn’t temporary fatigue. This is a state of deep depletion that occurs over a period of months or years. Over the long term, it is usually not one single factor that wears us down and results in exhaustion. Ask yourself if the stress is occurring too often, is too intense, or lasts too long. You can tolerate high levels of stress for a time, but consider setting a limit. Apply the same rule of thumb for psychological stress as you would for a physical health problem. Any condition that persists longer than three months is considered chronic. If the condition isn’t improving, or if it keeps coming back, seek professional help.

Lifestyle. To optimize your quality of life, despite the challenges you are facing, put yourself first. This is a time to say “no” and “stop.” At this stage, you definitely need to take more time for self-care, to look after yourself. Take ten to twenty minutes, three or four times a day, to meditate and relax. Exercise, but gently, aiming to do only about 60 percent of what you think you should do. Consider gentle, restorative forms of exercise such as yoga or qigong. If you feel tired when you exercise, cut down even more. This is also a good time to reduce stimulants such as chocolate and caffeine, especially after noon. Avoid junk food. Find other ways to support your energy. Consider the nutritional supplements suggested for the Wired and Tired phase, as well as adaptogenic herbal supplements, taken on an individual basis. Develop your regimen based on your own individual needs and response. Make just one change at a time, noting your response and tracking it in a journal.

Healing therapies. Here too, healing therapies can have a profound effect in transforming your health.

Stage 4. Transforming Exhaustion and Inflammation

In this stage of the Stress Curve, the body is screaming, “Help! I’m on fire!” Pay attention to your diet, moods, and lifestyle. At this point, we suggest following the same steps you would during the Exhausted phase.

- Lifestyle. Make sure you are addressing insulin resistance, which can be caused by high cortisol levels. Be adamant about cutting out sugar, simple carbs, and junk food. (One easy explanation for friends is just to say, “No thank you. Allergies.” Ensure that your diet is high in anti-inflammatory foods that are high in nutrients. Continue to exercise gently, aiming for 60 to 80 percent of what you think you can do.

- Mind-body techniques. At this point, the relaxation response becomes all-important. Learn to do this twice daily for ten to thirty minutes each time.

- Nutritional anti-inflammatories. These include mercury-free fish oils, turmeric (curcumin), resveratrol, green tea extract, and numerous others. Consider working with an experienced nutritionist or an integrative medicine physician to find the supplements that are best for you.

- Healing therapies. These interventions become an even more important aspect of your return to health.

Stage 5. Transforming Depletion

If you are depleted and overwhelmed, what can you do to speed your recovery?

- Lifestyle. At this point, you definitely need to be under the care of a physician. Everything we stated earlier about lifestyle becomes even more important. Follow the steps outlined here on dealing with everyday stress. Only restorative exercise should be done at this phase. Don’t overexert yourself at the gym, because what your body really needs is rest. Walking, yoga, qigong, and tai chi (a form of qigong) are all helpful.

- Body chemistry. Depression may be an issue; neurally mediated hypotension may be a concern. Your thyroid may be sluggish, often reflected in elevated thyroid-stimulating hormone (TSH), with other values normal. If you are working with an integrative or functional medicine practitioner, they may recommend immune-supportive supplements or therapies.

We have found holistic healing therapies to have an irreplaceable role in recovery from burnout. We have not found any conventional medical treatments that can do for you what integrative therapies offer. Treatment used in natural medicine such as acupuncture, energy healing, and frequency-specific microcurrent (FSM) work to gradually restore adrenal and thyroid capability, balance the autonomic and immune systems, and reduce inflammation.

In the Chinese language, the word for “crisis” is made up of two different characters, one meaning “danger” and the other “opportunity.” A health crisis is no different. We consider this a transformational moment. We have seen many patients harness the power of stress, use it to recover, and move on to a new and better level of health, quality of life, and personal well-being.

20

Recovering from Injury

This chapter is written for readers who have a health condition, an injury, or chronic pain related to computer use or sedentary workstyle. Know that it is usually possible to recover, but recovery depends on the severity of the injury, the support available, and the willingness to make workstyle and lifestyle changes.

For the types of conditions associated with computer work, the initial intervention at the work site is often an ergonomic assessment and recommendations. In other cases, the evaluation is conducted by a health care provider. The next step is usually a referral for treatment and health education, working with a provider such as a physical therapist or a biofeedback practitioner.

Readers are advised to see a health care provider if their condition is painful, if they have frequent symptoms, or if the problem has persisted for more than two months. When in doubt, seek professional advice.

Make Healing Your Priority

Healing and recovery can be complex. In order to effectively heal, you must become the priority. This means finding the best fit in terms of professional help and committing the time and money for treatment. On a practical level, it may mean setting aside the time to rest and relax, to do the recommended exercises, adapt your diet, and normalize your sleeping patterns. It is important to be proactive. When an injury persists or is severe, there may be an impact on employment, family, one’s support system, and lifestyle. Pain conditions can become time consuming, expensive, and emotionally draining.

It is important to remember that if we become injured, we can never be as we were before. We may become even better, but we cannot be the same. If we return to the same situation or circumstances, then we increase the risk of another injury.

In addition to finding health professionals to support your healing process, a shift in perspective also helps to promote healing. To heal means to change in positive ways. Recovery from injury implies an opportunity for growth. It is essential to develop a pragmatic point of view and acknowledge that the past cannot be changed. Although the clock cannot be turned back, it is possible to learn and grow from this experience.

Medical assessment by a health care professional. We encourage you to begin with a conventional assessment by a health care provider. These musculoskeletal evaluations are typically performed by a physician such as an orthopedist, physical medicine and rehabilitation physician, sports medicine doctor, neurologist, or neurosurgeon. Testing typically used in a conventional workup includes X-rays, an MRI, a CT scan, or an electromyogram (EMG). When chronic pain is the issue, patients are often referred to physical therapy, a pain management expert, or biofeedback.

Viewing the problem from a holistic perspective. In our experience, symptoms are often the result of many factors—ergonomics, inactivity, stress, workplace culture, and lifestyle, as well as genetics. A holistic approach to health includes treating immediate symptoms while enhancing the whole system. If you only address the immediate symptoms and the pain, you may be at risk of reinjury. Address the system as well as the symptom.

We recommend looking at the problem from a broad perspective, increasing your knowledge of your body and how it works, and becoming knowledgeable about diagnosis, treatment methods, and complementary therapies. In dealing with chronic pain, there is also value in deepening your understanding of the body-mind perspective. (This connection is illustrated, for example, by the effects of posture on mood, explored in chapter 8.) Conversely, our thoughts and emotions can have a profound effect on our body (see the sections on imagery in chapter 18). Becoming aware of these important psychological and physiological linkages may help you identify negative emotional patterns that interfere with healing or positive emotional habits that support health.

Exploring complementary therapies. If you have worked conscientiously with your health care provider, and you are not seeing progress, or you would like to explore another approach, consider mind-body techniques like biofeedback or body-mind practices like the Alexander Technique. There are also a number of integrative health interventions that have been found effective in reducing pain and restoring health. Clinical benefit depends on whether the therapy is relevant to your particular condition, the skill of the provider, and your level of commitment. If the pain or injury is severe, due diligence is usually required to find a health care professional who can help you build the skills needed for recovery. The effort is worth it because as you expand your experience beyond what is familiar, you have the opportunity to learn and grow from the situation.

Finding a holistic practitioner. Seek a referral from your health care provider, friends, family, or via social media in your community such as NextDoor.com. There is a wide range of therapies that can be helpful for pain conditions. Many integrative holistic practitioners incorporate a variety of interventions and therapies such as

- stress reduction techniques that include cognitive behavioral therapy, environmental psychology, meditation, mind-body medicine, mindfulness practice, nature therapy, neurofeedback, psychotherapy, somatic body work, spiritual counseling

- relaxation and body-mind practices such as qigong, tai chi, yoga

- functional techniques that train us how to use our body more effectively, such as the Alexander Technique and the Feldenkrais method

- structural approaches such as chiropractic, cranial sacral therapy, massage, myofascial release, osteopathy, and trigger point therapy

- anti-inflammatories, body chemistry, and nourishment including Chinese, European, and Ayurvedic herbal therapies, functional medicine, naturopathic medicine, and nutrition

This list is by no means exhaustive. All these strategies have been helpful to some patients at some point. Any of them can promote healing in some situations and can interfere with healing in others. Applying basic holistic health principles can benefit recovery and support an attunement and integration of body, mind, and spirit beyond the relief of pain.

Determining the skill and competence of the provider. This is a judgment call. In most cases, specialized credentials, certification, or licensure is the minimum indication of competence. Consequently, you will want to do initial research on the specific therapy and on the practitioner. When you meet with the provider, useful questions to ask include

- What do you think is the cause?

- How will you treat it?

- What is my role? What do I need to do to make the treatment more effective?

- How will I know that the treatment is beneficial?

- Are there negative side effects, and what are the symptoms of a reaction?

- If I feel worse, how do I contact you?

- How many sessions before I am likely to notice improvement?

- How much will it cost?

- All in all, is this approach realistic for me?

- What else can I do to improve my health?

- Would you recommend media resources that may be helpful for my condition, such as YouTube videos?

As a patient, when you leave, do you feel intuitively that you can trust this provider? Do they inspire hope? If not, consider seeing another provider.

Becoming attuned to your body, your emotions, and your energy level. When you are receiving treatment, it’s especially important to listen to your body and how it responds to the therapy. Be sure that you give any one treatment approach enough time. If you get better, continue with the treatment or educational program. If you get worse, discuss this with your practitioner immediately. If you have not seen improvement within six weeks, also discuss that with your practitioner, and consider exploring another approach.

Seeking a second opinion. If you suspect that the diagnosis is not correct, or if you are not experiencing improvement, it can be helpful to have a different perspective on your situation. Be certain that the source of the second opinion has no benefit in the outcome, financial or otherwise. You also want to avoid the kind of conflict of interest that occurs when colleagues are asked to assess one another. Obtain the second opinion from someone who does not work with and is not directly associated with your initial practitioner.

Consider bringing an advocate with you. If your condition is serious, and you are in a great deal of pain, it is worthwhile to bring a medical advocate to the appointment. You might also record the doctor’s instructions on your phone. If you are injured or in pain, you may be sleep deprived, exhausted, or overwhelmed. In that condition, it can be difficult to think clearly and to remember the details of the discussion and the recommendations. Your advocate could be your partner, a family member, or a friend. Two heads are better than one, especially if one of them is not emotionally involved.

Case Study: Biofeedback

The field of biofeedback is one of the perspectives that underlies this book. In this discipline, using monitoring devices, both the practitioner and the client can become aware of physical responses when the client works at the computer. Initially, this monitoring and coaching may occur in an office setting with a professional trained in specific therapeutic biofeedback equipment and techniques. In other cases, feedback may be provided with wearable technology (small sensors worn throughout the day). Biofeedback can be very helpful since it can identify unseen and unfelt physiological changes such as muscle tension. For example, the client may be stressed or reactive, indicated by rapid breathing, faster heart rate, perspiration, or cold hands, yet totally unaware this has occurred. Because the physiological monitoring occurs in real time, physical responses can be shown on a screen as they occur, so the feedback is clear and objective.

In this recording, as shown in figure 20.1, the task of bringing hands to the keyboard and resting them there caused the heart rate to increase to more than ninety beats per minute, breathing rate doubled to twenty-four breaths per minute, and skin conductance also increased (an indication of stress, i.e., high sympathetic arousal). In addition, tension in forearm muscles increased even when resting hands on the keyboard both before and after typing. While typing, shoulder muscles were tensed, and both forearm and shoulder muscles stayed tensed without any momentary relaxation. Although forearm muscle tension is unavoidable when typing, that tension can be released by totally relaxing one’s hands when not typing. Shoulder tension is not necessary. In order to address these issues, we optimize the work space, coach clients on ergonomic use of their computers, and teach relaxed breathing and stress management. In tandem, these strategies enable clients to reduce the tension that often underlies injury.

Figure 20-1 Resting hands on keyboard increases unnecessary arm and shoulder tension and breathing rate (Photo and EMG printout: Erik Peper)

In our research, we have shown that when participants became aware of muscle tension and learned to reduce that tension, they reported a decrease in discomfort and pain. When we taught this approach to groups over a six-week period, we observed a 54 percent decrease in neck and shoulder muscle tension. After six weeks, participants reported a significant decrease in headaches and fatigue, as well as pain involving their neck, shoulders, arms, wrists, or hands.

Practitioners who provide biofeedback include physical therapists, psychologists, physicians, chiropractors, occupational therapists, personal trainers, and nurses. To determine their credentials in this field, you can check to see if they are trained in applied psychophysiology and have BCB certification from the Biofeedback Certification International Alliance. A list of certified practitioners can be found at https://certify.bcia.org.

Creating the Basis for Healing

Identifying Resources

Prioritize the steps necessary to heal, and identify the areas in which you have some control. Determine the factors that contributed to your injury, the medical intervention(s) that you will need initially, changes that should be made to prevent reinjury on the job, and the resources you will require to implement this plan. Here are some questions to think through:

Workstyle factors. In terms of reducing risk, could your concerns be resolved by talking with a supervisor about ergonomics, workflow, or workload? You may have some flexibility in negotiating your hours, and you may even be able to arrange to work at home a few days a week. This is a significant and growing trend in the United States, Britain, and the European Union.

Social capital. Who do you know that could help you—family, good friends, coworkers with whom you are close, members of your faith community? What are their specific skills or abilities? If money is an issue (as it often is when there are frequent medical bills), are there people with whom you can trade resources? Who do you know that you can also help without depleting your energy while you are healing?

Material capital. What kinds of financial resources do you need? Do you need time off, extra funds for medical bills, physical therapy equipment, child care, or housekeeping to aid in rest, recovery, and healing? Carefully review copays. Talk with HR about other resources that may be available through your company. Consider reaching out to Workers’ Compensation, your health care provider, or social services. If you are highly active on social media and face a one-time expense, you might want to do a GoFundMe.com campaign.

Information capital. What are the types of information that you still need in terms of medical resources, stress reduction, ergonomics, or career retraining? What are the most affordable resources that will meet your needs? Do you need to start with basic information, or would intermediate or advanced-level knowledge be more appropriate? Who has the information you need?

Dealing with Stress

To optimize recovery, it is vital to reduce workplace stress. Stress is often part of the equation when people get injured on the job. Ultimately, it is the combination of poor ergonomics and stress that tends to be so harmful. When the stress response is activated, we become highly focused on survival.

- The relaxation response. To recap from earlier chapters, stress produces excessive levels of adrenaline and cortisol, which can compromise immune function, increasing the risk of injury, reinjury, or burnout. Since the immune and digestive systems assume primary roles in rebuilding and repair, it is essential to spend as much time as possible in the relaxation response (rest and repair mode).

- Stress and inflammation. When the body attempts to cope with infection and injury, these efforts include inflammation to nourish the injured area, which reduces infection by destroying harmful microbes and then cleans up the wreckage. The process of removing dead or damaged tissue is akin to a garbage truck carting away the trash. Although this trash removal is an essential aspect of inflammation, it can be disruptive. So when there is injury, we want to moderate inflammation as much as possible. Theoretically, cortisol helps to control inflammation. However, stress complicates this process. A research team at Carnegie Mellon University led by Sheldon Cohen recently found that chronic emotional stress compromises cortisol’s effectiveness in regulating inflammation. Since elevated or poorly managed inflammation can slow healing time, this is another good reason to make stress management a priority in recovery.

- Burnout and illness. In theory, we may realize that we can’t perform 24/7 365 days per year. However, when the situation demands it, we may be seduced into thinking that maybe we can meet those demands after all. Drs. Steve and Sandi Amoils, integrative physicians, report that patients who come in with chronic health issues almost always have a history of burnout. Getting well means restoring depleted nutrients and recovering from chronic stress. (For more on this perspective, see chapter 19.)

Recognizing the sources of the stress. The first step involves an analysis that may be broken down into simple questions (what, when, where, who, why, how, or similar categories). This phase of the process means identifying training or coaching that could be helpful in dealing with stress. Would the situation be improved by assertiveness training, better time management, or delegating more responsibility? How can these skills be incorporated in order to successfully recover from injury? (A self-assessment is included in chapter 16 on workplace stress.)

Retraining. Employees who have sustained serious injuries may find that they need to transfer to another department, another company, or another line of work. This step involves your own analysis and soul-searching, and feedback from those who care about you. Gaining a new skill set can enhance your coping ability, so the goal is to define where you are, where you want to be, and the resources you need to get there.

Getting well again. Despite the discomfort and frustration of an injury, develop a perspective that the injury can be an opportunity for meaningful growth. We may be tempted to focus on the limitations of our injury and the constrictions it causes. However, rather than thinking about what you cannot do, ask, “What can I do? How can I live a more meaningful and fulfilling life?” In the process of overcoming the injury, you may have experiences that are deeply enriching, eventually leading to new relationships, a different perspective on career, or a life of greater meaning.

Story: Braving the Tax Season as a First-Year Accountant

Consider the junior accountant who developed tendonitis in his wrists, yet persisted past the pain in order to meet the horrific work demands he faced during his first tax season. Highly conscientious, he took few breaks, hardly moving from his office, opting instead to have the printer, microwave, and other conveniences right next to his desk. The pain grew worse with continued overuse, the stress of the deadlines, and tension due to the necessity of absolute accuracy. Eventually he was diagnosed with carpal tunnel syndrome and opted for surgery rather than continue to fight the pain.

It is our hope that both people and companies implement prevention strategies such as those offered in this book to reduce discomfort and increase productivity.

Additional Resources for Recovery

There are many pathways to health. You can use the table of contents of this book and the chapters to connect you with additional resources. As you reflect on your situation, which of these issues may be contributing to your symptoms, and which might be instrumental in your recovery?

- reducing stress: chapters 2–4 and 16–19.

- overcoming inactivity: chapters 5, 14, and 15.

- reducing tension and strained muscles: chapters 6 and 15.

- dealing with screen addiction: chapters 7, 8, and 12.

- the stress of the 24/7 lifestyle and urban life: chapters 9 and 10.

- better sleep and more R&R: chapters 11, 12, and 19.

- getting off the grid and taking breaks: chapters 12 and 14.

- reducing inflammation and supporting healing with nutrition: chapter 13.

- supporting recovery with skills for sanity: chapters 17 and 18.

- overcoming burnout: chapter 19.

- improving ergonomics and workstyle: chapters 21–24.

- reducing risk of injury and EMF exposure: chapter 25.

PART 3

PRACTICAL ERGONOMICS

21

The Basics

The following chapters address back pain and strain injuries by emphasizing health from a holistic perspective. Creative problem solving is the key to a pragmatic approach. Offered here are realistic solutions to common issues and workarounds for problems that can’t be resolved easily on your own or without ergonomic expertise. Once you get the hang of this approach, in no time you’ll be able to optimize the use of your own equipment to reduce any aches and pains you routinely experience at the end of the day.

Ergonomics, a term coined in 1857 by Wojciech Jastrzębowski in Poland, combines two other terms: ergon, which roughly translates as “work” or “labor” and omics, which roughly translates as “laws” or “body of knowledge.” In the United States, military scientists expanded the field in search of better ways for soldiers to use machines and equipment more efficiently, so ergonomists came to be called efficiency experts. For example, in 1943, Alphonse Chapanis, a lieutenant in the U.S. Army, showed that so-called pilot error could be greatly reduced by redesigning the confusing layout of airplane cockpits. Another of the Army’s challenges was to make seats that would enable the pilots to sit comfortably for long periods of time. This project was one of the initial studies on the interface between human and machine. After the war, the Army Air Forces published nineteen volumes summarizing what had been learned from the research.

When computers came into widespread use in the 1980s, the field of ergonomics quickly expanded to include the new technology, and terms like human computer interface (HCI) became associated with ergonomics. In the software domain, graphical user interface (GUI) has been considered an ergonomic area of study, as GUIs relate to eyestrain and color preferences during computer use.

Figure 21-1 Early work in ergonomics focused on the needs of pilots during World War II. (Wikipedia, public domain)

In the office, ergonomics includes the design and organization of the desk and work space, chair, monitor, keyboard, lighting, noise, air temperature and quality, as well as software, intervention programs, and support materials. An uncomfortable chair, a misplaced monitor, or poor lighting can all contribute to discomfort or eventually to injury.

Although every computer comes with volumes of detailed instructions on how to use the hardware and software, almost nothing is mentioned about how to develop a healthy, productive, and creative work environment. Companies spend billions on equipment and training, yet often little is spent on injury prevention. Despite more than thirty years of ergonomic computer design, millions of people worldwide are still developing chronic back and neck pain and strain injuries. Complaints of workplace exhaustion and insomnia are still commonplace, and fatigue is among the top complaints that patients bring to their primary care doctor. The following guidelines are basic to commonsense ergonomics.

1. Everyone Is Different: There Is No “Average” Person

It seems obvious that we’re all different. Yet consider the dilemma of the folks who design seats for passenger airplanes. By necessity they have to work with data on averages, yet think back to your own comfort, your own experience the last time you flew economy class. If you’re 5 foot 1, you’ll find that the seat is too deep and you either have to put a pillow at your back or slump in your seat. If you’re 6 foot 2, you may have to squeeze yourself into a seat that was not designed for your frame. Among people of the same height, often the proportions of their body can vary a great deal from one person to the next, with implications for comfort.

Ergonomics is always a compromise, a give and take. Whenever possible, ergonomics should fit the individual and not the theoretical average. Consider this: if you were giving away a hundred pairs of sneakers, you wouldn’t take down everyone’s size, and then average all of the sizes to determine one single size to order. That would result in a hundred pairs of size 9 shoes.

Figure 21-2 In other words, an “average” person does not exist. (By permission from Peper and Weijman, De Computermens)

Essentials

- Adapt the world to you. Optimize your work so that your muscles are in a neutral position to work most effectively and conserve energy. For example, keep your hands closer to your lap or to the centerline of your body, rather than positioned far to the left or right of center.

- Take breaks. If a muscle position or posture is held too long, even if it is ergonomically correct, that can lead to muscle fatigue, and over time, to strain, pain, and possible injury.

- Stress exposures from various sources (personal, family, or workplace) increase the emotional reactions that in turn increase risk of workplace injury.

- Feeling safe is integral to health. For example, avoid sitting with your back to the door, so you can see who is entering the room.

- If you cannot optimize the ergonomics of the equipment (for example, you cannot get an adjustable chair, or get better lighting), develop a routine of microbreaks—one-second breaks you can do every few minutes, as well as three-minute stretch breaks.

- If you must work extensively on one side of your desk, balance your use of neck muscles by working on the other side of the desk to make your muscle use more symmetrical.

- Optimize your environment by identifying ways to improve the quality of the air, light, and sound where you work.

2. Arrange Your Physical Environment to Fit Your Body—to Your Specific Height, Weight, and Proportions—to the Extent That You Can

If you are 6 foot 3 and you’re receiving a new chair for your desk at the office, it doesn’t matter that the average person in your department is 5 foot 9. You need a chair that fits you.

Good ergonomics means adapting the equipment and environment to you and not the other way around. Ergonomics affects your efficiency and productivity, as well as your health and safety. In the office, good ergonomics includes addressing the design and organization of your desk, keyboard, monitor, chair; light, noise, drafts from vents and windows, room temperature, and air quality; as well as software training programs, support materials, and apps. The phone, especially when tucked between the shoulder and ear for long periods of time (for example, in a call center that has not replaced broken phone headsets), can be a major factor that adds to symptoms of strain and pain.

Try different ergonomic and equipment arrangements, if you can, before changing anything, and explore the advantages of each adjustment or approach. Often people compromise comfort so they can work more efficiently. For example, they ignore discomfort in order to complete a task despite poor ergonomics. Ideally, you want not only better ergonomics, but also comfort and efficiency as well.

The reasonable man changes himself to fit the conditions of the environment. The unreasonable man changes the conditions of the environ to fit him. All progress depends upon the unreasonable man.

—George Bernard Shaw

Making the World Yours

Thinking of effective ergonomics brings to mind a visit with a married couple, two psychiatrists. They were both just under 5 feet tall. Sitting on their couch in their living room, my knees literally touched my chest (I am 6 foot 2). However, the couch was perfect for them. To fit the furniture to their physiology, they had unscrewed the legs on the couch, lowering it about 5 inches. In fact, they had optimized all the furniture to fit their own needs, instead of trying to adapt themselves to the furniture. They had also redone the kitchen, so the countertops were at least 4 inches lower than normal. When I went into their kitchen, I kept hitting my head on lighting fixtures and cabinets.

Visiting their house, it was difficult take any of the adaptations personally, because their home was intended as a private refuge from their busy public lives, rather than as a showcase for entertaining. I was impressed and, from then on, began encouraging clients to design their home not only so it looks good, but also fits their needs. Applying the basics of good ergonomics, simply and inexpensively, this couple had created a home that was comfortable, attractive, and just right for them.

3. Uncomfortable Posture Is a Risk Factor for Injury

The research confirms what we know from common sense: working in awkward positions for long periods of time is associated with muscle fatigue, discomfort, and the potential for injury. Familiar examples include back pain after a Sunday of gardening, shoveling snow, or raking leaves. Another case in point is the aches and pains in arms and shoulders after painting the ceiling. All these scenarios are preventable. For example, during gardening, using a longer rake is less stressful. Similarly, use an extension for a roller when painting the ceiling. When raking leaves or shoveling snow, be sure to take periodic breaks. This may sound obvious, but the emergency rooms in every major city can become jammed with folks who forgot to take breaks and rest their fatigued muscles before they got injured.

Continuously working in an unnatural position that places extra strain on the joints is another major risk factor for injury. When people use the computer, they tend to sit in “frozen” positions for hours, forgetting to move. Assuming an uncomfortable position with intense concentration can increase what some refer to as stress immobilization syndrome. This form of Tech Stress affects many types of human–equipment interactions. It’s characteristic of architects using computer-aided design (CAD) software, production typists who enter data for hours on end, and children captured by the hypnotic nature of computer games. The combination of poor ergonomics, intense concentration, and lack of activity can affect any of us when we’re captured by the visual magic of a screen.

The Phone Can Be a Pain

Several years ago, we provided a consultation for an administrative hospital nurse who was struggling with horrible neck pain. No matter what strategy we tried to address her symptoms, she continued to experience bouts of intense pain. Concerned by the lack of progress, a site visit was scheduled, and here’s what was found. Two nurses were charged with receiving all the census data from the hospital: reports from every ward detailing the number of substitute nurses needed on any given day. These two employees were tasked with finding replacements among the nurses on call in order for the hospital to be adequately staffed.

In this particular office, there was just one phone, located in the center of the room on a large table, so they took turns stretching to take calls and then holding the phone on their shoulder with one hand and making notes on a big white board while they talked. They both suffered from massive neck and shoulder pain. Although the client had already gone for physical therapy and had tried a number of other interventions for the pain, it became obvious after seeing her work that her environment was a likely cause of the problem. The simple advice was that they get headsets, as well as two phones. Asking people to make changes (even small changes)—to assert themselves by asking for what they need—can be mind-boggling. Many people feel they do not have the right to ask for changes in their work situation, even when they actually do.

4. Remind Yourself That Adaptations Are Usually a Compromise

Almost all adaptations of equipment used in our physical environment are a compromise between optimal function and the efficient performance of a specific task. For example:

- An ergonomically shaped keyboard is helpful for typing data; however, having a keyboard that works well for typing may make using a mouse or other pointing device more difficult, especially when the width of the keyboard requires using the mouse too far to the side, away from the midline of the body.

- A laptop is usually a compromise. When your laptop keyboard is used at the correct height for your hands (the keyboard is just above the height of your lap), the screen will be too low, and you will have to bend your head down to see the screen. When the screen is placed at the correct height for your eyes, you have to lift your hands, increasing muscle strain in your arms, wrists, and shoulders, in order to type.

- A tablet is usually placed on a table or desk, which means you have to look down to read it when you enter content.

- A cell phone is held while texting and looking down. When you bring the screen to eye level, shoulder tension builds up unless the device is placed on a cell phone or tablet holder.

Solutions vary and almost always involve concessions, compromises, or adaptations. If you put the laptop on your lap, your arms and shoulders can relax, but you may increase the strain on your neck. Put the laptop on a table so that your screen is correctly positioned, and you’ll still tighten your neck. Use an external keyboard or a laptop stand and you’ll have to carry extra weight while transporting the portable computer (although fortunately laptop stands have become much lighter, and keyboards are now available that weigh as little as one-third of a pound). Clearly there is no perfect solution. You want to stay flexible while experimenting with the best adaptations for your situation.

5. Ergonomics Is Only One Piece of the Puzzle

Once our work space is optimized and we have the right equipment for the job, it often becomes clear that ergonomics is only one aspect of the problem.

Inactivity is an equally important issue, so we encourage your efforts to find a range of sports or fitness activities that bring you pleasure. If you work long hours under pressure without taking breaks, even with a well-designed chair, clearly there is the risk of chronic muscle fatigue, the buildup of tension, and the potential for injury. Under pressure, we tend to become preoccupied and forget to take breaks until muscle tension and pain force us to change our habits.

Who Pays for What?

Many employees get the furniture that was either selected by their employer or was already there from the previous employee. Even when the furniture or equipment is not ergonomically correct, unfortunately many employees will wait until they get injured to request a new chair or new equipment. Only then, after a workers’ compensation claim, will the employer get another chair. Not all organizations are like that, but it is surprisingly common for a company to wait until a medical claim necessitates the purchase of new equipment. The way these situations play out depends on whether there is some sense of job security and a good relationship with the supervisor. Some employees do not complain about discomfort because they fear they may lose their job or that voicing a complaint might affect their relationship with their supervisors.

Reality Check

The question is raised: What are the costs to the organization if workers’ comp claims occur? Are the costs paid for by corporate insurance? What are the other costs to the organization, such as low morale? The answers to these questions vary greatly, based on the type of insurance and the budgets available to supervisors for preventing injuries.

When the budgets for medical care and for preventative “risk management” are separate, handled by different divisions within a company, there may not be an awareness of the costs involved. Consider, for example, a situation in which a new chair would cost $150 to $500, but could reduce the risk of a workers’ compensation claim, which might be as high as $100,000. Furthermore, when the budgets for purchasing office furniture or computers and the budget for medical injury expenses are under separate management supervisors in a large company, any causal links between lack of ergonomic equipment and resulting injury get blurred. There are also additional hidden and indirect costs when injury prevention is ignored. From a positive perspective, researchers Devereux and Buckle found that for every dollar invested, employers can save as much as $18—a return on investment of 1,800 percent.

Hidden Costs to Management

- low morale

- lost productivity

- increased absenteeism

- work interruptions for medical appointments

- sick leave

- the expense of temporary staffing

- training for new hires

- extended leave with pay

- increases in workers’ comp premiums

- a blemish on corporate prestige

These claims do not represent a one-time cost. A single claim by one employee can result in increased workers’ comp premiums for all employees. Even a few claims over the course of a year can raise premium costs significantly. This is not conjecture—it is reality. While accounting may be aware of these rate hikes, data on these costs may be beyond the purview of floor supervisors and middle management.

Additionally, there is the matter of fairness and professional reputation. It’s a small world. The word gets around, even when the problem involves workers’ injuries at overseas subsidiaries.

Hidden Costs to Staff

- low morale

- discomfort and eventually chronic pain

- interrupted or nonrestorative sleep and exhaustion

- poor quality of life

- impact on family cohesion

- medical copays

- uncompensated therapies (acupuncture and chiropractic)

- time lost from work for medical appointments

- unpaid leave

- lost opportunities

Seeing Things Through Your Boss’s Eyes

We know intuitively that the right ergonomics is a win-win for the workplace and the employee. The benefits include a positive work environment, less absenteeism, higher productivity, and fewer injuries.

The challenge from the employer’s point of view is that when you give one employee a new chair, they are now seen as favored, and that is a real challenge for the corporation. What’s more, the moment one employee gets a new chair, everyone else wants one too. Even when the boss has a budget to purchase new chairs for everyone, not everyone needs a new chair. To make matters worse, a new chair may be perceived as a high-tech status symbol. (With fancy equipment, things can get very expensive, very fast.) Ergonomics can raise issues of expense and complicate office politics centered around how much money is spent, and on whom.

One of the premises of this book is that good ergonomics is not about throwing more money at the problem. Good ergonomics is not only about money—there’s a lot that can be done cost-effectively. As a solution, equipment is often ordered en masse, to avoid any suggestion of favoritism. In these situations, everyone gets the same chair, desk, or keyboard, even though their particular ergonomic needs vary widely.

The best ergonomic solutions are always individualized, so this usually doesn’t solve the basic issues. One size does not fit all.

The Solution: Teamwork

When supervisors and employees address the problem together, the first step is to ask, “How can we optimize the ergonomics for the whole unit while developing solutions for each of us as individuals?” Partnering supervisors and employees can address questions of fairness (such as who really needs to get new equipment). With that approach, the goal is to raise the awareness of everyone on the team that getting new equipment is about preventing injury. As a bonus, there may even be an increase in productivity.

New Does Not Always Mean Better

Avery is attached to a comfortable old chair, previously belonging to his dad. The chair was one of the best office chairs of its time. Now it’s Avery’s. The seat is worn, it has no rollers, and it’s not adjustable. However, it is just the right size for Avery, so it’s ergonomically correct. Having the chair makes Avery happy, since it periodically reminds him of his dad.

Jordan is Avery’s office mate who opted for a new, ergonomically designed chair. Jordan had hoped it would reduce his back pain, but it actually seems to have made things worse. True, the new chair provides better back support, but it surrounds his body like a cocoon. After two hours at the computer without a break, Jordan feels stiff and sore. Jordan had expected more from such an expensive chair.

The moral of the story: It’s possible to stay healthy using older equipment as long as it fits your shape and size. But whether your chair is old or new, it’s vital to take microbreaks, to get up and move around periodically, and to release the buildup of muscle tension.

Teamwork will enable the unit to acknowledge that some people (but not all) need new equipment to prevent injury. This also helps humanize the supervisors who will experience the employees as individuals with varied needs. Teamwork activities may also make it easier to feel more secure in talking to the boss about individual needs with less fear of being fired. Often employees worry that if they complain, they will be labeled as a complainer and eventually be fired. Worry adds stress, which increases the risk of chronic tension.

Be courageous. Remember, it is often easier to ask for forgiveness than permission in terms of making adaptations to your work space. In many organizations it is challenging to ask for permission to implement a change because of poor communication and organizational resistance to change. At the same time, most corporations are aware that happy workers are more creative and productive.

Jordan’s experience illustrates that ergonomics is only one aspect of creating healthy working conditions. Inactivity and mental stress are also huge factors. If you work for hours under pressure without a break, even with a well-designed chair, clearly you are at risk of injury. On the other hand, you can stay healthy even with an older-model chair that is not ergonomically designed if you periodically get up and move around, listen to your body, and work in an enjoyable, supportive environment. Optimizing ergonomics is often necessary, but not always sufficient to prevent injury, because workplace injuries involve a number of factors—ergonomics, inactivity, stress, workstyle, and work culture.

22

Which Desk? Which Chair?

There are so many choices for equipment. How do we decide which desk or chair to buy? As both authors and users of equipment, we have a bias. We encourage you to become attuned to your preferences by noticing your body’s response when you use the equipment.

Although examples of various desks, chairs, monitors, and mice are useful to let you know you have options, one size really does not fit all people equally. You will want to notice what works and what doesn’t. Is it comfortable, is it uncomfortable, or does it hurt? Brand matters less, price matters less—how you use equipment matters most.

In this section we will walk-through some of the same approaches we use to help clients and coworkers. We draw the information from experiences working in settings as varied as corporate offices, hospitals, gourmet food chains, gambling casinos, and university classrooms. Almost everywhere, people complain of a general sense of fatigue. It’s encouraging to find that when we improve our ergonomics, our physical and mental energy often improve dramatically. If we don’t have to work as hard to perform essential tasks, that makes it easier to get work completed, relieving a major drain on our energy.

The New Workstyle

A new approach to workstyle has been developed in Western Europe, initially in Holland, that is used now in Scandinavia and Great Britain as well. This workstyle

- reverses the trend toward inactivity in the office with an approach that allows greater comfort and freedom of movement.

- uses ergonomic principles to promote health and minimize strain injuries associated with computer work.

- is designed to be more physically active, including the use of sit-stand desks and chairs for “active sitting” like the one shown in figure 22.1.

- factors in flexible employment that enables employees to work from home some of the time. In the Netherlands, approximately half of the workforce works at home at least one day per week.

- includes consistent breaks, lunch time, and vacations, made available to employees as an aspect of this more flexible workstyle.

- is facilitated by proactive government regulation to optimize employee health by defining work hours, stipulating the physical space needed for each employee, and limiting the intrusion of work matters into employees’ home life.

In the industrial nations of the West, more than 60 percent of the population will experience lower-back problems at least once in their lives. This type of health issue provides the rationale for a more dynamic approach to work. These innovations are phased into work life, just as one would increase physical activity gradually for maximum success.

Figure 22-1 An adjustable chair and a sit-stand desk provide the basis for a more active workstyle. (Photo courtesy of Backshop NL)

Optimizing Your Chair

To optimize your desk, place the keyboard on the desk surface; then pull up your chair and adjust the chair height to a comfortable level. You want an arrangement in which you can rest your forearms on the desktop, while placing your fingers on the keyboard, so your arms form the letter “L” with your forearms and wrists resting on the tabletop. This enables you to take the weight off your arms and shoulders while you’re using your hands. Then you’re no longer fighting gravity while you’re typing. This is a more energy-efficient way to work, compared with using a keyboard tray, which does not allow you to fully relax your arms. What’s working well in figure 22.2:

- The woman’s knees are at a right angle, like the letter T.

- She has good back support, which positions her to sit up straight.

Figure 22-2 A traditional chair like this works well for most people (1) if it is adjusted correctly and (2) if workstyle includes frequent microbreaks (stretching while seated) and periodic movement breaks (getting up and moving around). (Photo courtesy of Backshop NL)

- The monitor is at eye level.

- Her hands and forearms are level.

- The armrests are at the right height.

The challenge here is that she could become captured by the chair. If we develop a habit of staying seated without stretching or moving around, we are more likely to develop aches and pains. If we don’t move, gravity will wear us down.

More Tips on Adjusting the Chair

Explore your chair’s adjustment functions. If you’re not sure how to adjust it, look for videos on YouTube or a downloadable manual.

- Seat height. Adjust the chair height so the angle of your hips and knees is about 90 to 100 degrees (level or slightly lower at the knee, while your feet rest easily on the floor). Both your heels and the balls of your feet should touch the floor. Note: There is a device called a goniometer that can measure the angle of objects as they move relative to one another, such as the angle of the seat relative to the floor, or the angle of your knees as they bend relative to the floor. An inexpensive goniometer is less than $10.

- A foot support. Use a footrest, stool, or box beneath your feet.

- Seat angle. Adjust the seat so that it tilts slightly downward at the front by perhaps ½ inch (so it will not create pressure on your spine or your thighs, constricting circulation). Be sure there is about 1½ to 2 inches between the back of your knees and the front edge of the seat.

- The seat pan. Many office chairs are too big for people who are petite. The seat pan is too deep, so when they try to rest against the back support, they are in a slouching position. If the seat is too wide, they must extend their elbows to use the armrests, and often the armrests are the wrong height. If your seat is almost a fit, you can adjust it with pillows. When you’re trying out a choice of chairs, ideally you want one that allows you to sit all the way to the back of the chair. There should still be an inch or two of space behind your knees.

- Back support. Most people need back support to reduce some of the strain of sitting erect. Adjust the height of the back support so that it supports your back just beneath the shoulder blades. If there is not enough support, explore using a small back pillow, foam pad, or a rolled-up towel taped in place.

- Armrests. Adjust the armrests so you do not have to raise your shoulders or lift your elbows to rest your arms on the armrest. In many cases, it is better to remove the armrests if they are too high, if they interfere with resting your arms in your lap, or if they prevent the chair from being close enough to the desk. Most armrests are bolted or screwed onto the bottom of the seat and can easily be removed. For many people the armrests are too high. One solution is to bring a pillow from home. In other cases, the armrests have hard edges that cause discomfort. This may be corrected by attaching a piece of foam or taping over the sharp edges.

- Leg room. You want to have enough foot or legroom underneath your desk or workstation. The moment you place your feet in a fixed position for an extended period of time, circulation is reduced, causing chronic muscle tension. You want to be able to stretch your legs and wiggle your toes. Remove anything that interferes with freedom of leg and foot movement. Often that’s the only place where you can put your bag, your briefcase, or backpack—or store files, notebooks, or important papers.

Cost-Effective Ergonomics

You don’t necessarily need to spend more money to optimize your office furniture and achieve a healthy outcome. What’s more, some furniture, although attractive, will not solve the problem. Many people are put off by expensive advanced functions, so you want to strike a happy medium. Some of the simple, inexpensive chairs are actually better designed from an ergonomic standpoint than the big, fancy, expensive ones. An advanced, fully featured chair can cost $1,000. However, there are basic, reasonably priced chair or stool options that start at $100 that are perfectly serviceable.

What if there’s no budget? We believe that employees need to think outside the box. There is the expectation that the boss always has to supply the equipment. In theory, they may be right. However, if they’re at risk of injury, that changes the priorities. It’s more important to avoid injury.

Putting things in perspective. Consider the actual costs of work-related health issues. This is now a massive problem with daunting statistics.

- Worldwide, lower-back pain has the highest burden of disease related to years lived with disability. Unlike cancer or cardiovascular disorders, although lower-back pain is not fatal, the burden of chronic pain is greater, because it can last a lifetime.

- Back pain is among the top five conditions people take to their physician.

- These are not rare conditions. The direct and indirect costs are estimated to be between $50 billion and $200 billion per year. The individual cost is estimated to be between $1,000 and $20,000.

Upgrading an Existing Chair

Typically, a lumbar support for the lower back can be purchased in a back store or online. Note that the pillow should be firm and supportive.

Correcting the angle of the hips and the pelvic bones provides support for comfortable, erect posture. Without that support, there is the tendency to slump, putting pressure on the back between the shoulder blades, with the potential for back pain.

Figure 22-3A Without good back support and correct seat angle, we’re tempted to collapse into a letter “C” posture with our hips at the wrong angle. This position may increase back and neck pain. (Copyright BackJoy Orthotics LLC)

Figure 22-3B A seat insert supports more erect posture, reducing the risk of back pain. It provides support for the pelvic bones which improves the alignment of the spine. (Copyright BackJoy Orthotics LLC)

Affordable Ergonomic Chairs

Often, the armrests can be taken off an existing chair, since all you really need is a good seat and good back support. Removing the armrests completely provides much more freedom of movement. Armrests also limit the ability of the chair to move underneath the desk or tabletop. Check to see if you can move your arms backward so they are not constrained. Taking a break in a chair with no arms can be surprisingly relaxing. Simply place your hands in your lap and rest your back against the chair.

Figure 22-4 A basic adjustable chair like this maximizes the opportunity for stretch breaks, reducing the risk of injury, and is usually affordable. (Photo courtesy of Backshop NL)

Options for “Active Sitting”

Another approach to simple seating is an inexpensive circular wooden stool. This is an effective option that is surprisingly comfortable. We realize that most people would hesitate to bring a stool to work, even if they had permission, because they don’t want to look different. However, if you have ever experienced carpal tunnel syndrome, repetitive strain injury, or chronic neck or back pain, you realize the importance of a preventative measure such as an appropriate chair. Economical secondhand office chairs and stools can usually be found on Craigslist.org.

Figure 22-5 Optimizing a stool: A firm, narrow, wedge-shaped pillow with a small angle puts your knees slightly lower than your seat. All these tweaks are up to the individual. You may need to try a couple of different options to find the one that works best for you. (Source: Erik Peper)

Whimsical Approaches to Active Sitting

On the ball. If you’re working at a desktop workstation, you might want to consider setting aside that stuffy old chair and alternate sitting in your chair with sitting on a large bouncy ball, an exercise or balance ball. Enjoy bouncing, wiggling, and rocking on the ball. The appropriate ball diameter depends upon your individual height, as well as the keyboard and desk height. The size can be increased or decreased depending on how much you inflate the ball and your position in relation to the keyboard. Ball sizes:

- If you are over 6 foot 3 and have long legs, try a 75-centimeter (30-inch) diameter ball.

- For those between 5 foot 2 and 6 foot 2, a 65-centimeter (26-inch) ball.

- Folks under 5 foot 2 may try a fully inflated 55-centimeter (22-inch) ball or a partially inflated 65-centimeter (26-inch) ball.

You want a ball made of burst-resistant materials. When you sit on the ball, let your hips be slightly higher than your knees. Keep track of your ball—even though your coworkers may think you’re eccentric, they will almost all want to use it. Note: Most burst-resistant balls are rated to support up to 300 pounds and cost between $25 and $50.

Other options include different types of flexible stools as well as kneeling chairs. With these chairs there are some concerns about knee problems, which are arguably worse than back pain. Stay tuned as the equipment evolves with our understanding of more dynamic ways to work.

Figure 22-6 Ball chairs come in a variety of styles, are comfortable to use, and avoid the problem of sitting statically at the computer. (Photo courtesy of Backshop NL)

Choosing a Chair

Can employees adjust the chair themselves? During workplace consultations, one observation is that the fancier the chair, the less likely that people will know how to operate it. Sometimes the adjustments are hidden from view, but in other cases there are simply too many complicated settings. Fortunately, good ergonomics is not just about money. Rather, it is more about making adjustments that match the individual’s needs, which reflects a kind of precision performance-based ergonomics.

The politics of buying a chair. When new office equipment or furniture is considered, everyone seems to be attracted to labels like “executive furniture” that shine with polish and prestige. Yet providing expensive equipment for some folks and not others can complicate office politics.

More expensive is not necessarily better. Large, well-padded executive-style chairs (and other traditional office chairs) tend to be confining and may be an unrecognized cause of strain injuries. These chairs can be so cozy that people take fewer stretch breaks, with disastrous results over the long term.

Captured by the furniture? The more immobilized we are, the less the opportunity for movement and flexibility, and the more we risk eventual injury. Many people love these expensive, fancy chairs. But the chair tends to act like a cocoon, surrounding them, insulating them, and limiting their ability (and motivation) to take little stretch breaks. (See chapter 14 on microbreaks for more on this topic.) Employees who use these cocoon-like chairs will want to use an app such as a break app, which will remind them periodically to stretch a little.

One size does not fit all. Medical researchers, such as Sackett, have used the term precision medicine to describe health practices that are tailored for the individual rather than an approach in which one size fits all. We feel that precision ergonomic practices (PEP) are a key concept. Namely, we need to adjust the furniture and equipment to the individual and not the individual to the furniture. For example, although chair manufacturers have worked very hard to make a chair that universally fits most people, those who are either very petite or have a generous build need to use furniture and equipment that fits their individual body type.

Too big, too small, or just right? Is the chair for Papa Bear right for Mama Bear or Baby Bear? Is the chair for Baby Bear right for Mama Bear? Clearly the furniture for a large person who is 6 foot 6 and a small person who is 4 foot 8 needs to be different. It’s almost impossible to adjust the same chair for someone who weighs 320 pounds and someone else who weighs 87 pounds.

Check the scale of the chair. For people who are trim and petite, chairs are almost universally too tall, too wide, and generally too large. In addition to the fact that their feet may not touch the floor when they’re at the right height for their desk or table, there’s also the problem of the size of the seat itself, and as a result, a lack of back support.

Think in terms of three sizes. Even if you select only one specific model of chair, it’s very helpful to think in terms of at least three sizes (for small, medium, and large-framed individuals). The following are a few ideas on furniture selection, based on how you, your chair, and your desk interact.

Re-envisioning the Desk

Sit-Stand Desks

This unit provides an easy alternative to sitting, enabling you to stand while you work periodically through the day.

Benefits. The data on this approach suggest that people are less fatigued and more productive when they vary between sitting and standing. Investment in one of these units also makes sense if the desk is being shared by more than one person of a very different height or build. Specific benefits, identified in the research of Gibbs and colleagues, include

- a measurable increase in energy and reduced fatigue

- improved concentration and focus

- increased productivity reported by people who spend most of the day typing

- improved circulation, helping to clear the muscles of waste products that make us tired and sore

- burning more calories, and more optimal weight, which could translate into reduced risk of diabetes

Getting started. It is important that employees accustom their bodies to the exertion of standing, just as one would phase in any form of exercise, activity, or exertion. Ideally, begin by working standing for an hour, and if you find that’s too long, you can adjust your work pattern to fit your experience.

Figure 22-7 Three strategies to support productivity: a sit-stand desk, use of a laptop stand, and a second external monitor. (Photo courtesy of Backshop NL)

Figure 22-8 An individual worktable maximizes desktop space and freedom of movement. (Photo courtesy of Bakker Elkhuizen)

THE SPECS

The European Union standards for good ergonomics provide a helpful baseline:

1. Desks. 32 inches deep × 48 inches wide (80 × 120 cm). A generous-size desktop will accommodate the use of a standing-desk riser, a laptop stand, and extensive work materials.

2. Worktables/desks. Range of height adjustment: 24–33 inches (60–82 cm), which is sufficient for 90 percent of all users.

3. Sit-stand tables. Adjustment range: 25–48 inches (62–120 cm). Sit-stand desks contribute to a higher level of work comfort, relieve back complaints, and increase concentration, found in one study to result in a 53 percent increase in productivity.

Figure 22-9 Using a sit-stand riser to support a laptop. (Photo courtesy of Backshop NL)

Affordable tables with legs of various heights are available at Ikea, on Amazon.com, and from suppliers of ergonomic equipment. You will want a table with a flat top, without wood trim at the bottom of the tabletop, and no drawer. If there is wood trim and a drawer, the table is usually too high, since the table has to be higher for you to fit under it.

Options for a Desk

The desk and chair work together. You want the desktop to be at elbow level, so you can rest your forearms on the desktop when you are using the keyboard.

Adjustable desk. If the desk can be adjusted in height, begin by raising or lowering it to the correct height when you are sitting comfortably in your chair. See the Quick Start Guide at the end of this chapter. (Also see Appendix A for more tips on optimal desk arrangements for your desk, chair, and computer.)

Fixed-position desk. If the desk cannot be lowered or raised, then optimize your work space with an adjustable chair.

Chair. Arrange the height of the chair so that you can rest your elbows on the desktop without raising your shoulders or winging your elbows out while you type. Almost all office chairs are adjustable in height. If there’s no budget for a chair, take a look at the suggestions for using a pillow on the chair to make it more supportive: either a firm pillow for the seat or a pillow for the small of your back to make it more comfortable.

Classic wooden worktables. In the United States, offices most often use desks, whereas in Europe, offices tend to use tables with no drawers, because that maximizes the space of the desktop. When the desktop is at the right height, that enables you to rest your arms on the table while you type, conserving precious energy. A generous desktop will enable you to use two monitors, found to increase productivity and useful for a broad range of tasks.

An existing table. If you already have a wooden table, but the height is wrong for a computer worktable, consider trimming the legs using a wood saw or metal hacksaw, or raising the height of the chair relative to the desk. In a work environment, this type of change can only be done with permission.

A new table. When buying a table for a small business or for your home work space, a tabletop can be purchased separately from the legs at retailers such as Ikea, where you may also find table legs that are specific to the height that you want. Mixing and matching tabletops and legs is an inexpensive solution that’s attractive for a single user or two users who are close in physical size. Another affordable option is to get an inexpensive wooden table and then give yourself permission to trim the legs to the height you want. These tables currently are in the $60 to $100 range and go up from there.

An inexpensive sit-stand riser. If you’re interested in using a standing-desk riser, you’ll want to be sure that when you purchase a new desk, the new desktop is large enough to accommodate a riser comfortably.

Adjustable sit-stand desks. Investment in one of these units makes sense if you want to alternate sitting on a chair, sitting on a stool, or standing. This is also a useful option if the desk is being shared by two people of very different height or build. These desks are designed so you can preset more than one height, enabling users to quickly switch from one height to another. That could be an investment close to $500. The electric or automatic desk has a mechanism that works with the press of a button. That’s more ideal if the desk is shared. You can browse a variety of designs using a search term such as “sit-stand desks” or “adjustable computer desks.”

Desktops. Make it a point to notice how you interact with the furniture and equipment. You want the greatest amount of real estate on your desktop as possible. Standards developed in the European Union recommend a minimum size of 32 by 48 inches. If you’re buying any type of desk, there should no drawer below the desktop because that would impinge on your legs and put your arms at the wrong angle. Similarly, keyboard trays are less in use now, found to cause tension and fatigue in arm muscles. A large desktop enables you to use a larger monitor or two monitors.

Quick Start Guide

1. Adjust the chair.

1. Your seating could consist of a chair, a stool, or a kneeling chair. Adjust the seat height for comfort. Raise the chair so your forearms are level, resting on the surface of the desk, when you are typing.

2. Footrest?

- Are your feet on the floor?

- If not: You will need some form of footrest—a footrest, a low stool, a box, or even a stack of thick catalogs.

1. Note: If you use a conventional footrest, you’ll want to download an app for your phone to remind you to take split-second breaks (microbreaks), since the footrest confines your movement a little.

3. Optimize your desk. You want your forearms horizontal and level with the surface of the desk.

- Are your arms level? If yes, skip to step 4.

- Desk too high? If your desk is too high, and you have to raise your arms and wing your elbows out to work on the keyboard, then you need to raise the height of your seat. Most office chairs have a lever under the seat that will enable you to adjust the height.

- Once you raise your chair, your feet will be dangling, so you will need a footrest.

- If the chair cannot be adjusted for height, explore using a small, firm pillow.

- Desk too low? In this case, the only recommended option is to raise the desk. For example, if you are tall, you may need to raise your desk. Often this can be achieved by using furniture risers available from the hardware store.

4. Adjust the monitor.

- Set the monitor height so that the top of the screen is at the level of your eyebrows.

- If the monitor is too low, raise it with some form of support.

- Can you read the screen content without leaning forward?

- Use the zoom function so print and graphics are large enough for you to read without having to crane your neck to get closer to the screen.

5. Check the keyboard.

- Set the keyboard on top of the desk surface. Ideally, your arms are relaxed with your forearms level, resting on the surface of the desk or worktable when your hands are comfortably positioned on the keys.

- Do you need the number pad? If you use math a great deal in your job, there are two choices: using a keyboard that includes the number pad or using a keyboard with no number pad and a separate dedicated number pad. If you don’t use the number pad much in your work, the optimal choice is a narrow keyboard without the number pad. The less you have to stretch your arm to use the mouse, the better.

23

Monitors and Mice

Computer monitors and visual displays vary in size, shape, and technology. Current technologies include liquid crystal display (LCD), light emitting diode (LED), thin film transistors (TFT), and a variety of similar designs for displaying picture elements (pixels) on a screen. Retina displays, for example, permit densities so fine as to reproduce dense, high-quality images, as fine as four thousand pixels (4K) per inch.

Ultimately, your ability to see the display and read the screen is key to reducing neck and eye strain. Key factors involve

- Height. Adjust the height of your monitor so the top is at eyebrow level, so you can look straight ahead at the screen.

- Distance. Place the monitor so that it is about an arm’s length away from your eyes (23–28 inches). You want the font to be large enough for you to read the screen without having to lean forward.

- Zoom feature. When entering text or data or surfing the web, use the zoom feature to enlarge the font to a comfortable size (minimum 12 or 14 points). No need to use a large font in word processing documents or email—simply adjust the visual display to a size that is comfortable for you.

- Sharpness and size of characters. If the font size is too small or the edges of the text are fuzzy, we tend to bring our head closer to the screen and squint. Be sure that that the screen is in focus when you are sitting comfortably in your chair.

Adjusting the Monitor

Figure 23-1 The monitor needs to be positioned at eye level so you can sit in an erect, comfortable position. (Photo courtesy of Backshop NL)

- Checking the resolution. Adjust the screen resolution so the content or text is large enough for comfortable viewing. In many cases, the monitor resolution can be adjusted through software settings on your internet browser or in your software. Remember to optimize the screen resolution (the number of vertical and horizontal lines). The higher the resolution, the finer and sharper the images; however, the characters or icons may become very small. Reducing the resolution increases the character and icon size and often improves readability. Explore lower resolutions such as 800 by 600. (In Windows, this adjustment is made through the Control Panel; just click on the display icon, then Settings, and adjust the resolution. In an Apple operating system, click System Preferences, then Displays, select Scaled, and choose the resolution you want.)

- Details. Remember to periodically clean the monitor screen, as well as your glasses.

- Choosing typeface and size of font. For email, word processing, or web content, consider using a sans serif typeface. Fonts that have fewer curved lines and flourishes (serifs) tend to be more readable on screen.

- Selecting focal length. The importance of adjusting the distance to the screen (and therefore the focal length) applies whether the screen is the size of a watch, a virtual reality (VR) headset, a large screen monitor, or a display that is the size of a room’s wall (wideband, visually continuous, and seamless displays).

- Using a tablet with an external monitor. Currently, some people are using large smartphones as desktop computer replacements and view their documents on the small screen of their phone. Sync your tablet or phablet (a device with smartphone capabilities and a screen size between that of a phone and a tablet) to a monitor to minimize tension in your neck and shoulders, especially when working for an extended period of time.

- Checking your vision. Many adults benefit from computer glasses to see the screen. Generally, we do not recommend bifocals or progressive glasses because they force the person to look through the narrow slit of the segment of the lens that is at the correct focus to see the screen. This causes them to hold their head in a fixed position. On the other hand, computer glasses allow you to move your head in any position and still have the screen in focus.

- Remembering to blink. As we focus on the screen, our blinking rate is significantly reduced. Develop the habit of blinking periodically: at the end of a paragraph, for example, or when sending an email.

- Resting your eyes. Throughout the day, pause and focus on the far distance to relax your eyes. When looking at the screen, your eyes converge, which can cause eyestrain. Each time you look away and refocus, that allows your eyes to relax. It’s especially soothing to look at green objects such as a tree that can be seen through a window.

Using Two Monitors

Figure 23-2 Researchers have found that using two monitors can increase productivity by as much as 40 percent. (Photo by Erik Peper)

Productivity increases with the use of a large screen or two screens because there is access to more visual information at a glance. For example, visually identifying documents is easier when there are distinct areas of the screen available for sorting and filing. As a result, there is less cognitive load when searching for and finding documents and objects. Another nuanced reason for increases in productivity relates to being able to use deeply nested menus on a toolbar that would otherwise require switching displays.

The following are considerations for optimal monitor use.

- Using multiple monitors. Centrally position yourself when viewing the primary monitor. Having a rolling chair is useful when moving from one monitor to the other.

- Managing interruptions. There are some programs that interrupt the user at certain intervals, reminding them to take a break. By having two monitors, it is possible to have interrupt messages appear on only one monitor, not both. The interruptions may come not only from a break reminder program but also from notifications, email, instant messages, or news items. In almost all cases, having the interruption appear on a second screen in a visual field away from the primary screen helps with focus and primary task productivity.

- Optimizing a low monitor. Optimizing a monitor for someone who is tall may require finding a stable platform for the unit to bring the screen to eye level. However, even when monitors are the right height, the user may be scrunching their neck or hunched over the keyboard while engaging with the screen, especially if they have been working (or playing online games) for hours at a time.

- Blocking blue light. If you work in the evening or at night, consider getting a pair of blue light blocking glasses or clip-ons for your eyeglasses, to avoid insomnia (see chapter 11).

Minimizing Glare

Figure 23-3 The desk is positioned so the intense light comes from the side, minimizing glare. (Photo courtesy of Bakker Elkhuizen)

Reflection problems are minimized when light sources are at a 90-degree angle to the monitor (with the light coming from the side). The worst situations occur when the light source is either behind or in front of you.

Reflections. If the room is lit with artificial light, there may be glare from your light source if the light is right in front of you or right behind you, causing reflection on your screen. As mentioned, it’s better to have the light to one side. An easy test is to turn off your monitor, and look for reflections on the screen. Everything that you see in the monitor when it’s turned off is there when you’re working at the monitor. If there are bright reflections, they will interfere with your vision. Once you’ve identified the source of the glare, change the location of the reflected objects or light sources, or change the location of the monitor.

Contrast. Adjust the light contrast in the room so that it is neither too bright nor too dark. If the room is dark, turn on the lights. If it is too bright, close the blinds or turn off the lights. It is exhausting for your eyes to have to adapt from bright outdoor light to the lighting of your computer screen. You want the light intensity of the screen to be somewhat similar to that in the room where you’re working. You also do not want to look from your screen to a window lit by intense sunlight. Reduce glare by blocking bright light sources, or again by moving the computer so it is at a right angle to the light source.

Consider Computer Glasses

Our eyes are a dynamic sense organ rather than a mechanistic lens like a camera. As you change the focus of your attention, your eyes adjust with each movement, shifting from the screen to the keyboard, to the materials on your desk, or to any point of focus in your environment. Each shift means adjusting the focal depth, like the automatic focus adjustment in a digital camera.

Decreases in visual flexibility (less ability to accommodate near and far distances) are frequently experienced in midlife. Difficulty focusing on nearby objects is part of the normal aging process, and reading glasses become the norm. The eyes and vision slowly change. Initially it may be more difficult to read when there is less light (the menu in one’s favorite candlelit restaurant becomes illegible). Other indications include perching forward and straining to read text, or moving away from the screen in order to bring the text into focus.

Reading glasses, bifocals, trifocals, and progressive lenses are often not optimal for computer work. They tend to allow clear vision at only one focal length. To see through the near-distance correction of the lens requires you to tilt your head back. Although progressive lenses allow you to see both close up and at a distance, the segment of the lens for each focal length is usually too narrow for working at the computer.

Wearing progressive lenses requires you to hold your head in a fixed position to be in focus. Yet you may be totally unaware that you are adapting your eye and head movements to sustain your focus. When that is the case, most people find that special computer glasses are a good solution.

Consider computer glasses if you must bring your nose to the screen to read the text, wear reading glasses and find that their focal length is inappropriate for the monitor distance, wear bi- or trifocal glasses, or are older than forty.

Computer glasses correct for the appropriate focal distance to the computer. Typically, monitor distance is about 23 to 28 inches, whereas reading glasses correct for a focal length of about 15 inches. To determine your individual, specific focal length, ask a coworker to measure the distance from the monitor to your eyes. Provide this personal focal distance at the eye exam with your optometrist or ophthalmologist and request that your computer glasses be optimized for that distance.

Keyboarding

Avoiding Flexed Wrists

Figure 23-4 Typing with wrists bent at an angle too great increases the risk of tendonitis or carpal tunnel syndrome. (Photo courtesy of Kinesis Corp.)

If the keyboard is placed at too great an angle to your arms, your wrists will be flexed and bent backward at an uncomfortable angle. If you hold your wrists in a flexed position for most of the day as you type, there is increased possibility of fatiguing the tendons, eventually leading to inflammation. Typing with too much wrist flexion can lead to a series of small irritations that range from tendonitis to potentially painful carpal tunnel syndrome that can require surgery to correct. (The carpal tunnel consists of tendons and ligaments within the wrist.) Working with wrists at an awkward angle, these tendons and ligaments can become inflamed to the point of nerve irritation and chronic pain.

Important note: Using a laptop propped on a laptop stand makes it difficult to use the laptop keyboard. It is vital to use an external keyboard with a laptop stand. For schoolchildren, consider a flexible keyboard that fits in their backpack.

THE IDEAL HEIGHT OF YOUR KEYBOARD:

The keyboard height should be set so that your upper arms hang straight down while your elbows are bent at a 90-degree angle (like the letter L) with your forearms and wrists held horizontally.

ASSESSING A POTENTIAL KEYBOARD PURCHASE:

- Do the contours of the keyboard shape fit your body?

- How does the keyboard feel while typing? For example, are the keys responsive to the way you type?

- Are the keys built with a mechanical or membrane technology? Heavy users and gamers may want a more durable mechanical design.

- Do you need the number pad?

- How many keys can be pressed at the same time? For example, in some games, you must press five keys at once, and in some software packages, you are directed to press three keys at once (such as CTRL+ALT+DELETE).

- Are the keys backlit for work in dim light conditions?

- Are the keys programmable or customizable?

- Are there features for working wirelessly (Bluetooth or ZigBee) or other RF technology?

- Are there flexible features (roll-up materials) or projection features (such as one that projects the keyboard into the air or onto a surface)?

Split and Narrow Keyboards

If you have a large midsection, your elbows may wing out and your wrists will assume a greater angle at the keyboard or mouse. This is among the most common and potentially damaging keyboard postures and can lead to tendonitis, carpal tunnel syndrome, and other serious repetitive strain injuries.

Figure 23-5 Sitting with elbows winged out requires the wrists to be held at an awkward, uncomfortable angle. (Photo courtesy of Kinesis Corp.)

The solution is the use of a split keyboard, which enables the forearm and wrist to be aligned in a straight line.

Figure 23-6 Split or splayed keyboard. (Photo courtesy of Kinesis Corp.)

Leaning in to see the screen? As you crane your neck and bend forward, that will force you to wing your elbows out. Have your eyes checked to be sure you can see the screen clearly.

Avoiding carpal tunnel syndrome. As much as possible, allow your hands and fingers to be in a straight line with your forearms when you are keyboarding.

Research on Mousing

We found that people experience the least amount of bracing and muscle tension when they work with the keyboard directly in front of their body, whether that involves typing, mousing, or data entry. The wider the keyboard, the farther one must reach to use the mouse, and as a result, the greater the tension in neck, back, and arm muscles, inducing strain and discomfort (as shown in figure 23.7).

Figure 23-7 An EMG showing the tension in shoulder and upper arm muscles when mousing to the side of a wide keyboard. (Photo: Backshop NL; EMG: Peper and Harvey)

The solution is to use a compact, narrow keyboard that is shoulder width or less, with no number pad (figure 23.8) or a split keyboard without the number pad (figure 23.6).

Figure 23-8 An EMG showing the reduced tension in shoulder and upper arm muscles when mousing with a narrow keyboard. (Photo: Backshop NL; EMG: Peper and Harvey)

STRATEGIES FOR REDUCING STRAIN:

A centrally located trackpad and/or an external number pad. Employing a separate number pad for entering numbers enables you to have the best of both devices; these number pads can be purchased for as little as $10. For people who do a great deal of data entry, a separate keypad provides flexibility while reducing the strain produced by working at a wide keyboard.

An embedded keyboard. Manufacturers have addressed mouse overreach by “embedding” the numeric keypad in the right key module. An embedded keypad shrinks the overall width of the keyboard and allows for placement of the pointing device directly in front of your shoulder for maximum comfort. The keypad actions can be quickly accessed using the Function key.

Sources of Strain When Mousing

- Precision. Symptoms tend to increase significantly when using programs that require precise cursor control.

- Tension. To accomplish precise movements, we must stabilize our body. Breathing becomes shallow, so as not to affect the movement of the mousing hand and arm.

- Impatience. Many mouse users hold their index finger right above the mouse, ready to click any second. Unknowingly, their anticipation is a form of vigilance. This can be exhausting for your finger muscles.

- Pressure. The urge to perform at maximum speed produces hypervigilance that can result in chronic tension in your hands, wrists, and arms, as well as your neck and shoulders.

- Poor circulation. Bracing inhibits blood flow and lymph return. No wonder many people who mouse observe that their hands become cool, or even cold.

Production Work

CHECK THE FOLLOWING:

If you work as a production typist, in data entry, or on a CAD program, consider the ergonomic aspects of your mouse:

- Are you stabilizing your core while mousing?

- Are you holding your breath while mousing?

- Are you tensing your shoulders or arms?

- Do you hold your index finger up, waiting on the computer?

- Is the technology usable on a variety of surfaces? For example, an optical mouse may not work on all surfaces in contrast to a mechanical mouse that usually does.

- Do small mouse movements cause large cursor movements on the screen?

- Is the pointing device limited by a wire, or can the device work wirelessly?

- Is the size of the mouse too small or too large for your hand, or does it cause cramping?

- Is the device operated by placing your hand horizontally or vertically—and is that comfortable?

- Do you move your entire hand, or roll a ball with your fingers?

POSSIBLE SOLUTIONS:

- Rearrange your desk and remove items that hinder mousing.

- Organize your work area so you don’t have to reach so far to use the mouse.

- Bring the mouse closer to the center of your keyboard. If you are on a laptop, consider a mouse that can be used right on the surface of the laptop next to the trackpad.

- Install a mouse bridge over the number pad.

- Explore other types of pointing devices, such as a pen pad, touchpad, vertical mouse, or one of the various types of track balls.

- Use a mousepad to allow smoother movements.

- Use a wider trackpad so you can use your thumb or fingers to control the cursor.

- Use a wireless mouse or a mini mouse.

- Change the sensitivity of the mouse through your software so that you are doing larger movements to control the cursor. (To do this in a Windows operating system, click Start, click the Control Panel or Settings, double click the mouse icon, and adjust the settings.)

A much better way to work is to take momentary stretch breaks (see chapter 14, on microbreaks, for more suggestions). Also allow your hands to drop in your lap while waiting between mousing movements. By integrating microbreaks during mousing, you can work significantly longer without fatigue.

24

Laptops, Tablets, and Phablets

As laptops merge with tablets and tablets merge with large smartphones (referred to as phablets), that raises new questions about how to optimize our workstyle. This move toward smaller and smaller devices reflects Moore’s Law, which states that processor speeds and overall processing power for computers double every two years. (We expect that in the near future a single portable device may become the only device people use, thereby making the single device indispensable. In most cases, the technology will rely on a touch screen, using gestures or voice commands to interact with programs and content.)

Working anywhere and everywhere. In 2017, about 10 percent of Europeans and 5 percent of Americans worked full time remotely from home. However, more than 40 percent of Americans currently work at home some of the time. This may help to explain why the laptop is the new desktop computer. Although the laptop computer is an important piece of a fluid, transitional workstyle, it is still overlooked in terms of ergonomics. At home, we may be working at the kitchen table, using a kitchen chair. At work, we may share a desk or a workstation. Some of the time, we’re working in a coffee shop. Most of us work fluidly wherever we are, without ever giving the ergonomics a second thought.

Figure 24-1 A lightweight laptop stand paired with an external keyboard enables you to work comfortably in a range of environments. (Photo courtesy of Bakker Elkhuizen)

Experience It: Which Device to Use, When, Where, and for How Long?

Here are some quick strategies you can use to optimize your devices wherever you are:

1. Establish your baseline for comfort. How long can you work on a laptop or type notes into your phone before you get truly uncomfortable? Next time you’re working at home, jot down some quick notes on how long you worked and when you got uncomfortable. The next time after that, stop earlier, and see if that feels better.

2. Optimize your device. Work out the best ergonomic setup for that particular device. (If you use a laptop, we recommend optimizing that first.) Do you need a stand? In terms of ergonomics, that means a stand that will raise the device to your eye level. If so, you’ll also need an external keyboard. If you work at multiple locations, the weight and therefore choice of the keyboard will matter more than if you’re choosing an external keyboard for your home office.

3. Track your new baseline. Do these tools increase your comfort level? Do they enable you to work longer?

4. Shorten the time you work before taking a break, until your comfort is maximized. Continue tracking your comfort level when you’re in a situation without a deadline, at a time when you can divide your attention. At what point do you become uncomfortable, now that you’ve optimized your device?

5. 5. Apply the strategy above to another of your devices. If you use a tablet or phablet, optimizing your workstyle for the smaller device will be less familiar, and less intuitive. However, if you use it extensively, your efforts should increase your comfort and productivity.

6. Be sure to factor in microbreaks. If you aren’t already including these moments to stretch and relax, begin practicing split-second microbreaks and periodic stretches (see chapter 14 to refresh your thinking on microbreaks and their importance).

7. Remind yourself that “sitting is the new smoking.” You’ll also want to take movement breaks. Get up, stretch, and walk around (wiggle, if that’s appropriate to the culture at your work site). Do this a few times an hour.

8. Select which device to take where, and why. Taking brief notes on your phablet at a meeting might be fine for two hours. Taking detailed, accurate notes for your boss at a full-day conference, not so much. Deciding whether to carry one device or another depends on the task at hand, how far we have to travel, how much we need to carry, and whether we’ll be driving or taking rapid transit. To travel light, people periodically use their phone for everything from project notes to college papers, which can ultimately cramp your style and your output.

9. Define the main environments where you spend the most time working. Office, home, and coffee shops? Multiple offices? Car? One particular coffee shop? Set aside time in each environment to optimize for that setting.

10. A checklist can be helpful. You may want to develop a checklist for each setting. Examples of personal reminders: Bring a laptop stand and an external keyboard for work on-site with a client. Put a cushion in your trunk for use at the coffee shop.

11. Work your plan. Before you start working, optimize the space. Use the Quick Start Guide at the end of chapter 22, applying these ideas, one situation at a time.

12. Do your best. Know that whatever you do, there will be an element of compromise involved. That said, when you get the ergonomics right, you will feel the difference.

If you are unable to optimize your laptop or tablet in a particular setting, try to limit your use to two hours.

Optimizing Your Laptop

There’s a trade-off when we use a laptop. Although we can’t optimize our work space as easily as we might with a stationary desktop computer, we gain mobility. With the laptop, we can adjust dynamically to the posture that feels best. However, when we’re using a laptop on a desk, the compromise is that the moment we bring the keyboard down to the right height, the screen is too low. If we bring the screen up to the right height, the keyboard is too high. One response is to hunch over the keyboard, creating neck and shoulder tension, and another is to lean back with your laptop on your lap and slouch.

Figure 24-2 The posture theory diagram. The challenge of portable devices is that we collapse our posture in order to see the screen. (With permission from Max Banfield)

Laptop stand. One solution is a laptop stand and an external keyboard. Both stands and keyboards are now available in designs that weigh less than half a pound, so they are exceedingly portable. However, be certain to use the stand with an external keyboard.

External keyboard. When you select a keyboard, it’s best to choose a narrow design, one that does not have a separate numeric pad built into the keys (see chapter 23 for specifics). Lightweight external keyboards are available in a wide range of styles, including some so flexible they can be slipped into a backpack. If you need to plug and unplug a dongle, carry it in a fancy pill box to avoid losing it.

Connecting or docking a laptop, tablet, phablet, or phone to an external monitor. Although laptop docking stations have been available for some time, there are now a few technology options emerging that permit connecting tablets or smartphones to a larger screen. For example, Samsung makes a DeX docking port for its smartphones, and Apple offers a Logi BASE station for its iPad Pro tablets.

Buying a laptop. When opting for a handy compact model, buy one with the biggest screen that is comfortable for you to carry. If you have medium-sized or large hands and you buy a small unit (11.6 inches or so), make it a point to get one with full-sized keys for speed and comfort. Conversely, if you have small to medium-sized hands, you might find a wireless mini mouse useful, because it can fit nicely on the laptop surface right in front of the keyboard.

Optimizing your tablet or phablet. The guidelines for optimizing a tablet are similar to those for a laptop. It’s worth mentioning that not all tablet “stands” are created equal. When you’re using the tablet for an extended period of time, you want an ergonomic stand that will hold your device at eye level. As with your laptop, you’ll want to pair that with a wireless external keyboard.

Optimizing your phone. If you are texting on the subway, you may find a PopSocket or a finger grip (finger ring) useful. That will enable you to hold the phone closer to eye level, reducing neck fatigue (see chapter 8). At work, if you’re using your phone extensively to read text, consider plugging it into a monitor or using a dedicated cell phone stand that puts the text close to eye level.

Sharing a Desk at the Office

Following the guidelines in chapter 22, work your way through the options. If the scale of your desk, workstation, or worktable is vastly out of sync with your physical size and/or body type, see if there are any workarounds. Could you trade the desk, cubicle, or worktable with someone else in your office? Or work at home one more day a week? If not, it becomes more important to take microbreaks, stretch breaks, walk around hourly, and to exercise or walk on your lunch hour, in order to reduce the risk of inflammation or injury.

When different people sit in the same chair or use the same computer or laptop, each person needs to take time to adjust the equipment, similar to the way you adjust the mirrors of a car when you first get in.

Shared furniture and equipment are becoming more common, not only in the workplace, but also in co-working and shared-space environments where people rent by the month, week, day, or, sometimes, the hour.

Portable sit-stand risers. If you want to use a sit-stand workstyle and share a desk or work at multiple locations, you may find a desktop sit-stand riser useful. At the time of this writing, they range in price from $125 to $300 and weigh about 35 pounds.

Chairs. If your chair is too low, consider bringing a small, firm cushion with you or storing one at work in a drawer.

Figure 24-3: Using a sit-stand riser.

Working in a Coffee Shop

The secret to optimizing your work in a coffee shop is to find the ideal table-chair combination specific to you, given your height, your build, and the type of device you’re using. That might mean finding optimal seating in the café you frequent or identifying a new favorite place to work. Here are some of the questions to ask yourself:

- Which table or chair height will seat you with the tabletop at elbow level?

- If the chairs are too low, it may be worth keeping a small, firm cushion in your car or backpack.

- If you are working in a coffee shop in a busy urban area, avoid sitting outside or near the door to minimize theft.

- Be sure to periodically stretch and move about, taking your device with you.

Figure 24-4 captures how people actually work in a coffee shop—and some of the drawbacks. Here, the tabletop is too high, so she is resting her elbows on the surface. (Ideally the position of her arms should resemble the letter “L” with her upper arms parallel to her body, the table at elbow level, and her forearms resting flat on the tabletop.) The high table requires her to splay her elbows, winging her arms and arching her wrists. As if that weren’t enough, she has to hunch over to type and see the screen.

When possible, sit with your back against the wall facing the entrance. For some people this increases the sense of safety, while others purposely want to face the wall and not be distracted. Regardless, be aware of your surroundings, given the hypnotic nature of electronic devices. In terms of lighting, although it is great to be able to look up from the screen to the outside (which allows your eyes to relax), often there is too much sunlight. If possible, orient your screen 90 degrees to the light source, which will reduce glare.

Figure 24-4 Working at a coffee shop often means that you must adapt to poor ergonomics. (Photo by Erik Peper)

On the Road

Wi-Fi on a train, subway, or rapid transit. If you are using your laptop connected to the internet via your cell phone, you may be unintentionally exposing yourself to increased cell tower radiation, because the cell signal must be larger to meet the demands of the internet compared with a simple phone call.

When possible, avoid connecting to the internet if you are in a place that requires a larger cell signal: for example, if you are surrounded by metal (e.g., a train, car, or bus) or within a building surrounded by lots of concrete and steel (e.g., an elevator or the basement). Using the airplane mode of your phone shuts down the connection to the microwave transmission from the cell tower.

Safety. It is also important to be aware of our environment. The moment we’re on the phone our focus narrows, and we are more vulnerable to theft.

At a conference. When working in a large auditorium with your laptop or tablet, the device often rests on your lap, balanced on your legs. Because your legs are motionless, the primary strategy is to take frequent movement breaks and microbreaks. If you’re taking notes, you may be looking down at the screen a great deal, so remember to do neck rolls and take eye breaks. Do get up, move, and stretch your legs every twenty minutes if possible.

Hotel Rooms

Adapt the hotel room to suit your needs. Decide where you want to work and then optimize that area. Be willing to move the furniture about just a bit.

Which desk, which chair? Optimize for the height of the desktop. Often the desk or table provided is too high and you have to reach up to work at the keyboard. If the chair is too low, the quickest solution is to sit on a pillow or a folded blanket. Optimize the height of the chair so your upper arms are parallel to your body and your elbows are bent at a right angle (90 to 110 degrees). Road warriors may opt to pack a keyboard and a simple laptop stand since they are now very affordable and weigh less than a pound.

Working on the bed. If you’re unable to work at the desk, consider the bed. It is much less stressful to work looking down than to keep your arms raised to reach the keyboard for an extended period of time. If necessary, use a thick magazine or book, a blanket, or a pillow as a temporary riser. Remember to allow for airflow to avoid overheating your laptop. When working for longer durations of time, find a more suitable work space.

Lighting. Shift the furniture closer to lighting. If the light is low or too bright, request a lamp from the front desk. If you are working in bed, use the lamp on the night stand or a floor lamp, if one is available.

Working Informally at Home

By definition, it’s impossible to achieve perfect ergonomics. However, you can definitely improve your situation.

Heat and Wi-Fi exposure. It’s helpful to be aware of exposures to heat and Wi-Fi, which have been implicated in reproductive issues for both men and women (see chapter 25 for some of the research on this). If you are working with the laptop on your lap and you don’t need Wi-Fi, in Windows you can quickly turn it off by going to Settings, entering “Wi-Fi,” and switching into airplane mode. Using a Mac, click on the Bluetooth icon in the top menu bar and choose Turn Bluetooth Off. Next, click the Wi-Fi icon next to it and choose Turn Wi-Fi Off.

Figure 24-5 When working with the laptop on your lap, turn the Wi-Fi off if you don’t need it, but if you do, put the laptop on an end table, rather than your lap, and use a wireless keyboard. On the couch, use your favorite microbreak strategies, moving about in place every few minutes and getting up, when possible, about every twenty minutes.

The desk. If you are optimizing your home office, obviously you have much more freedom. At home the key is to remember that most furniture can be changed. (See chapter 22 for suggestions on the home office.) Desks can be raised by using blocks or by purchasing risers from the hardware store. If the desk is too high, give yourself permission to just neatly trim the legs. Another option is to purchase an inexpensive replacement desk on Craigslist.org or from other secondhand sources that you can alter to suit your needs without guilt.

Workarounds for a sit-stand desk at home. If you would like to create the sit-stand workstyle, you may already have a credenza or dresser that is the perfect height for standing work. For a woman of medium height, credenzas make marvelous, roomy standing desks. If you are tall, a dresser might be the ideal height for a standing desk. Here, too, you want the surface to be at about elbow height.

Monitor. At home, you have the option of syncing your laptop, tablet, and even your phone with an external monitor, syncing your laptop with two monitors, or using your laptop or tablet with an inexpensive laptop stand. YouTube has instructions on the kind of cable you’ll need and how to sync your monitor and devices.

Chair. When the table is too high, raising your seat will make you more comfortable. If you’re using a dining room or kitchen chair, often it makes a noticeable difference to simply use a pillow. Even better, use a small, firm pillow that is cut in a slight wedge shape so your knees are about an inch lower than your hip joint. If you are planning to purchase a chair, remember to try it first, whether it’s new or secondhand.

In bed. The same strategies you use when working in a hotel room apply here. However, if you are working at home and confined to bed due to an illness or injury, there are a few peripherals to consider—a laptop stand (similar to a music stand) that can be placed next to the couch or bed, a tray similar to those used for meals by hospital patients, or a laptop stand intended for use when lying down.

Figure 24-6 Lying on the floor is surprisingly comfortable for a brief period of time, but quickly becomes uncomfortable. In a study at Temple University in Philadelphia, participants in this posture reported discomfort after only seven minutes.

At the End of the Day

To raise your awareness of how you are interacting with your home or office furniture and computer equipment, do body scanning techniques to increase awareness of unconscious muscle tension. The moment you observe that you feel stiff or sore, do something to reduce the tension, by either shifting your position or getting up and moving around. (See chapters 6 and 14 for specific suggestions.)

25

Minimizing Risk

Tendonitis in eSports and Gaming

My name is Kevin Toy, and I am a twenty-five-year-old eSports athlete. The field of eSports is defined as professional video gaming in which people like me, young and old, compete globally at the highest level for glory on a worldwide scale and cash prizes up to millions of dollars.

As many as 70 million people watch a single eSports final, which is higher than the viewership for U.S. professional baseball, soccer, and hockey finals. This is an exploding field and in 2018, there were 215 million occasional viewers and 165 million enthusiasts. By 2021, it is estimated that there will be 250 million eSports enthusiasts and that consumers will watch three billion hours of eSports, which accounts for 10 percent of all sports viewing.

Although I have been an eSports professional since 2013, my journey truly began as a young eight-year-old kid who loved playing video games casually with my cousins. People grow, as do our dreams of answering a higher calling in our lives, to work toward something greater.

Figure 25-1 More than twenty thousand fans watched the 2019 World Finals of the League of Legends World Championship at the AccorHotels Arena in Paris. (Photo courtesy of Riot Games, www.riotgames.com)

I have been an eSports professional for more than six years now, representing a world-renowned eSports company, Counter Logic Gaming (CLG), for the past four years. At this point in my career, I am known as the best doubles player in the world, and in the conversation of greatest doubles players of all time throughout this game’s sixteen-year life. A fresh attitude, diligence, and sacrifice have led me to this point in my career. As in other sports, these skills take a surprising amount of time—often at the expense of our physical health. Professional gaming requires thousands of hours of practice. As a top professional in the space, I still spend several hours every day honing my proficiency, day in, day out.

On the surface, gaming doesn’t seem to be something that could be damaging to our bodies. However, the professional environment of eSports demands that we commit long hours, playing in high-stress situations. That can lead to persistent damage due to repetitive motion, overuse without rest, and high-volume stress on our muscles. I have been competing in the game of Super Smash Brothers Melee for thirteen years now, practicing for about three to five hours per day. In the summer of 2019, I encountered my first career-threatening injury after a tournament.

Tendonitis in my left forearm from high-volume stress led to debilitating pain that prevented me from competing in tournaments for several months. As a professional, injuries are daunting and led me to an episode of deep depression and existential dread.

Figure 25-2 An eSports competition and success at the games. (Courtesy of Kevin Toy)

I sought help from a well-known physical therapist, Matt Hwu, who specializes in eSports, so I could learn how to handle my problem. As it turns out, my tendonitis was the result of ongoing overexertion and excessive efforts involving my left forearm, with major impact on my left trigger finger. Tournament weekends typically last from Friday to Sunday with ten-hour days of playing and few breaks. My left trigger finger took on the highest volume of stress throughout these tournament weekends. Most of the controller motions involve squeezing the left index finger, so I held a lot of tension in that finger, always anticipating the next action. Much of the stress was the result of not realizing the consequences, not knowing how to prevent injury, so I unintentionally ignored my body and the pain in order to be successful at the games that brought me so much happiness and success.

Embarking on the path back to health has been eye-opening as an eSports athlete, and I have learned invaluable lessons in what it means to take care of my body. As a gamer who has undergone physical therapy for an injury, my hope is that the use of biofeedback can help others within the industry. I believe that EMG technology can and should be used to accurately identify issues and prescribe treatments. I wish for others to be proactive in taking care of their physical health so that all of us can live healthier lives and have more prolific careers. (For more insight into biofeedback and EMG technology, see chapter 20.)

Figure 25-3 Gamers are typically negligent of their bodies, because the stereotype is that video games cannot lead to injury. (Courtesy of Kevin Toy)

Why is there an issue with tendonitis within eSports and gaming? Like any professional level skill, gaming requires thousands of hours to perfect the craft, with heavy use of hands, wrists, and tendons. Usually young people begin gaming and eSports at home and become captured by the thrill of the sport. As they begin eSports, they do it by themselves without any coaching or instruction on how to use their bodies in a healthy, ergonomic manner. They sit in a competitive, static position for hours while operating the devices. In many cases, potentially harmful body patterns are established without awareness, and only much later do symptoms occur.

Conclusion. As young people begin to play, we need to teach them to play in a healthy style to avoid future injury. Just as basketball players learn how to strengthen the appropriate muscles to avoid injury, cyclists wear a helmet, and computer users arrange their ergonomics and take microbreaks to avoid discomfort, young people need to know how to perform eSports to maintain and optimize their health.

EMF: Knowing Your Risks

Clearly, none of us are going to be giving up our phones any time soon. That said, we want to encourage you to take a few key steps to protect your health when you’re using your phone. Most of these steps are obvious, but it never hurts to have a reminder.

Several large studies from Europe indicate an association between the use of cell phones and an increase in the incidence of cancers of the brain and auditory nerves (ear to brain). Despite these increases, the rates in younger people are currently low, possibly because the accumulated effects take years to become apparent. From 2011 through 2015, there were fewer than 4.5 brain cancer cases for every 100,000 people in the United States under age 65, compared with approximately 19.1 cases for every 100,000 people in the United States who were age 65 or older. Given the increases in cancer rates over the past twenty years, there is wisdom in taking a precautionary approach.

Your Phone and Other Wi-Fi Devices

- Avoid carrying your mobile phone on your body, in your pocket, or in your bra.

- Keep your smartphone at least three feet away from your body while sleeping, and ideally in another room.

- Pregnant women should keep their phone away from their abdomen.

- Ideally, use a headset or speaker mode.

- Put your phone on “airplane mode” when not in use, and keep it turned off if you need to carry it in your pocket.

- Avoid working with your laptop directly on your lap unless Wi-Fi is off. You can turn it off quickly within the Settings function in both Windows and Mac.

- Minimize EMF exposure to your pelvic area. Special computer pillows were once recommended, but recent research shows that they may not provide sufficient protection against EMF.

- If you’re buying a laptop or a tablet, aim to get one with a metal casing on the bottom, reducing EMF exposure. Hard plastic provides little protection from excess EMF radiation.

- Avoid putting the display side of a tablet facedown on your lap or chest.

- Identify the antenna on your device and point that away from your body when you’re using it.

- People with pacemakers will want to keep their tablet at least six inches away from their body.

- Minimize use of your phone in cars, trains, and elevators.

Cancer Risk

Cell phones use frequencies similar to those used in a microwave oven, except at an intensity a thousand times lower. Although the intensity is much lower, researchers have found some increased incidence of cancer with extensive or long-term phone use, so talking on the phone with a headset or on speaker mode is an excellent habit. The following are studies that give some sense of risk.

Animal study involving two-year exposures. A large study by the U.S. National Toxicology Program reported statistically significant increases in cancer among genetically identical rats that were exposed to cell phone frequencies for a period of two years at three different levels of intensity. Some of the exposed animals had significantly higher rates of brain tumors (gliomas) and cancer affecting the nerves that connect the inner ear with the brain (neurofibrosarcomas). Animals in the study that were not exposed to radiation (the control group) did not develop either type of tumor. Conclusions after a decade of research using G2 and G3 cell phones reported these findings:

- Clear evidence of tumors in the hearts of some male rats (malignant nerve cells)

- Some evidence of tumors in the brains of male rats (malignant gliomas)

- Some evidence of tumors in the adrenal glands of male rats

Study with exposures to ten thousand animals. A two-year Italian study monitored the health of more than ten thousand animals exposed to low-frequency (50 Hz) EMF. The exposed animals experienced a significant increase in tumors, including brain malignancy. Note that current Android and Apple phones, and various tablets, operate at 120 Hz.

British population studies. Three British studies of interest analyzed the incidence of brain cancers population-wide over the past twenty years. The first study, in Britain from 1996 to 2007, looked at cancers that might implicate the first popular mobile phones—the flip (clamshell) phones introduced by Motorola in 1996. Two points are important when considering this study:

- The numbers are small: 2,500 newly diagnosed cases in a population of about 50 million. In the United States that translates to about 10,000 new cases a year. On the other hand, if that is you or your child, the issue takes on new meaning. Additionally, over a ten-year period, that figure becomes 100,000 people diagnosed with brain cancer.

- There was about a 70 percent increase over ten years. There was an increase from 3.75 cases per 100,000 people to 5.25 per 100,000 from 1996 to 2007.

Million Women Study. Conducted in Great Britain, this study used questionnaire data from study participants. The original published findings reported an association with an increased risk of acoustic neuroma (cancers involving the nerves from the ear to the brain), stating, “For acoustic neuroma … RR = 2.46 … the risk increasing with duration of use.” RR means “relative risk,” indicating more than double the risk with years of use.

A more recent British study by Volkow and colleagues analyzed data from 1995 to 2015 for incidence of one particular type of brain tumor, glioblastoma multiforme. Although the numbers were low, new cases had more than doubled. In exploring possible environmental and lifestyle causes, use of CT scans and mobile phones were cited, reporting: “In healthy participants … a fifty-minute cell phone exposure produced a statistically significant increase in brain glucose metabolism in the … regions closest to the handset.” One implication is that longer phone calls may influence brain metabolism, relevant to cancer processes.

The Interphone Study. A survey by a consortium of researchers from thirteen countries reported three findings suggesting possible risk:

- Data from all thirteen participating countries reported a statistically significant association between the location of tumors within the brain and reported location of phone use.

- Data from five Northern European countries in the study showed an increased risk of brain tumors and cancer of auditory nerves (acoustic neuroma) in those who had used a cell phone for ten or more years.

- A modest increase in the risk of brain cancer (gliomas) was identified among a small proportion of study participants—those who spent the most total time on their phone.

Scandinavian research. Recent analyses of cancer data by Michael Carlberg and Lennart Hardell of the Department of Oncology, University Hospital, Örebro, Sweden, reported that long-term cell phone use was associated with an increased risk of malignant gliomas (brain tumors), with the greatest risk in people who used the cell phone before the age of twenty. They also pointed out an evaluation of the scientific evidence on these risks by the International Agency for Research on Cancer (IARC) at the World Health Organization (WHO) in May 2011. An increased risk for glioma and acoustic neuroma was concluded, based on human epidemiological studies.

Male Reproductive Health

Guys, we strongly encourage you to avoid working with portable computers on your lap, because laptops generate heat. Heat suppresses sperm production, but researchers have also found adverse effects due to frequent and high intensity exposure to Wi-Fi signals (in the absence of heat).

Research from Argentina. At a medical center in Cordoba, researchers on reproductive health reported that exposure of human sperm to a wireless internet-connected laptop decreased sperm motility and induced DNA fragmentation that was not due to the effects of heat. The authors stated, “We speculate that keeping a laptop connected wirelessly to the internet on the lap near the testes may result in decreased male fertility. Further in vitro and in vivo studies are needed to prove this contention.”

Finnish research. Researchers pointed out that both animal and human studies have found that EMF exposure negatively affects sperm quality, including sperm count, structure, motility, and cell metabolism, producing toxic effects on genetic material, and causing oxidative stress.

Chinese studies. When a group of animals was exposed to pulsed EMF, researchers found that exposure in the first generation was associated with adverse effects that occurred in male offspring of the second generation: animals that had never been exposed to EMF. Specific effects included decreases in testosterone, sperm quantity, and sperm enzyme activity. There was an insidious quality to the changes, because by all other measures the reproductive health of the second generation was unchanged.

A second Chinese study of 150 male workers, half with high occupational EMF exposure compared with workers who had low exposure, reported that chronic exposure to EMF decreased male testosterone levels in the blood stream and increased markers of inflammation.

Research in Iran. Using an animal model, researchers reported that exposure to EMF from cell phones produced increases in testicular proteins related to cancer risk and reproductive damage. This is important in light of the widespread practice of men carrying their phone in their pocket, since exposures to reproductive organs could at times exceed manufacturer guidelines for proper usage.

5G. The international rollout of 5G networks has started, with small-size transmission cells in close proximity to where people live. Preliminary observations showed that millimeter-wave (MMW) radiation at high frequency can alter gene expression, promote cell proliferation, increase oxidative stress (a cancer precursor), and raise levels of inflammation.

Reproductive Health in Women

Results from a ten-year study of EMF by the U.S. National Toxicology Program (NTP) studied 2G and 3G transmission exposures and reported the following conclusions of particular interest to women of childbearing age:

- “The studies question the long-held assumption that radio frequency radiation (RFR) is of no concern as long as the energy level is low and does not significantly heat the tissues.”

- “NTP found lower body weights among newborn rats and their mothers, especially when exposed to high levels of RFR during pregnancy and lactation, yet these animals grew to normal size.”

Researchers in China monitored the health of 180 female workers exposed to EMF for more than one year in comparison with 349 female workers not exposed to EMF in the workplace. The researchers found that increased exposure to EMF was associated with an increased incidence of menstrual disorders at a rate two to three times that of those with no exposure.

Individuals experiencing issues in terms of fertility will want to assess their exposure to EMF associated with their phone and computer use to reduce excessive exposure. Researchers have pointed out that because reproductive tissue grows so rapidly, these cells are more vulnerable to levels of damage from excessive EMF radiation.

Risks to Children

The models that are used for assessing EMF exposure in adults may not be sufficient when applied to children. Research studies have shown that EMF signals can penetrate a child’s brain more easily than the adult brain. At this point in time, it is not clear what this means in terms of actual risk. Researchers Fernández-Rodríguez, Claudio Enrique, and Alvaro de Salles measured skull thickness and bone mass in children and adults in relation to EMF exposure associated with smartphones and Wi-Fi transmitters. Simply stated, all their measurements suggest that the brains of children absorb more EMF than adults.

Your device’s safety warnings and disclaimer: Have you read them? A printed copy of safety information is provided with the purchase of all computers. However, in some cases, the manual is so small it is practically illegible. For a legible copy, consumers must look up the manual on the internet. Although the greatest risks are likely to affect children and teens, most parents and teachers never read the warnings, despite the caution from manufacturers: “Read all safety information below and operating instructions before using [this device] to avoid injury.”

Manufacturer’s guidelines indicate that the most intense EMF exposure occurs near the antenna, while the device is connecting to a cell phone tower. For example, according to the safety guidelines required by the municipal government of Berkeley, California, with the purchase of every cell phone: “If you carry or use your phone in a pants or shirt pocket … when the phone is on and connected to a wireless network, you may exceed the federal guidelines for exposure to RF radiation.” Researchers have suggested that these exposures could have more serious consequences for children, particularly in terms of cell phone use because the bones of a child’s skull are thinner.

Each manufacturer applies its own antenna design, so you will want to download the instructions online to be sure you know where the antenna is located. A review of manufacturers’ guidelines consistently revealed the following three points:

- Orient the antenna away from your body.

- Orient the device so the display side is not directly in contact with your body.

- Limit the frequency and duration of tablet use in wireless mode to limit exposure to EMF signals.

Promoting Balance in Our Children’s Lives

“It’s time for dinner,” the mother said to her thirteen-year-old son, who was engrossed in a computer game.

“I’ll be up in a minute,” he replied.

Gaming creates a world unto itself, an experience that is enticing, hypnotic, addictive.… Thirty minutes later, the boy still had not surfaced for dinner. The changing visuals had activated his hypervigilance, so he was captured by the game, totally unaware of how much time had passed or the changes in his body chemistry and responses. These patterns were established genetically, and reinforced as a young child, when his parents gave him their smartphone to quiet him during dinner at a restaurant.

As he played, his breathing rate doubled, and his shoulder tension increased. (Figure 25-4 shows typical changes in a young boy playing computer games.) He focused on the screen intently, and that reduced his blinking rate. Although this sounds minor, all the gamers in his neighborhood needed glasses for nearsightedness by junior high, and this impact on vision is a trend that is occurring globally with the rise of digital media.

Excessive duration of gaming, TV, or social media has been found to increase several concerns:

- potential for a lifelong habit of sitting while being physiologically aroused

Figure 25-4 Representative recording of a young boy playing computer games in which neck and shoulder tension and breathing rate increased and stayed high for the duration of the game. Gaming often induces hypervigilance, hyperreactivity, and rapid shallow breathing while playing. (Source: Erik Peper, Adam Burke, and Eliot Peper)

- accompanying risk of diabetes and heart disease

- loss of opportunities to develop other physical skills

- social isolation due to reduced interpersonal time

- potential for effects on the brain and brain development that are not yet fully understood

We are not alone in these observations, as reflected in the book Glow Kids by addictions specialist Nicholas Kardaras. The book describes a generation of kids who are forming intense dependencies on the glowing screens of smartphones, gaming devices, tablets, and computers. Kardaras reviews neurological effects ranging from addictive behaviors to psychosis. Recent research from the Veterans Administration reported that video games were as effective as morphine in treating pain.

Risk of ADHD. Just as too little stimulation reduces neural growth and development, excessive stimulation also reduces neural growth and development. Researcher Dimitri Christakis and colleagues published a study in 2018 describing the effects of overstimulation by media. This team found a close association between excessive stimulation and symptoms commonly associated with ADHD (attention deficit hyperactivity disorder).

Prediabetes. Excessive sitting is clearly associated with an increased risk of diabetes. Among American teens, one in five is now prediabetic. Among young adults in the United States, one of every four is prediabetic. These young people have high blood pressure, increased abdominal fat, and insulin resistance, all symptoms of elevated risk of heart disease. Gaming and digital media use contribute to these issues, but are not the sole cause. Another major influence is the generally inactive lifestyle of modern urban life. Commercial interests also have a major impact on these problems via the marketing of fast food, sugar, and other high-carb foods.

Our mission, if we choose to accept it … We cannot ask children to have voluntary control, since their response patterns are activated by the evolutionary traps that have allowed our species to survive. Thus, it is up to us to promote lifestyle strategies that optimize our children’s health. If you have young children, now is the time to shape lifelong habits by emphasizing nonscreen activities and role-modeling to reduce screen-time behaviors. This means spending time together that is totally free of digital media.

After gaming, include a cooldown period. Since gaming tends to promote excessive stimulation, and a sense of hypervigilance, afterward it’s helpful to include an opportunity to unwind. (Hypervigilance is managed by the sympathetic nervous system, the same system that implements fight or flight.) This could mean five minutes of free weights, of push-ups and pull-ups, or simply taking the dog for a walk.

Dining together. To maintain and deepen your relationship with your kids: (1) don’t use your phone or other devices during meal times; (2) be truly present with your child; (3) converse with them, encourage them to share what they did during the day, and share your own world with them as well. Talk about things that interest you both, on subjects that they care about.

Investing your time. As much as possible, do activities with your child, and when possible, include their friends in these activities. At times this will be more work for you than if your child were playing video games, watching TV, or hanging out on social media. However, your investment now in creating enriched experiences and emotional memories will provide the foundation for their future health and growth.

Being physically active. When feasible, encourage your child to balance time spent gaming with physical activity such as skateboarding, riding their bike, running, martial arts, baseball, basketball, or gymnastics. (We no longer encourage soccer because of the known risk of concussion when players do headers.) Take your kid to the gym once a week, or swimming—whatever you and they like to do. When running errands, create as many opportunities as possible to walk (exercise in disguise), parking at the farthest end of the lot, and taking the stairs instead of the escalator or elevator.

Stim (stimulation). Build enrichment into your child’s life and expose them to multisensory experiences and opportunities for learning—traveling together; exploring new places; going to science centers, museums, and art studios; going hiking together, to the beach, and visiting national parks. At some point your child will shift toward their peer group, but if there is a favorite aunt or uncle, a godparent, or a friend of the family who can socialize with them periodically, so much the better. Trading visits or overnights with the families of your child’s friends may be another option, if you know their parents have similar values.

Building skills. We want our kids to develop useful skill sets, to have the opportunity to create as well as consume. Share your own skills with your child, especially if that’s a gift they clearly have as well. Whatever you enjoy doing, do it with them—that could mean animal care, doing chef duty together, learning a musical instrument, conversing in another language, working on the car together, teaching them chess, making art, or any type of craft. If your kids are young, this means reading to them and having them read to you. (A fond memory as a fifth-grader was being read to each afternoon for a full hour by our lovely teacher, who chose everything from Charlotte’s Web to The Iliad, while everyone in the class rested, listening with rapt attention.)

Making sense of cultural issues. In the United States, we have moved from country life to urban living in less than a hundred years. Physical activity was always an aspect of country lifestyle and of farm work. Food grown without chemicals was a given until recently. However, with the mass migrations to American cities that began during World War II, more than seventy-five years ago, the social structures are not yet fully in place that would make this transition from farm life to urban lifestyle a success. If we want to live successfully in an urban environment, we need to recreate communities that include key aspects of the lifestyle that enabled our ancestors to survive and eventually thrive.

Learning by imitation. As parents we need to role-model healthy behavior, set boundaries for our kids, and offer them enriching environments. Children are hardwired to learn and grow—our role is to provide a range of emotionally satisfying options so they can have quality of life, living on a human scale, interacting with their friends and their family without digital distractions. This means

- role-modeling smart use of smartphones

- having digital-free time at home

- allowing your child to become “bored” periodically, giving them the opportunity to become creative

- creating social opportunities to play and engage with friends without digital media

- providing opportunities to be in nature

An emerging perspective. A surprising number of the leaders and software engineers in Silicon Valley who have been instrumental in the development of social media do not allow their own children to have smartphones or tablets. Many send their kids to Waldorf schools. (Silicon Valley now has the highest concentration of Waldorf schools in the United States.) The Waldorf approach encourages creativity, crafts, simplicity, and an emphasis on the natural world. The use of digital devices is discouraged at home, and devices are not used in school as part of the teaching curriculum.

Children are predisposed, genetically, to be curious and to explore, which is how they learn. This innate drive allows them to grow and mature, which they can do naturally when they are having new experiences, when they are outside in a natural environment, and when they are playing with friends.

However, in the United States, because of our concern about safety, our kids tend to stay in the house once they get home from school. Confined to the house, the child quickly becomes bored, and the only options left to fill their time and their curiosity are video games, television, or social media. The solution is both obvious and extremely challenging. The obvious piece is that we need to respect the evolutionary background of our kids. They need novelty, they need to use their curiosity, they need to explore nature. This is both easy and difficult, particularly in the inner city.

This brings to mind the work in Iceland, where an extensive alcohol problem developed among teens. The state instituted a countrywide program of midnight basketball and other ways for young people to become more active, and their misbehavior was remarkably reduced.

An animal study on the effects of stimulation makes this clear. Rats housed in a boring environment, when offered a choice between water and opiates, quickly became addicted. Another group of rats was housed in a rich environment with lots of toys and equipment, room to be active, and other rats to interact with. When the second group was offered a choice between opiates and water, they were satisfied with water and did not become addicted.

The digital world is also highly addictive and incorporates a number of evolutionary traps. However, with skillful use, our devices can function as extraordinarily useful tools. Ultimately it takes a family, a community, a village to raise a child. We need to invest time and insight to support the health and development of our children—in the midst of our busy lives—to create the foundation for lifelong health.

26

Final Thoughts

If these ideas resonate with you, consider lifestyle as the first step. We need to build dynamic physical activity into our lives, as well as the lives of our children. We’re typically not living in nature, so we have to make an effort to stay connected with the natural world. There’s less time for socializing and face-to-face connection, so we should spend our precious spare time doing something we really care about, with people we care about, doing things that bring meaning and purpose to our lives, which raises questions about how we place value on our time and activities.

Strengthen your ability to adapt. To build adaptive capacity, incorporate the elements of an optimum lifestyle as your basic goal. Like most of us, you are probably strong in some elements and struggling with others. One person is great about making it to the gym, but can’t kick sugar. The next has the diet piece down tight, but is always pushing deadlines and hasn’t gone running for two months. The third is all over the social piece, at the expense of their professional development. Which aspects of lifestyle do you want to factor in, one by one, over the coming months? What will be most essential in strengthening your capacity to adapt, to negotiate stress, and to create a rewarding life? What do you need to further develop a sustainable, polished workstyle?

Practice dynamic balance. We want kinetic and dynamic balance, rather than static balance. This is a concept like riding a bicycle, involving motion, equilibrium, poise, aliveness, constant adjustment, and progress. Because humans are continually in motion, from breathing to sitting to walking throughout the day, we need not only furniture and equipment that adapt to our lives, but also workstyle, fitness, nutrition, purpose, and relationships that are a good fit. The goal is to achieve dynamic balance, which implies presence, noticing, paying attention to keep us attuned, enabling us to dynamically shift, adjust, and engage in our lives more fully.

Reduce overexertion. We want to master working smart. When we see the need for change, we want to compare how often things happen, how intense the experiences are, as well as how long they take. It’s useful to make comparisons from one time to the next, by tracking frequency, intensity, and time duration (FIT) statistics. Knowing the numbers will make it easier to optimize your workouts, expand the amount of sleep you need until you reach the ideal level, and build in personal time for yourself. Getting off the grid once a week is a great idea. Track yourself to see if you actually have time to do it. If not, why not? Clearly you deserve it. If this is a sticking point, what is the workaround?

Move your body. Because breath is life, moving your body helps you breathe more. In our work, we have come to believe that breath and breath work are basic to good health. Physical activity helps to synchronize and harmonize all of our vital organ systems, literally the core of our health. If you already work out or exercise, you have this one covered. If not, seriously consider brisk walking or hiking, yoga or tai chi, bicycling, dancing, swimming, team sports, high-intensity training, interval sprints, or any number of other ways to move your body that strengthen and build lung capacity and by extension, stamina, and vitality. Moving your body also means paying attention to how breathing affects your mood and perceptions. Being outside is usually an uplift, so choose to move your body in natural settings whenever possible, whatever form that takes, whether that means running on the beach, hiking trails, or top rope rock climbing—but it could also mean an afternoon of soccer or softball. Being outside is the factor that adds an energetic dimension.

Pay attention. When we are truly present, that helps us shift our intention so we can choose to act in a useful way, rather than simply reacting to circumstances. Pay closer attention to the things you consume and the effects they have on your mind and body. Know what you like and always reserve the right to change your opinion as you learn more about yourself.

Share what you learn. The ideas represented in this book are going to resonate to greater or lesser degrees with some of you. Reread those sections that call to you. Pass along anything that you find interesting or curious or funny or useful. Remember that not everyone has all the benefits that you may have. Everyone has a variety of strengths (and limitations), so share your strengths, and continue working through any limits. Help others learn and grow from your experiences.

Working with Joy and Purpose

1. If you can Pause before and between actions by connecting with the senses;

2. If you can avoid being Critical of others and be Curious instead;

3. If you can resist taking matters personally until fully examined;

4. If you can rest the Attention where your work is happening and let your Creativity shine through;

5. If you have Courage to pursue your dragons and watch them diminish;

6. If you can feed the Heart, Mind, and Spirit every day just as we feed the body;

7. If you can exercise the Body, Mind, Heart, and Spirit every day by dropping circling thoughts, opening the heart, and embracing your beliefs;

8. If you are aware that the Creation is always moving and is built upon Truth, Love, and Consciousness.

—Derek Doyle, P. Eng, MBA

We hope that this book will help you continue to work with joy and purpose.

Acknowledgments: A Note from Erik Peper

Working with colleagues Rick Harvey, Vicci Tibbets, Dianne Shumay, and Katherine Gibney, we began our initial research in 1995, applying a systems perspective and biofeedback to prevent computer injuries. Our research led to the development of group training programs for employees at San Francisco State University, with the support and encouragement of Marsha Allsopp and Denise Fox from human resources.

Our work was a holistic approach to optimize health at the work site. To remind employees to practice health-promoting habits at the computer, Dianne Shumay and I created “Healthy Computing Email Tips,” which were sent weekly. These tips were continued with my colleague Katherine Gibney for the next ten years, in approximately six hundred mailings. Our research studies at San Francisco State University showed that 98.7 percent of the recipients continue to subscribe and more than half (58 percent) of the respondents reported feeling better since receiving the email tips. They were also translated into Dutch by my colleague Albert C. Weijman.

The intervention program at San Francisco State University received a positive response. Our work was subsequently acknowledged with a 2004 State of California Governor’s Employee Safety Award that recognizes performance of individual state employees and groups.

Our research emphasized monitoring psychophysiology at the work site (the actual physical responses of people as they work) resulting in the publication of numerous scientific articles and a book: Erik Peper and Katherine Hughes Gibney, Healthy Computing with Muscle Biofeedback: A Practical Manual for Preventing Repetitive Motion Injury (Woerden, Netherlands: Biofeedback Foundation of Europe, 2000), written for practitioners. In 2006, we published an updated edition complete with a manual: Erik Peper and Katherine Hughes Gibney, Muscle Biofeedback at the Computer: A Manual to Prevent Repetitive Strain Injury (RSI) by Taking the Guesswork Out of Assessment, Monitoring and Training (Amersfoort, Netherlands: Biofeedback Foundation of Europe, 2006).

The concepts that emerged from the research and from collaborations with my Dutch colleague and friend, biologist Albert Weijman, PhD, provided the basis for our 2003 book published in the Netherlands for the general public: Erik Peper and Albert Weijman, De Computermens: Evolutie en preventie van RSI (Rijswijk: Elmar, 2003). We wrote the first draft of that book together facing each other, working on two separate computers, one cold January in Ameland in the Netherlands. Albert wrote in Dutch while I wrote in English. This collaboration also was the basis for the train of thought that came to fruition in this book, seeing contemporary issues from an evolutionary perspective.

The current book in its present form would not have been possible without collaboration with Rick Harvey, PhD. Rick’s exceptional capacity for research has provided an additional dimension to the work, enriching and expanding the concepts, and anchoring them in the research literature. He also has an aptitude to translate complex ideas into a series of logical, pragmatic steps so they are more accessible to readers. His ongoing good nature, humor, and generosity have made this project enjoyable and cemented our friendship.

We thank the many people and students who so generously contributed to the concepts explored in the book: Vietta Wilson, PhD, whose knowledge of sports psychology helped shape our thinking; I-Mei Lin, PhD, who investigated our first exploration of the psychophysiology associated with cell phone use; and Annette Booiman, MSCT, who generously shared the important clinical training insights developed from integrating biofeedback and the Mensendieck method. I also want to thank Michael Schermer and other colleagues from the Nederlands Paramedisch Instituut for providing me the opportunity to participate in and teach the postgraduate training workshops for Dutch physical therapists. We also thank Alex Rodi, who helped distribute the Dutch “Email Tips” and shared our concepts with the general public.

There are so many people who knowingly and unknowingly have contributed to the development of our ideas: Susan Middaugh, PhD; Gabe Sella, MD; George Whatmore, MD; William Taylor, MD; Dennis L. Ettare; Lawrence Schleiffer, PhD; Mari Swingle, PhD; Jeffrey R. Cram, PhD; Kees Lanser; Deborah Quilter; Cathy Holt; Kathy Bender; Alex Pierce; Lawrence Klein; Didier Combatalade; Arlene Frobish, OT; Jasmine Mitose; Emily Rogers; Lauren Mason; John Chetwynd; Yuval Oded, PhD; Devra Davis, PhD; and many others. We thank all the employees, clients, and students who generously shared their experiences and were willing to participate.

We especially want to thank the Backshop, Bakker Elkhuizen, Kinesis Corporation, and BackJoy Orthotics, LLC, for their generosity in sharing the elegant photographs included in the book. We also thank Erik Rosegard, Aiko Yoshino, Christian Martinez, and Matt Thompson for their help with the photos.

This book would never have seen the light of day if it were not for the encouragement and ongoing support of Nancy Faass, MSW, MPH, and her terrific team at HealthWritersGroup.com. Previously, she also skillfully assisted Robert Gorter and me in completing the book Fighting Cancer: A Nontoxic Approach. We also thank our gallant editors at North Atlantic Books, Keith Donnell and Trisha Peck, for their support and encouragement; and Emma Cofod and Kate Kaminski their artistry in the production and design of the book.

Rick thanks his friends and family, and especially Lily Wang Harvey, whose love and support have enormously enriched his life for the better.

I thank my own family, and my caring wife, Karen Peper, for her ongoing support and love that allow me to work creatively and productively and that continue to deepen our relationship.

Rick, Nancy, and I hope you find this book useful.

—Erik

Glossary

applied psychophysiology: A field of study that focuses on the educational and clinical uses of psychophysiology. Emphasis is upon the interrelationship, awareness, and control of physiological, cognitive, and social processes. It is a recent, expanded scientific term used for biofeedback.

asynchronous communication: A message transmitted without receiving immediate feedback as a result of the nature of texting and email. The communicator is unaware of the impact of the communication.

biofeedback: The use of instrumentation to provide individuals with instantaneous information about changes in their physiology; i.e., a psychophysiological mirror showing the mind/body connection.

break program: See computer interrupt programs.

carpal tunnel syndrome (CTS): Compression of the median nerve in the carpal tunnel of the wrist. This is usually associated with soreness, tenderness, and weakness of the thumb muscles. The term is often used to label extreme discomfort and inability to use the arm. One of the disorders associated with CRD. See also computer-related disorders.

cocontraction: The tensing of the agonist and antagonist muscles when only one of them should be contracting.

computer interrupt programs: Computer programs that give a visual or auditory message to remind you to take breaks.

computer-related disorders (CRD): A cluster of chronic symptoms that often involves discomfort or pain, associated with nerves, muscles, tendons, bones, and/or the vascular system, usually attributed to repetitive motion and habitually exceeding maximum work capacity while working at the computer. However, in most cases the etiology is multicausal.

cortisol: Produced by the adrenal cortex, this steroid hormone can become elevated in response to physical or psychological stress. It regulates a wide range of processes throughout the body and has anti-inflammatory and immunosuppressive properties.

DHEA (dehydroepiandrosterone): A hormone produced in the adrenal gland, DHEA is converted into other hormones, including testosterone and estrogen.

deltoid muscle: A large muscle that covers the shoulder and abducts and rotates the arm. Often monitored for excessive efforts during typing and mousing, especially if the arm is abducted or reaching forward.

diabetes: See type 2 diabetes; type 3 diabetes.

diaphragmatic breathing: A breathing pattern in which the major movement is initiated with the diaphragm. The abdomen increases in diameter during inhalation and decreases in diameter during exhalation. A slight chest expansion may occur near the end of inhalation to increase inhalation volume. Usually associated with a slower breathing rate, post-exhalation pauses, and lower arousal. This breathing pattern, if done effortlessly, promotes an anabolic, regenerative state.

differential relaxation: The tightening and relaxing of individual muscles without engaging any other muscle (e.g., tightening the forearm extensors without tightening the deltoid, trapezius, or masseter muscles).

dynamic relaxation: A sequence of relaxation and self-mastery techniques to promote regeneration during the day. It integrates somatic awareness, muscle relaxation, breathing, imagery, and self-healing strategies. See Erik Peper, Katherine Hughes Gibney, and Cathy Holt, Make Health Happen: Training Yourself to Create Wellness (Dubuque, IA: Kendall Hunt, 2002).

dysponesis: Misplaced efforts, muscle contractions, or energy expended during an activity that are not required for the performance of that activity (e.g., raising shoulders when working at the keyboard). From the Greek dys (“bad”) and ponos (“effort,” “work,” or “energy”).

effortless breathing: Breathing diaphragmatically without effort. See diaphragmatic breathing.

electrical and magnetic fields, a.k.a. electromagnetic fields (EMFs): Invisible areas of energy, often referred to as nonionizing radiation, that are associated with the use of electrical power and various forms of natural and artificial lighting. It is the energy by which cell phones and laptops communicate with cell towers.

electromyography (EMG): The recording of the electrical activity of muscles; this measurement is the sum of all the action potentials recorded by the electrodes and correlates with the actual muscle activity.

EMFs: See electrical and magnetic fields.

EMG: See electromyography.

EMG gap: See microbreak.

ergonomics: A process that aims to design appliances, technical systems, and tasks in such a way as to improve human safety, health, comfort, and performance.

esport: Multiplayer video game played competitively by professional gamers who compete globally at the highest level, often watched by millions of people.

forearm extensor muscles: Muscles in the forearm that extend the wrist and fingers (top of the forearm).

forearm flexor muscles: Muscles in the forearm that flex the wrist and fingers (bottom of the forearm).

GERD (gastroesophageal reflux disease): A digestive disorder often described as acid reflux that affects the lower esophageal sphincter muscle area between the esophagus and stomach.

hangry: The combination of the words hungry and angry to describe the irritable moods that people experience when their blood sugar level drops.

interrupt program: A computer program that reminds you to take a break.

La-Z-Boy syndrome: A condition in which a trainee does not generalize the skills, but can only perform them only in the situation in which they learned the skill; e.g., a client receiving training in progressive muscle relaxation can only relax in the recliner chair in the therapist’s office.

macrobreak: A minimum five-minute break every sixty to ninety minutes in which the person leaves the computer station.

microbreak: A momentary break, to reduce muscle tension, that allows regeneration. The blood flows more freely, thus bringing nutrients to the tissue and removing waste products. Microbreaks, also known as EMG gaps, should occur approximately every thirty to sixty seconds and last between 0.5 and 2 seconds.

mindfulness: An attitude of remaining present, watchful, and aware of what is happening without becoming involved or captured by images or feelings. Being truly present implies the absence of anticipating, ruminating, or mind wandering.

overuse syndrome (OS): A syndrome commonly associated with excessive use of a muscle; also called repetitive motion injury and cumulative trauma injury. See also computer-related disorders.

Paleolithic: Relating to a time period when early humans first began to use tools, usually more than ten thousand years ago.

passive attention: An attitude of nonstriving, of allowing versus forcing or trying, which is characterized by the absence of concern for performance and end result.

performing efforts: Muscle efforts necessary for task performance.

phablet: A smartphone with a screen that is intermediate in size between a typical cell phone and a tablet.

precision ergonomic practice (PEP): Applying ergonomic guidelines specifically for the individual and not for the group average.

progressive relaxation: A technique of muscular relaxation developed by Edmund Jacobson. The procedure consists of alternately contracting and relaxing each of the muscle groups of the body. It is frequently used as an adjunctive technique with biofeedback training. See dynamic relaxation.

psychophysiology: A field of study that focuses on the interrelationship, awareness, and control of physiological, cognitive, and social processes. See applied psychophysiology and biofeedback.

repetitive strain injury (RSI): The most common term used to describe the discomfort and injury caused by the repetition of the same movements. See computer-related disorders.

RSI: See repetitive strain injury.

SAR: See specific absorption rate.

scalene muscles: Muscles in the neck that connect the C3, C4, and C5 vertebrae to the first rib, at the top of the rib cage. They stabilize the neck and are accessory muscles of breathing. Increased sEMG activity from these muscles is associated with dysfunctional thoracic breathing.

sEMG: See electromyography

smombie: People who are captured by their smartphones without being aware of the world around them so that they bump into other people or are at risk of becoming a pedestrian fatality. The word is a combination of smartphone and zombie.

somatic awareness: Awareness of the interconnection of mind and body. Our bodies respond to and affect our thoughts and emotions. A process to minimize the negative impact of any stimuli on our psychophysiology.

specific absorption rate (SAR): Measurement of the rate of electromagnetic energy absorption by the body. The standard testing procedures for exposure to electromagnetic energy include positioning devices at a certain distance from the body, such as a few millimeters. In some cases, popular products such as cell phones made by Apple, Samsung, and other manufacturers have SAR ratings very close to the U.S. legal limits, and using the digital devices too close to the body increases the risk of energy exposure from the device at higher than the legal limits.

sternocleidomastoid muscle: The two-headed muscle between the mastoid process and the sternum and clavicle. When contracting, it rotates the head to the opposite side.

surface electromyography: The use of surface electrodes to measure the aggregate electrical potential in the muscles located beneath and between the active electrodes. See also electromyography.

sympathetic arousal: Activation of the sympathetic branch of the autonomic nervous system to prepare the body to respond to stress with vigorous action. The result is an increase in arterial blood pressure, increased cardiac output, increased blood flow to muscles, decreased blood flow to organs that are not needed for defense or running, increased cellular metabolism throughout the body, increased muscle strength, and increased mental activity. Prolonged or chronically high sympathetic arousal shifts the body to a catabolic state.

synchronous communication: A message that is transmitted to which the receiver can give immediate verbal and nonverbal feedback. This is the structure of normal human communication.

texting: The activity of sending text messages from one cell phone to another cell phone. In most cases the language complexity is reduced and simplified with abbreviations such as “u” for you, “4” for for, or “TNX” for thanks.

thoracic breathing: A dysfunctional and strained breathing pattern in which the major movement is initiated by lifting the chest. Usually associated with a faster breathing rate, rapid shallow inhalation, and increased arousal. In most cases there is minimal or even paradoxical abdominal movement. A pattern commonly seen in individuals who are prone to hyperventilation syndrome, anxiety, and upper body and shoulder girdle discomfort. This breathing pattern may promote a catabolic state.

trapezius muscle: Muscle on the upper back and shoulders that rotates the scapula, raises the shoulder, and pulls the head back and to the side. Increased sEMG activity from the upper trapezius muscle (top of the shoulder) is a common dysponetic pattern with individuals working at the computer and those with thoracic breathing patterns.

trigger points: Small tender spots located in a taut band of skeletal muscle and sympathetically enervated and which, when activated, can induce referred pain.

type 2 diabetes: The most common type of diabetes that occurs when blood sugar levels are chronically too high and the body’s cells become resistant to normal levels of insulin. (Insulin helps get blood sugar into the cells to be used for energy.)

type 3 diabetes: Type 3 diabetes is a term that has been proposed for Alzheimer’s disease, which results from resistance to insulin in the brain. The data suggest that people with type 2 diabetes have an increased risk for developing Alzheimer’s disease.

upper extremity musculoskeletal disorder (UEMSD): A descriptor for repetitive motion injury. See computer-related disorders.

Appendix A

Checklist

(Courtesy of Bakker Elkhuizen)

Appendix B

Evolutionary Traps

1. Evolutionary Trap 1.We are genetically hardwired with an attraction to sugars and fats, high-calorie sources of energy for survival. Today this puts us at risk of obesity and diabetes.

2. Evolutionary Trap 2.We are wired to identify danger, which makes us reactive to stress.

3. Evolutionary Trap 3.We are wired to conserve energy in order to heal and regenerate. This also helps us burn fewer calories when food is scarce, hence the potential for lack of movement and sedentary lifestyle (sitting disease).

4. Evolutionary Trap 4.We are wired to see artificial images and to hear reproduced sounds as real. The brain does not discriminate between actual and visual-auditory images that are artificial, which explains one aspect of our attraction to our phones, to binge-watching, and to gaming.

5. Evolutionary Trap 5.We are wired to react to any stimuli that suggests potential danger or the presence of game animals. Whether the stimuli is auditory, visual, tactile, or kinesthetic, it triggers excessive arousal. This makes us vulnerable to screen addiction, because our biology compels us to respond.

6. Evolutionary Trap 6.We are wired to attend to social information about power within our group, a major factor in social media addiction.

7. Evolutionary Trap 7.We are wired to be active during daylight (with its blue-spectrum light), which is why blue-white light from our phones and computers can negatively affect the ability to fall sleep.

Tech Stress Reading and References

Part 1. How Technology Is Hijacking Our Lives

Chapter 1. Getting Back in Sync

INTRODUCTION

Guest at Shankar Vedantam, “Our Better Nature: How the Great Outdoors Can Improve Your Life,” Hidden Brain podcast, September 10, 2018.

REFERENCES

Boers, Elroy, Mohammad H. Afzali, Nicola Newton, and Patricia Conrod. “Association of Screen Time and Depression in Adolescence.” JAMA Pediatrics 173:9 (2019), 853–59. doi:10.1001/jamapediatrics.2019.1759.

Ma, V. Y., L. Chan, and K. J. Carruthers. “Incidence, Prevalence, Costs, and Impact on Disability of Common Conditions Requiring Rehabilitation in the United States: Stroke, Spinal Cord Injury, Traumatic Brain Injury, Multiple Sclerosis, Osteoarthritis, Rheumatoid Arthritis, Limb Loss, and Back Pain.” Archives of Physical Medicine and Rehabilitation 95:5 (May 1, 2014), 986–95.

Swingle, Mari K. i-Minds: How and Why Constant Connectivity Is Rewiring Our Brains and What to Do about It, 2nd edition. Gabriola, Canada: New Society Publishers, 2019.

Weinstein, Stuart I., and Edward H. Yelin. The Burden of Musculoskeletal Diseases in the United States. Forthcoming. www.boneandjointburden.org.

Chapter 2. Genetics

RECOMMENDED READING

Yuval Noah Harari, Sapiens: A Brief History of Mankind (New York: Harper, 2015).

Joseph C. Pearce, Evolution’s End: Claiming the Potential of Our Intelligence (New York: HarperCollins, 1992).

Gary Taubes, The Case Against Sugar (New York: Knopf, 2016).

REFERENCES: EVOLUTIONARY CONTEXT

Bradshaw, Gay A. Elephants on the Edge: What Animals Teach Us about Humanity. New Haven, CT: Yale University Press, 2009.

Braterman, Paul. “Why the Sea Squirt Eats Its Brains Out.” 3 Quarks Daily. June 15, 2015.

Robertson, Bruce. A., Jennifer S. Rehage, and Andrew Sih. “Ecological Novelty and the Emergence of Evolutionary Traps.” Trends in Ecology & Evolution 28:9 (2013), 552–60. doi:10.1016/j.tree.2013.04.004.

Schlaepfer, Martin A., Michael C. Runge, and Paul W. Sherman. “Ecological and Evolutionary Traps.” Trends in Ecology & Evolution 17:10 (2002), 474–80. doi:10.1016/S0169-5347(02)02580-6.

Smithsonian. “Laysan Albatrosses’ Plastic Problem.” Smithsonian Ocean. https://ocean.si.edu/ocean-life/seabirds/laysan-albatrosses-plastic-problem.

Wilcox, Chris, Erik Van Sebille, and Britta Denise Hardesty. “Threat of Plastic Pollution to Seabirds is Global, Pervasive, and Increasing.” Proceedings of the National Academy of Science of the United States of America (PNAS) 112:38 (2015), 11899–904. doi:10.1073/pnas.1502108112.

SUGAR’S ATTRACTION

De la Monte, S. M., M. Tong, and J. R. Wands. “The 20-Year Voyage Aboard the Journal of Alzheimer’s Disease: Docking at ‘Type 3 Diabetes,’ Environmental/Exposure Factors, Pathogenic Mechanisms, and Potential Treatments.” Journal of Alzheimer’s Disease 62:3 (2018), 1381–90. doi:10.3233/JAD-170829.

Murray, C. J. L., M. Ng, and A. Mokdad. “The Vast Majority of American Adults Are Overweight or Obese, and Weight Is a Growing Problem among US Children.” Institute for Health Metrics and Evaluation, University of Washington. May 28, 2014.

Chapter 3. Stress

RECOMMENDED READING

Jon Kabat-Zinn, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, revised edition (New York: Bantam, 2013).

David Ropeik, How Risky Is It, Really? Why Our Fears Don’t Always Match the Facts (New York: McGraw-Hill, 2010).

Stanley Rosenberg, Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism (Berkeley, CA: North Atlantic Books, 2017).

Robert Sapolsky, Why Zebras Don’t Get Ulcers (New York: Owl Books, 2004).

Tarthang Tulku, Kum Nye Relaxation (Cazadero, CA: Dharma Publishing, 1978).

REFERENCES

European Agency for Safety and Health at Work. “European Opinion Poll on Occupational Safety and Health 2013.” EU-OSHA. https://osha.europa.eu/en/facts-and-figures/european-opinion-polls-safety-and-health-work/european-opinion-poll-occupational-safety-and-health-2013.

Humphreys, R. K., and G. D. Ruxton. “A Review of Thanatosis (Death Feigning) as an Anti-Predator Behaviour.” Behavioral Ecology and Sociobiology 72:2 (2018), 22. doi:10.1007/s00265-017-2436-8.

McEwen, Bruce S., Nicole P. Bowles, Jason D. Gray, Matthew N. Hill, Richard G. Hunter, Ilia N. Karatsoreos, and Carla Nasca. “Mechanisms of Stress in the Brain.” Nature Neuroscience 18:10 (2015), 1353. doi:10.1038/nn.4086.

Taylor, S. E., L. C. Klein, B. P. Lewis, T. L. Gruenewald, R. A. Gurung, and J. A. Updegraff. “Biobehavioral Responses to Stress in Females: Tend-and-Befriend, Not Fight-or-Flight.” Psychological Review 107:3 (2000), 411. doi:10.1037/0033-295x.107.3.411.

Tulku, Tarthang. “A View of Mind.” Journal of Transpersonal Psychology 8:1 (1976), 41.

Chapter 4. A Closer Look at Stress

REFERENCES

Gottman, J. M., and J. S. Gottman. “Gottman Couple Therapy.” In Clinical Handbook of Couple Therapy, 5th edition, edited by A. S. Gurman. New York: The Guilford Press, 2008.

Lehrer, Paul. M., and Richard Gevirtz. “Heart Rate Variability Biofeedback: How and Why Does It Work?,” Frontiers in Psychology 5 (2014), 756. https://doi.org/10.3389/fpsyg.2014.00756

Moss, Donald, and Fredric Shaffer. Foundations of Heart Rate Variability Biofeedback: A Book of Readings. Wheat Ridge, CO: Association for Applied Psychophysiology and Biofeedback, 2016.

Porges, Stephen W. (2017). The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. New York: W. W. Norton & Company.

Chapter 5. Inactivity

RECOMMENDED READING

B. K. S. Iyengar, B. K. S. Iyengar Yoga: The Path to Holistic Health (London: DK, 2013).

Bill Phillips, Body for Life (New York: William Morrow, 1999).

John Ratey, Spark: The Revolutionary New Science of Exercise and the Brain (New York: Little, Brown Spark, 2008).

Michelle Segar, No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness (New York: Amacom, 2015).

REFERENCES

Dunstan, Frank, David L. Fone, Myer Glickman, and Stephen Palmer. “Objectively Measured Residential Environment and Self-Reported Health: A Multilevel Analysis of UK Census Data.” PLoS ONE 8:7 (2013), e69045. doi:10.1371/journal.pone.0069045.

Lovett, Richard A. “Sitting Target: Why Doing Nothing Can Kill.” New Scientist 218:2923 (2013), 44–47. doi:10.1016/S0262-4079(13)61627-9.

Chapter 6. Strain

RECOMMENDED READING

Pete Egoscue and Roger Gittines, Pain Free: A Revolutionary Method for Stopping Chronic Pain (New York: Bantam, 2000).

Esther Gokhale and Susan Adams, 8 Steps to a Pain-Free Back: Natural Posture Solutions for Pain in the Back, Neck, Shoulder, Hip, Knee, and Foot (Palo Alto, CA: Pendo Press, 2008).

C. S. Lewis, The Problem of Pain, revised edition (San Francisco: HarperOne, 2015).

John E. Sarno, Healing Back Pain: The Mind-Body Connection (New York: Warner Books, 1991).

REFERENCES

Devereux, J. J., and P. W. Buckle. “The Impact of Work Organisation Design and Management Practices upon Work Related Musculoskeletal Disorder Symptomology.” In Human Factors in Organizational Design and Management—VI, edited by P. Vink, E. A. P. Koningsveld, and S. Dhondt, 275–79. Amsterdam: North-Holland, 1998.

Hansraj, K. K. “Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head.” Surgical Technology International 25 (2014), 277–79.

Muller, Jon. “Repetitive Strain Injuries: 42 New Statistics on RSI and Carpal Tunnel Syndrome Every Worker Should Know.” Ergonomic Trends. http://ergonomictrends.com/rsi-statistics/.

Nixon, P. “Predicting Illness by Numbers.” British Medical Journal 2:6035 (1976), 586.

Peper, E. “Support Healthy Brain Development: Implications for Attention Deficit/Hyperactivity Disorder.” Psychophysiology Today 9:1 (2014), 4–15.

RSI Awareness. “Prevalence.” n.d. http://www.rsi.org.uk/whatis/prevalence.html.

Shumay, D. M., and E. Peper. “Subjective Awareness of Muscle Tension at the Keyboard.” Biofeedback and Self-Regulation 20:3 (September 1995), 283.

Travell, J. G., and D. G. Simons. Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1982.

U.S. Department of Labor. Bureau of Labor Statistics. “Unemployment in November 2009.”

Chapter 7. Am I Addicted to My Phone?

RECOMMENDED READING

Adam Alter, Irresistible: The Rise of Addictive Technology and the Business of Keeping Us Hooked (New York: Penguin Press, 2017).

Aziz Ansari and Eric Klinenberg, Modern Romance (New York: Penguin Press, 2015).

Joe Clement and Matt Miles, Screen Schooled: Two Veteran Teachers Expose How Technology Overuse Is Making Our Kids Dumber (Chicago: Chicago Review Press, 2017).

Robin Dunbar, Grooming, Gossip, and the Evolution of Language (Cambridge, MA: Harvard University Press, 1997).

Franklin Foer, World without Mind: The Existential Threat of Big Tech (New York: Penguin Press, 2017).

Cal Newport, Deep Work: Rules for Focused Success in a Distracted World (New York: Grand Central, 2016).

Eliot Peper, Borderless (Seattle: 47North, 2018). A series of thrillers, focused on the intersection of tech and culture. The series also includes Bandwidth and Breach.

Erik Peper, “Millennials and the Impact of Technology,” The Peper Perspective, https://peperperspective.com/2016/11/.

Simon Sinek, The Infinite Game (New York: Portfolio, 2019).

Jean M. Twenge, iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy—and Completely Unprepared for Adulthood—and What That Means for the Rest of Us (New York: Simon & Schuster, 2017).

REFERENCES

Brinols, A. B., and R. Rajesh. “Multitasking with Smartphones in the College Classroom.” Business and Professional Communication Quarterly 77:1 (2014), 89–95.

Christakis, Dimitri A., Frederick J. Zimmerman, David L. DiGiuseppe, and Carolyn A. McCarty. “Early Television Exposure and Subsequent Attentional Problems in Children.” Pediatrics 113:4 (2004), 708–13. doi:10.1542/peds.113.4.708.

Danner, D. D., D. A. Snowdon, and W. V. Friesen. “Positive Emotions in Early Life and Longevity: Findings from the Nun Study.” Journal of Personality and Social Psychology 80:5 (2001), 804–13.

Darcq, E., and B. L. Kieffer. “Opioid Receptors: Drivers to Addiction?” Nature Reviews Neuroscience 19:8 (2018), 499.

Diamond, Marian C., Bernice Lindner, Ruth Johnson, Edward L. Bennett, and Mark R. Rosenzweig. “Difference in Occipital Cortical Synapses from Environmentally Enriched, Impoverished, and Standard Colony Rats.” Journal of Neuroscience Research 1:2 (1975), 109–19. doi:10.1002/jnr.490010203.

Dunbar, R. I. “Gossip in Evolutionary Perspective.” Review of General Psychology 8:2 (2004), 100–10.

Everitt, B. J., and T. W. Robbins. “Neural Systems of Reinforcement for Drug Addiction: From Actions to Habits to Compulsion.” Nature Neuroscience 8:11 (2005), 1481.

Jarmon, A. L. “Multitasking: Helpful or Harmful?” Student Lawyer 36:8 (2008), 31–35.

Joels, M., H. Karst, D. Alfarez, V. M. Heine, Y. Qin, E. van Riel, M. Verkuyl, P. J. Lucassen, and H. J. Krugers. “Effects of Chronic Stress on Structure and Cell Function in Rat Hippocampus and Hypothalamus.” Stress 7:4 (2004), 221–31.

Maceyko, Ed. “Pedestrian Accident Rates.” Data based on infographic by Ed Maceyko. Ohio State University.

Miyatake, T., K. Katayama, Y. Takeda, A. Nakashima, A. Sugita, and M. Mizumoto. “Is Death-Feigning Adaptive? Heritable Variation in Fitness Difference of Death-Feigning Behaviour.” Proceedings of the Royal Society of London B: Biological Sciences 271:1554 (2004), 2293–96. doi:10.1098/rspb.2004.2858.

Nasar, J. L., and D. Troyer. “Pedestrian Injuries Due to Mobile Phone Use in Public Places.” Accident Analysis and Prevention 57 (2013), 91–95.

Peper, E. “Evolutionary/Environmental Traps Create Illness: Be Aware of Commercialized Stimuli.” Psychophysiology Today 10:1 (2015), 9–11.

Peper, E., and R. Harvey. “Digital Addiction: Increased Loneliness, Depression, and Anxiety.” NeuroRegulation 5:1 (2018), 3–8.

Peper, E., R. Harvey, E. Lin, S. Lau, J. Mitose, and E. Rogers. “Cell Phone and Multitasking Survey of College Students.” Unpublished manuscript. San Francisco State University, 2014.

Peper, E., L. M. Silva, and G. Grasham. “Cell Phone Use by University Students.” Unpublished manuscript. San Francisco State University, 2016.

Povolotskiy R, Gupta N, Leverant AB, Kandinov A, Paskhover B. “Head and Neck Injuries Associated With Cell Phone Use.” JAMA Otolaryngol Head Neck Surg. Published online December 05, 2019. doi:https://doi.org/10.1001/jamaoto.2019.3678

Roberts, J. A., L. H. P. Yaya, and C. Manolis. “The Invisible Addiction: Cell-Phone Activities and Addiction among Male and Female College Students.” Journal of Behavior Addictions 3:4 (2014), 254–65.

Rosenzweig, M. R. “Environmental Complexity, Cerebral Change, and Behavior.” American Psychologist 21:4 (1966), 321–32.

Schulson, Michael. “User Behaviour: Websites and Apps Are Designed for Compulsion, Even Addiction.” Aeon, November 24, 2015.

Snowdon, D. Aging with Grace: What the Nun Study Teaches Us about Leading Longer, Healthier, and More Meaningful Lives (New York: Bantam, 2002).

Snowdon, D. “Healthy Aging and Dementia: Findings from the Nun Study.” Annals of Internal Medicine 139:5, Pt. 2 (2003), 450–54.

Spangler, T. “Are Americans Addicted to Smartphones? U.S. Consumers Check Their Phones 52 Times Daily, Study Finds.” Variety, November 14, 2018.

Chapter 8. Is My Phone Depressing Me?

RECOMMENDED READING

Amy Cuddy. “Your Body Language May Shape Who You Are,” Filmed June 2012 in Edinburgh, Scottland. TED video, 20.48. https://www.ted.com/talks/amy_cuddy_your_body_language_may_shape_who_you_are?language=en

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

M. Strom, A Life Worth Breathing: A Yoga Master’s Handbook of Strength, Grace, and Healing (New York: Skyhorse, 2012).

REFERENCES

Babyak, M., J. A. Blumenthal, S. Herman, P. Khatri, M. Doraiswamy, K. Moore, W. E. Craighead, T. T. Baldewicz, and K. R. Krishnan. “Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months.” Psychosomatic Medicine 62:5 (2000), 633–38.

Canales, J. Z., T. A. Cordás, J. T. Fiquer, A. F. Cavalcante, and R. A. Moreno. “Posture and Body Image in Individuals with Major Depressive Disorder: A Controlled Study.” Revista Brasileira de Psiquiatria 32:4 (2010), 375–80.

Carney, D. R., A. J. Cuddy, and A. J. Yap. “Power Posing Brief Nonverbal Displays Affect Neuroendocrine Levels and Risk Tolerance.” Psychological Science 21:10 (2010), 1363–68.

Cuddy, A. J., S. J., Schultz, and N. E. Fosse. “P-Curving a More Comprehensive Body of Research on Postural Feedback Reveals Clear Evidential Value for ‘Power-Posing’ Effects: Reply to Simmons and Simonsohn (2017).” Psychological Science 29:4 (2018), 656–66.

Deloitte. “Connectivity and Mobile Trends Survey.” 2018. Deloitte Insights. https://www2.deloitte.com/us/en/insights/focus/future-of-mobility/overview.html?id=us:2ps:3bi:confidence:eng:cons:102218:nonem:na:EmgCJc9K:1123805620:77584354592466:bb:Brand_Future_of_Mobility:Brand_Future_of_Mobility_BMM:br.

Dominus, S. “When the Revolution Came for Amy Cuddy.” New York Times Magazine, October 18, 2017.

Eadicicco, L. “Americans Check Their Phones 8 Billion Times a Day.” Time, December 15, 2015.

Faucett, J., and D. Rempel. “VDT‐Related Musculoskeletal Symptoms: Interactions between Work Posture and Psychosocial Work Factors.” American Journal of Industrial Medicine 26:5 (1994), 597–612.

Guan, X., G. Fan, Z. Chen, Y. Zeng, H. Zhang, A. Hu, G. Gu, X. Wu, X. Gu, and S. He. “Gender Difference in Mobile Phone Use and the Impact of Digital Device Exposure on Neck Posture.” Ergonomics 59:11 (2016), 1453–61. doi:10.1080/00140139.2016.1147614.

Hansraj, K. K. “Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head.” Surgical Technology International 25:25 (2014), 277–79.

Michalak, J., N. F. Troje, J. Fischer, P. Vollmar, T. Heidenreich, and D. Schulte. “Embodiment of Sadness and Depression: Gait Patterns Associated with Dysphoric Mood.” Psychosomatic Medicine 71:5 (2009), 580–87. doi:10.1097/PSY.0b013c31e081a2515c.

Michl, L. C., K. A. McLaughlin, K. Shepherd, and S. Nolen-Hoeksema. “Rumination as a Mechanism Linking Stressful Life Events to Symptoms of Depression and Anxiety: Longitudinal Evidence in Early Adolescents and Adults.” Journal of Abnormal Psychology 122:2 (2013), 339. doi:10.1037/a0031994.

Morris, B., V. Smith, J. Elphick, and D. E. Laws. “Compensatory Head Posture and Neck Problems: Is There an Association? A Cohort Study of Nystagmus Patients.” Eye 23:2 (2008), 279. doi:10.1038/sj.eye.6703087.

Peper, E., A. Booiman, I.M. Lin and R. Harvey. (2016). Increase strength and mood with posture. Biofeedback. 44(2) (2016), 66–72.

Peper, E., R. Harvey, and L. Mason. “‘Don’t Slouch!’: Improve Health with Posture Feedback.” Townsend Letter: The Examiner of Alternative Medicine (November 2019), 58–61.

Peper, E., and I-M. Lin, “Increase or Decrease Depression: How Body Postures Influence Your Energy Level.” Biofeedback 40:3 (2012), 126–30.

Peper, E., I-M. Lin, R. Harvey, and J. Perez. “How Posture Affects Memory Recall and Mood.” Biofeedback 45:2 (2017), 36–41. doi:10.5298/1081-5937-45.2.01.

Sharan, D., and P. S. Ajeesh. “Risk Factors and Clinical Features of Text Message Injuries.” Work 41:Suppl. 1 (2012), 1145–48.

Sharan, Deepak, Mathankumar Mohandoss, Rameshkumar Ranganathan, and Jeena Jose. “Musculoskeletal Disorders of the Upper Extremities Due to Extensive Usage of Handheld Devices.” Annals of Occupational and Environmental Medicine 26:1 (2014), 22.

Singal, Jesse, and Melissa Dahl. “Here Is Amy Cuddy’s Response to Critiques of Her Power-Posing Research.” The Cut, September 30, 2016. https://www.thecut.com/2016/09/read-amy-cuddys-response-to-power-posing-critiques.html.

Taylor, Kevin, and Nicola Green. “Psychosocial Risk Factors: What Are They and Why Are They Important?” Wellnomics white paper, 2015.

Tsai, H. Y., E. Peper, and I-M. Lin. “EEG Patterns under Positive/Negative Body Postures and Emotion Recall Tasks.” NeuroRegulation 3:1 (2016), 23–27.

Waderich, K., E. Peper, R. Harvey, and S. Suter. “The Psychophysiology of Contemporary Information Technologies: Tablets and Smartphones Can Be a Pain in the Neck.” Applied Psychophysiology and Biofeedback 38:3 (September 2013), 219.

Wilkes, C., R. Kydd, M. Sagar, and E. Broadbent. “Upright Posture Improves Affect and Fatigue in People with Depressive Symptoms.” Journal of Behavior Therapy and Experimental Psychiatry 54 (2017), 143–49.

Wilson, V. E., and E. Peper. “The Effects of Upright and Slumped Postures on the Generation of Positive and Negative Thoughts.” Applied Psychophysiology and Biofeedback 29:3 (2004), 189–95.

Chapter 9. Caught Up in the 24/7 Lifestyle?

RECOMMENDED READING

Linda Geddes: Chasing the Sun: How the Science of Sunlight Shapes Our Bodies and Minds. New York: Pegasus Books, 2019.

M. Lesser, Less: Accomplishing More by Doing Less, 16th edition (Surry Hills, Australia: ReadHowYouWant, 2012).

W. Muller, Sabbath: Finding Rest, Renewal, and Delight in Our Busy Lives (New York: Bantam, 2005).

REFERENCES

Content on Circadian Balance

Bellis, M. “The History of the Shopping Mall.” ThoughtCo, March 31, 2018.

Bernier, D. “A Study of Coping: Successful Recovery from Severe Burnout and Other Reactions to Severe Work-Related Stress.” Work & Stress 12 (1998), 50–65.

Dembe, A. E., J. B. Erickson, R. G. Delbos, and S. M. Banks. “The Impact of Overtime and Long Work Hours on Occupational Injuries and Illnesses: New Evidence from the United States.” Occupational and Environmental Medicine 62:9 (2005), 588–97. doi:10.1136/oem.2004.016667.

Dijk, D.-J., D. F. Neri, J. K. Wyatt, J. M. Ronda, E. Riel, A. Ritz-De Cecco, R. J. Hughes, A. R. Elliott, G. K. Prisk, J. B. West, and C. A. Czeisler. “Sleep, Performance, Circadian Rhythms, and Light-Dark Cycles during Two Space Shuttle Flights.” American Journal of Physiology—Regulatory, Integrative and Comparative Physiology 281:5 (2001), R1647–64. doi:10.1152/ajpregu.2001.281.5.R1647.

Fottrell, Q. “People Spend Most of Their Waking Hours Staring at Screens.” MarketWatch, August 4, 2018.

Gross, Daniel A. “This Is Your Brain on Silence.” Nautilus 21 (2014). https://getpocket.com/explore/item/this-is-your-brain-on-silence.

Katz, L. F., and A. B. Krueger. “The Rise and Nature of Alternative Work Arrangements in the United States, 1995–2015.” ILR Review 72:2 (2019), 382–416.

Lynch, Teresa, Jessica E. Tompkins, Irene I. van Driel, and Niki Fritz. “Sexy, Strong, and Secondary: A Content Analysis of Female Characters in Video Games across 31 Years.” Journal of Communication 66:4 (2016), 564–84. doi:10.1111/jcom.12237.

McCrate, E. “Unstable and On-Call Work Schedules in the United States and Canada.” International Labour Organization. 2018. No. 994978592602676.

Megdal, S. P., C. H. Kroenke, F. Laden, E. Pukkala, and E. S. Schernhammer. “Night Work and Breast Cancer Risk: A Systematic Review and Meta-Analysis.” European Journal of Cancer 41:13 (2005), 2023–32. doi:10.1016/j.ejca.2005.05.010.

Travis, Ruth C., Angela Balkwill, Georgina K. Fensom, Paul N. Appleby, Gillian K. Reeves, Xiao-Si Wang, Andrew W. Roddam, Toral Gathani, Richard Peto, Jane Green, et al. “Night Shift Work and Breast Cancer Incidence: Three Prospective Studies and Meta-Analysis of Published Studies.” Journal of the National Cancer Institute 108:12 (2016), djw169. doi:10.1093/jnci/djw169.

van Stralen, Myrthe. “The Effect of Light on Performance.” Bakker Elkhuizen. n.d. https://www.bakkerelkhuizen.com/en-us/knowledge-center/the-effect-of-light-on-performance/.

Role of Circadian Rhythm in 24/7 Lifestyle

Dijk, D.-J., D. F. Neri, J. K. Wyatt, J. M. Ronda, E. Riel, A. Ritz-De Cecco, R. J. Hughes, A. R. Elliott, G. K. Prisk, J. B. West, and C. A. Czeisler. “Sleep, Performance, Circadian Rhythms, and Light-Dark Cycles during Two Space Shuttle Flights.” American Journal of Physiology—Regulatory, Integrative and Comparative Physiology 281:5 (2001), R1647–64. doi:10.1152/ajpregu.2001.281.5.R1647.

Flynn-Evans, E., Laura K. Barger, Alan A. Kubey, Jason P. Sullivan, and Charles A. Czeisler. “Circadian Misalignment Affects Sleep and Medication Use before and during Spaceflight.” NPJ Microgravity 2 (2016), 15019. doi:10.1038/npjmgrav.2015.19.

Kleitman, N. “Studies on the Physiology of Sleep: VIII. Diurnal Variation in Performance.” American Journal of Physiology 104 (1933), 449–56.

Lockley, S. W., G. C. Brainard, and C. A. Czeisler. “High Sensitivity of the Human Circadian Melatonin Rhythm to Resetting by Short Wavelength Light.” Journal of Clinical Endocrinology & Metabolism 88:9 (2003), 4502–5.

Lockley, S. W., E. E. Evans, F. A. Scheer, G. C. Brainard, C. A. Czeisler, and D. Aeschbach. “Short-Wavelength Sensitivity for the Direct Effects of Light on Alertness, Vigilance, and the Waking Electroencephalogram in Humans.” Sleep 29:2 (2006), 161–68.

Sack, R. L., M. L. Blood, R. J. Hughes, and A. J. Lewy. “Circadian-Rhythm Sleep Disorders in Persons Who Are Totally Blind.” Journal of Visual Impairment & Blindness 92:3 (1998), 145–61.

van Stralen, Myrthe. “The Effect of Light on Performance.” Bakker Elkhuizen. n.d. https://www.bakkerelkhuizen.com/en-us/knowledge-center/the-effect-of-light-on-performance/.

Chapter 10. Living a Virtual Life?

RECOMMENDED READING

J. Clement and M. Miles, Screen Schooled: Two Veteran Teachers Expose How Technology Overuse Is Making Our Kids Dumber (Chicago: Chicago Review Press, 2017).

J. Mander, Four Arguments for the Elimination of Television (New York: William Morrow, 1978).

R. D. Putnam, Bowling Alone: The Collapse and Revival of American Community (New York: Simon & Schuster, 2000). See “Culture and Politics,” pp. 223–34.

Jean M. Twenge, iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy—and Completely Unprepared for Adulthood—and What That Means for the Rest of Us (New York: Simon & Schuster, 2017).

REFERENCES

Hensley, B., P. Martin, J. A. Margrett, M. MacDonald, I. C. Siegler, L. W. Poon, S. M. Jazwinski, R. C. Green, M. Gearing, J. L. Woodard, et al. “The Georgia Centenarian Study, 1. Life Events and Personality Predicting Loneliness among Centenarians: Findings from the Georgia Centenarian Study.” The Journal of Psychology 146:1–2 (2012), 173–88. doi:10.1080/00223980.2011.613874.

Kross, E., P. Verduyn, M. Boyer, B. Drake, I. Gainsburg, B. Vickers, O. Ybarra, and J. Jonides. “Does Counting Emotion Words on Online Social Networks Provide a Window into People’s Subjective Experience of Emotion? A Case Study on Facebook.” Emotion 19:1 (2018), 97–107.

Part 2. Coping Strategies

Chapter 11. Thirty Hacks for Sleep

RECOMMENDED READING

N. Littlehales, Sleep: The Myth of 8 Hours, the Power of Naps, and the New Plan to Recharge Your Body and Mind (New York: Hachette, 2018).

C. Ober, S. T. Sinatra, and M. Zucker, Earthing: The Most Important Health Discovery Ever? (Laguna Beach, CA: Basic Health, 2010).

J. L. Oschman, G. Chevalier, and A. C. Ober, “Biophysics of Earthing (Grounding) the Human Body,” Bioelectromagnetic and Subtle Energy Medicine 38 (2015), 427–48.

S. Rosenberg and B. Shield, Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism (Berkeley, CA: North Atlantic Books, 2017).

Mark Stephens, Yoga for Better Sleep (Berkeley, CA: North Atlantic Books, 2019).

M. Walker, Why We Sleep: Unlocking the Power of Sleep and Dreams (New York: Scribner, 2017).

REFERENCES

Allebach, N. W. “The Royal Air Force Institute of Aviation Medicine, Farnborough, Hampshire (No. ONRL-R-49-69).” Office of Naval Research, London. 1969.

Blask, D. B. “Melatonin, Sleep Disturbance and Cancer Risk.” Sleep Medicine Reviews 13 (2009), 257–64.

Chevalier, Gaétan, Stephen T. Sinatra, James L. Oschman, Karol Sokal, and Pawel Sokal. “Earthing: Health Implications of Reconnecting the Human Body to the Earth’s Surface Electrons.” Journal of Environmental and Public Health (2012), 291541. doi:10.1155/2012/291541.

Dijk, D., and R. Winsky-Sommerer. “Sleep: How Much We Need and What Keeps Us Awake.” New Scientist 213:2850 (2012), i–vii.

Gooley, J. J., K. Chamberlain, K. A. Smith, S. B. Khalsa, S. M. Rajaratnam, E. Van Reen, J. M. Zeitzer, C. A. Czeisler, and S. W. Lockley. “Exposure to Room Light before Bedtime Suppresses Melatonin Onset and Shortens Melatonin Duration in Humans.” Journal of Clinical Endocrinology & Metabolism 96:3 (2011), E463–72. doi:10.1210/jc.2010-2098.

Kleitman, N. “Studies on the Physiology of Sleep: VIII. Diurnal Variation in Performance.” American Journal of Physiology 104 (1933), 449–56.

Morelle, R. “Light Pollution Affects 80% of Global Population.” BBC News, June 10, 2016. https://www.bbc.com/news/science-environment-36492596.

Sack, R. L., M. L. Blood, R. J. Hughes, and A. J. Lewy. “Circadian-Rhythm Sleep Disorders in Persons Who Are Totally Blind.” Journal of Visual Impairment & Blindness 92:3 (1998), 145–61.

Teitelbaum, J. “Piecing Together the Puzzle of Fibromyalgia.” Alternative and Complementary Therapies 19:6 (2013), 296–300.

Tronick, E. The Neurobehavioral and Social-Emotional Development of Infants and Children. New York: W. W. Norton, 2007.

Chapter 12. Getting Off the Grid

RECOMMENDED READING

M. Lesser, Less: Accomplishing More by Doing Less (Novato, CA: New World Library, 2009).

R. Louv, Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder (Chapel Hill, NC: Algonquin Books, 2008).

S. Pellis and V. Pellis, The Playful Brain: Venturing to the Limits of Neuroscience (London: Oneworld, 2009).

Chapter 13. Hangry? Low Blood Sugar?

RECOMMENDED READING

T. Christofferson, Tripping over the Truth: How the Metabolic Theory of Cancer Is Overturning One of Medicine’s Most Entrenched Paradigms (White River Junction, VT: Chelsea Green Publishing, 2017).

M. Hyman, The Blood Sugar Solution 10-Day Detox Diet (New York: Little, Brown Spark, 2014).

M. Hyman, Eat Fat, Get Thin (New York: Little, Brown Spark, 2016).

M. Hyman, Food: What the Heck Should I Eat? (New York: Little, Brown Spark, 2018).

Michael Pollan, The Omnivore’s Dilemma: A Natural History of Four Meals (New York: Penguin Press, 2006).

Michael Pollan, In Defense of Food: An Eater’s Manifesto (New York: Penguin Press, 2009).

Gary Taubes, The Case Against Sugar (New York: Knopf, 2016).

T. Wahls and E. Adamson, The Wahls Protocol Cooking for Life (New York: Avery, 2017).

REFERENCES

Barański, M., D. Srednicka-Tober, N. Volakakis, C. Seal, R. Sanderson, G. B. Stewart, C. Benbrook, B. Biavati, E. Markellou, C. Giotis, et al., “Higher Antioxidant and Lower Cadmium Concentrations and Lower Incidence of Pesticide Residues in Organically Grown Crops: A Systematic Literature Review and Meta-Analyses.” British Journal of Nutrition 112:5 (2014), 794–811. doi:10.1017/S0007114514001366.

Carter, S. E., R. Draijer, S. M. Holder, L.Brown, D. H. J. Thijssen, and N. D. Hopkins. “Regular walking breaks prevent the decline in cerebral blood flow associated with prolonged sitting.” Journal of Applied Physiology 125: 3 (2018), 790-798.

Chhabra, R., S. Kolli, and J. H. Bauer. “Organically Grown Food Provides Health Benefits to Drosophila melanogaster.” PLoS ONE 8:1 (2013): e52988.

Danziger, S., J. Levav, and L. Avnaim-Pesso. “Extraneous Factors in Judicial Decisions.” Proceedings of the National Academy of Sciences of the USA 108:17 (2011), 6889–92.

Das, U. N. “Sucrose, Fructose, Glucose, and Their Link to Metabolic Syndrome and Cancer.” Nutrition 31:1 (2015), 249–57.

Imamura, F., L. O’Connor, Z. Ye, J. Mursu, Y. Hayashino, S. N. Bhupathiraju, and N. G. Forouhi. “Consumption of Sugar Sweetened Beverages, Artificially Sweetened Beverages, and Fruit Juice and Incidence of Type 2 Diabetes: Systematic Review, Meta-Analysis, and Estimation of Population Attributable Fraction.” British Medical Journal (2015), 351:j3576. doi:10.1136/bmj.h3576.

Kandimalla, R., V. Thirumala, and P. H. Reddy. “Is Alzheimer’s Disease a Type 3 Diabetes? A Critical Appraisal.” Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease 1863:5 (2017), 1078–89. doi:10.1016/j.bbadis.2016.08.018.

Kummerow, F. A. “The Negative Effects of Hydrogenated Trans Fats and What to Do about Them.” Atherosclerosis 205:2 (2009), 458–65.

Price, Weston. Nutrition and Physical Degeneration, 8th ed. Lemon Grove, CA: Price-Pottenger Nutrition Foundation, 2009.

Waller, G., M. Babbs, R. Milligan, C. Meyer, V. Ohanian, and N. Leung. “Anger and Core Beliefs in the Eating Disorders.” International Journal of Eating Disorders 34:1 (2003), 118–24.

Yang, Quanhe, Z. Zhang, E. W. Gregg, W. D. Flanders, R. Merritt, and F. B. Hu. “Added Sugar Intake and Cardiovascular Diseases Mortality among US Adults.” JAMA Internal Medicine 174:4 (2014), 516–24. doi:10.1001/jamainternmed.2013.13563.

Chapter 14. Taking Microbreaks

RECOMMENDED READING

Carter, Sophie E., Richard Draijer, Sophie M. Holder, Louise Brown, Dick H. J. Thijssen, and Nicola D. Hopkins. “Regular Walking Breaks Prevent the Decline in Cerebral Blood Flow Associated with Prolonged Sitting.” Journal of Applied Physiology 125:3 (2018), 790 -98.

Chapter 15. Dynamic Movement (a.k.a. Exercise)

RECOMMENDED READING

See the chapter 5 recommended reading list.

REFERENCES

See the chapter 3 reference list.

Chapter 16. Dealing with Chronic Stress

RECOMMENDED READING

John M. Gottman, and N. Silver. The Seven Principles for Making Marriage Work (New York: Harmony, 2015).

A. Huffington, Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, and Wonder (New York: Harmony, 2014).

P. Walker, Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma (Scotts Valley, CA: Createspace, 2013).

REFERENCES

Chronic Stress

Gurian, D. What Could He Be Thinking? (New York: St. Martin’s Press, 2003).

Hedges, Chris. What Every Person Should Know about War (New York: Free Press, 2003).

Miller, Diane B., and James P. O’Callaghan. “Neuroendocrine Aspects of the Response to Stress.” Metabolism—Clinical and Experimental 51:6 (2002), 5 -10.

Ouanes, S. and J.Popp. “High Cortisol and the Risk of Dementia and Alzheimer’s Disease: A Review of the Literature.” Frontiers in Aging Neuroscience 11 (2019).

Patterson, Kerry, Joseph Grenny, Ron McMillan, and Al Switzler. Crucial Conversations: Tools for Talking When Stakes Are High (New York: McGraw-Hill, 2002).

Rosenberg, S., and B. Shield. Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism (Berkeley, CA: North Atlantic Books, 2017).

Sapolsky, R. Why Zebras Don’t Get Ulcers (New York: Owl Books, 2004).

Selye, Hans. The Stress of Life. New York: McGraw-Hill Book Company, 1956.

Tolle, E. The Power of Now (Novato, CA: New World Library, 1999).

Vedantam, Shankar. Hidden Brain, NPR podcast, 2020, https://www.npr.org/podcasts/510308/hidden-brain.

Gender Differences in Stress

Bateup, Helen S., Alan Booth, Elizabeth A. Shirtcliff, and Douglas A. Granger. “Testosterone, Cortisol, and Women’s Competition.” Evolution and Human Behavior 23:3 (2002), 181–92. doi:10.1016/S1090-5138(01)00100-3.

Gao, Shan, Benjamin Becker, Lizhu Luo, Yayuan Geng, Weihua Zhao, Yu Yin, Jiehui Hu, Zhao Gao, Qiyong Gong, Rene Hurlemann, et al. “Oxytocin, the Peptide That Bonds the Sexes Also Divides Them.” Proceedings of the National Academy of Sciences of the USA 113:27 (2016), 7650–54. doi:10.1073/pnas.1602620113.

Gottman, J. M., and J. S. Gottman. “Gottman Method Couple Therapy.” In Clinical Handbook of Couple Therapy, 4th ed., edited by A. S. Gurman, 138–64. New York: Guilford Press, 2008.

Heinrichs, M., T. Baumgartner, C. Kirschbaum, and U. Ehlert. “Social Support and Oxytocin Interact to Suppress Cortisol and Subjective Responses to Psychosocial Stress.” Biological Psychiatry 54:12 (2003), 1389–98. doi:10.1016/s0006-3223(03)00465-7.

Shansky, R., M. C. Glavis-Bloom, D. Lerman, P. McRae, C. Benson, K. Miller, L. Cosand, T. L. Horvath, and A. F. Arnsten. “Estrogen Mediates Sex Differences in Stress-Induced Prefrontal Cortex Dysfunction.” Molecular Psychiatry 9:5 (2004), 531–38. doi:10.1038/sj.mp.4001435.

Taylor, S. E., L. C. Klein, B. P. Lewis, T. L. Gruenewald, R. A. Gurung, and J. A. Updegraff. “Biobehavioral Responses to Stress in Females: Tend-and-Befriend, Not Fight-or-Flight.” Psychological Review 107:3 (2000), 411. doi:10.1037/0033-295x.107.3.411.

Stress and Coping

Gross, James J., ed. Handbook of Emotion Regulation (New York: The Guilford Press, 2013).

Kemeny, M. E. “The Psychobiology of Stress.” Current Directions in Psychological Science 12:4 (2003), 124–29.

McCraty, R. “Heart-Brain Neurodynamics: The Making of Emotions.” In Media Models to Foster Collective Human Coherence in the PSYCHecology, edited by S. B. Schafer, 191–219. Hershey, PA: IGI Global, 2019.

McEwen, Bruce S., Nicole P. Bowles, Jason D. Gray, Matthew N. Hill, Richard G. Hunter, Ilia N. Karatsoreos, and Carla Nasca. “Mechanisms of Stress in the Brain.” Nature Neuroscience 18:10 (2015), 1353. doi:10.1038/nn.4086.

Chapter 17. Skills for Sanity

17.1. IDENTIFYING ENERGY DRAINS AND GAINS

Recommended Reading

D. Goleman, Emotional Intelligence (New York: Bantam, 2006).

J. Gordon, The Energy Bus: 10 Rules to Fuel Your Life, Work, and Team with Positive Energy (New York: Wiley, 2007).

Lawrence LeShan, Cancer as a Turning Point: A Handbook for People with Cancer, Their Families, and Health Professionals (New York: Penguin, 1994).

M. E. P. Seligman, Flourish: A Visionary New Understanding of Happiness and Well-being (New York: Atria Books, 2012).

M. E. P. Seligman, Learned Optimism (New York: Alfred A. Knopf, 1991).

17.3. KNOWING WHO YOU ARE

Recommended Reading

Loretta Graziano Breuning, Habits of a Happy Brain (Avon, MA: Adams Media, 2015).

H. Fisher, Why Him? Why Her? Finding Real Love by Understanding Your Personality Type (New York: Henry Holt and Co., 2009).

David Kiersey and Marilyn Bates, Please Understand Me: Character and Temperament Types (Del Mar, CA: Prometheus Nemesis, 1978).

Isabel Briggs Myers, Mary H. McCaulley, Naomi L. Quenk, and Allen L. Hammer, MBTI Manual: A Guide to the Development and Use of the Myers-Briggs Type Indicator, 3rd edition. (Mountain View, CA: Consulting Psychologists Press, 1998).

J. Niednagel, Brain Typing: The Amazing New Science for Understanding Yourself and Others, audiobook (Wheeling, IL: Nightingale-Conant, 2014).

J. Widerstrom, Diet Right for Your Personality Type (New York: Harmony Books, 2017).

References

Arikha, N. Passions and Tempers: A History of the Humours (New York: Ecco Press, 2007).

Garland, E. L., B. Fredrickson, A. M. Kring, D. P. Johnson, P. S. Meyer, and D. L. Penn. “Upward Spirals of Positive Emotions Counter Downward Spirals of Negativity: Insights from the Broaden-and-Build Theory and Affective Neuroscience on the Treatment of Emotion Dysfunctions and Deficits in Psychopathology.” Clinical Psychology Review 30:7 (2010), 849–64.

Klassen, R. M., L. L. Krawchuk, and S. Rajani. “Academic Procrastination of Undergraduates: Low Self-Efficacy to Self-Regulate Predicts Higher Levels of Procrastination.” Contemporary Educational Psychology 33:4 (2008), 915–31.

Peper, Erik. “Change Learned Behavior and Increase Energy by Changing Thoughts.” Western Edition, April 2016, 4.

Peper, Erik, Katherine Hughes Gibney, and Cathy Holt. Make Health Happen: Training Yourself to Create Wellness (Dubuque, IA: Kendall Hunt, 2002).

Peper, Erik, R. Harvey, and I-M. Lin. “Increase Productivity, Decrease Procrastination and Increase Energy.” Biofeedback 42:2 (2014), 82–87.

Sandvik, A. M., P. T. Bartone, S. W. Hystad, T. M. Phillips, J. F. Thayer, and B. H. Johnsen. “Psychological Hardiness Predicts Neuroimmunological Responses to Stress.” Psychology, Health & Medicine 18:6 (2013), 705–13.

Solomon, L. J., and E. D. Rothblum. “Academic Procrastination: Frequency and Cognitive Behavioral Correlates.” Journal of Counseling Psychology 31:4 (1984), 503–9.

Chapter 18. Reframing

18.1. TURNING FAILURE INTO SUCCESS

Recommended Reading

David D. Burns, Feeling Good: The New Mood Therapy (New York: Harper, 2008).

Fred Luskin, Forgive for Love: The Missing Ingredient for a Healthy and Lasting Relationship (San Francisco: HarperOne, 2007).

References

Chan, C. K., and L. D. Cameron. “Promoting Physical Activity with Goal-Oriented Mental Imagery: A Randomized Controlled Trial.” Journal of Behavioral Medicine 35:3 (2012), 347–63.

Fisher, Helen. Anatomy of Love: A Natural History of Mating, Marriage, and Why We Stray (New York: Ballantine, 1994).

Fisher, Helen. Why We Love: The Nature and Chemistry of Romantic Love (New York: Henry Holt, 2004).

Gorter, R. and E. Peper. Fighting Cancer: A Nontoxic Approach to Treatment (Berkeley, CA: North Atlantic Books, 2011), 107–200.

Liu, K. P., C. C. Chan, T. M. Lee, and C. W. Hui-Chan. “Mental Imagery for Promoting Relearning for People after Stroke: A Randomized Controlled Trial.” Archives of Physical Medicine and Rehabilitation 85:9 (2004), 1403–8. doi:10.1016/j.apmr.2003.12.035.

Sommers-Flanagan, J., and L. Barr. “Three Constructive Interventions for Divorced, Divorcing, or Never-Married Parents.” The Family Journal 13:4 (2005), 482–86.

Chapter 19. Overcoming Burnout

RECOMMENDED READING

D. Glouberman, The Joy of Burnout. How the End of the World Can Be a New Beginning (Novato, CA: Inner Ocean, 2003).

E. Nagoski and A. Nagoski, Burnout: The Secret to Unlocking the Stress Cycle (New York: Ballantine, 2019).

Chapter 20. Recovering from Injury

RECOMMENDED READING

S. R. Maddi, R. H. Harvey, D. M. Khoshaba, J. L. Lu, M. Perisco, and M. Brow, “The Personality Construct of Hardiness, III: Relationships with Repression, Innovativeness, Authoritarianism, and Performance,” Journal of Personality 74:2 (2006), 575–98. doi:10.1111/j.1467-6494.2006.00385.x.

S. R. Maddi, “Hardiness as a Pathway to Resilience under Stress,” The Routledge International Handbook of Psychosocial Resilience, edited by Updesh Kumar, 104–10. (Abingdon, UK: Routledge, 2016).

S. McGill and B. Carroll, Gift of Injury: The Strength Athlete’s Guide to Recovering from Back Injury and Winning Again (Ontario, Canada: BackFitPro, 2017).

B. Walker, The Anatomy of Stretching: Your Illustrated Guide to Flexibility and Injury Rehabilitation, 2nd edition (Berkeley, CA: North Atlantic Books, 2011).

REFERENCES

Cohen, Sheldon, Denise Janicki-Deverts, William J. Doyle, Gregory E. Miller, Ellen Frank, Bruce S. Rabin, and Ronald B. Turner. “Chronic Stress, Glucocorticoid Receptor Resistance, Inflammation, and Disease Risk.” Proceedings of the National Academy of Sciences 109:16 (2012), 5995 -99.

Peper, Erik, Katherine H. Gibney, and Vietta Wilson. “Group Training with Healthy Computing Practices to Prevent Repetitive Strain Injury (RSI): A Preliminary Study.” Applied Psychophysiology and Biofeedback 29:4 (2004), 279–87.

Part 3. Practical Ergonomics

Chapter 21. The Basics

REFERENCES

Pascarelli, E., and D. Quilter. Repetitive Strain Injury: A Computer User’s Guide (New York: Wiley, 1994).

Peper, Erik, and Katherine Hughes Gibney. Healthy Computing with Muscle Biofeedback: A Practical Manual for Preventing Repetitive Motion Injury. Woerden, Netherlands: Biofeedback Foundation of Europe, 2000. Available in the United States from BiofeedbackHealth, 2236 Derby Street, Berkeley, CA 94705.

Peper, Erik, and Katherine Hughes Gibney. Muscle Biofeedback at the Computer: A Manual to Prevent Repetitive Strain Injury (RSI) by Taking the Guesswork out of Assessment, Monitoring and Training (Amersfoort, Netherlands: Biofeedback Foundation of Europe, 2006).

Peper, Erik, and A. C. M. Weijman. De Computermens: Evolutie en preventie van RSI (Rijswijk, Netherlands: Elmar, 2003).

Quilter, D. The Repetitive Strain Injury Recovery Book (Bloomington, IN: iUniverse, 2008).

Shaw, Bernard. (1890). Man and Superman: A Comedy and a Philosophy. New York: Penguin Classics.

VISION AND LIGHTING

Recommended Reading

D. Norman, The Design of Everyday Things: Revised and Expanded Edition (New York: Basic Books, 2013).

S. Russell, The Architecture of Light (2nd edition): A Textbook of Procedures and Practices for the Architect, Interior Designer and Lighting Designer (Conceptnine, 2012).

M. Schneider, Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement (Berkeley, CA: North Atlantic Books, 2016).

References

Devereux, J. J., and P. W. Buckle. “The Impact of Work Organisation Design and Management Practices upon Work Related Musculoskeletal Disorder Symptomology.” In Human Factors in Organizational Design and Management—VI, edited by P. Vink, E. A. P. Koningsveld, and S. Dhondt, 275–79. Amsterdam: North-Holland, 1998.

Holden, Brien A., David A. Wilson, Monica Jong, Padmaja Sankaridurg, Timothy R. Fricke, Earl L. Smith III, and Serge Resnikoff. “Myopia: A Growing Global Problem with Sight-Threatening Complications.” Community Eye Health 28:90 (2015), 35.

Joyce, Nick. “Alphonse Chapanis: Pioneer in the Application of Psychology to Engineering Design.” APS Observer, April 1, 2010, 23.

Meister, D. The History of Human Factors and Ergonomics (Mahwah, NJ: Lawrence Erlbaum Associates, 1999).

van Stralen, Myrthe. “The Effect of Light on Performance.” Bakker Elkhuizen. n.d. https://www.bakkerelkhuizen.com/en-us/knowledge-center/the-effect-of-light-on-performance/.

Whitebread, D., and S. Bingham. “Too Much, Too Young.” New Scientist, November 16, 2013, 28–29.

Chapter 22. Which Desk? Which Chair?

REFERENCES

Alderman, B. L., R. L. Olson, and D. M. Mattina. “Cognitive Function during Low-Intensity Walking: A Test of the Treadmill Workstation.” Journal of Physical Activity and Health 11:4 (2014), 752–58.

Gibbs, B. B., R. J. Kowalsky, S. J. Perdomo, M. Grier, and J. M. Jakicic. “Energy Expenditure of Deskwork When Sitting, Standing, or Alternating Positions.” Occupational Medicine 67:2 (2017), 121–27. doi:10.1093/occmed/kqw115.

Pronk, N. P., A. S. Katz, M. Lowry, and J. R. Payfer. “Reducing Occupational Sitting Time and Improving Worker Health: The Take-a-Stand Project, 2011.” Preventing Chronic Disease 9:E154 (2012). doi:10.5888.pcd9.110323.

Sackett, David L. “Evidence-Based Medicine.” Seminars in Perinatology 21:1 (1997), 3-5.

Chapter 23. Monitors and Mice

RECOMMENDED READING

K. B. Bennett and J. M. Flach, Display and Interface Design: Subtle Science, Exact Art (Boca Raton, FL: CRC Press, 2011).

P. Linden, Comfort at Your Computer: Body Awareness Training for Pain-Free Computer Use (Berkeley, CA: North Atlantic Books, 2000).

Chapter 25. Minimizing Risk

ESPORTS

References

Helfenstein Jr., M., M. S. Ferreira, A. B. Maia, C. A. Siena, and A. Techy. “Ultrasonography for the Diagnosis of Tendinitis and Electromyography for the Diagnosis of Peripheral Neuropathy and Upper Limb Radiculopathy—Rheumatologists’ Perspectives.” Revista Brasileira de Reumatologia 53:3 (2013), 282–87.

Influencer Marketing Hub. “Leverage the Growth of eSports in 2019.” March 28, 2019. https://influencermarketinghub.com.

Syracuse Staff. “With Viewership and Revenue Booming, eSports Set to Compete with Traditional Sports.” Whitman School of Management, Syracuse University. January 18, 2019 https://onlinebusiness.syr.edu/blog/esports-to-compete-with-traditional-sports/.

EMF EXPOSURE

Recommended Reading

Devra Davis, Disconnect: The Truth about Cell Phone Radiation, What the Industry Has Done to Hide It, and How to Protect Your Family (New York: Dutton, 2010).

Links

Davis, Devra. “Cell Phone Radiation FAQs.” Environmental Health Trust. https://ehtrust.org/take-action/educate-yourself/cell-phones-and-wireless-radiation-faqs/.

National Cancer Institute, “Cell Phones and Cancer Risk.” https://www.cancer.gov/about-cancer/causes-prevention/risk/radiation/cell-phones-fact-sheet.

National Toxicology Program. “Cell Phone Radio Frequency Radiation Studies.” NIH, National Institute of Environmental Health. https://www.niehs.nih.gov/health/topics/agents/cellphones/index.cfm.

S. Watkins, “Smartphone Ergonomics—Safe Tips—Mobile or Smartphone Use While Driving, Traveling on the Move,” 2019. YouTube.https://www.youtube.com/watch?v=4FBMWGGJMbY.

References

Agarwal, A., A. Singh, A. Hamada, and K. Kesari. “Cell Phones and Male Infertility: A Review of Recent Innovations in Technology and Consequences.” International Brazilian Journal of Urology 37:4 (2011), 432–54. doi:10.1590/s1677-55382011000400002.

Apple Inc. “Important Product Information Guide for iPad.” 2019.

Avendaño, C., A. Mata, C. A. Sanchez Sarmiento, and G. F. Doncel. “Use of Laptop Computers Connected to Internet through Wi-Fi Decreases Human Sperm Motility and Increases Sperm DNA Fragmentation.” Fertility and Sterility 97:1 (2012): 39–45.e2. doi:10.1016/j.fertnstert.2011.10.012.

Benson V. S., K. Pirie, J. Schüz, G. K. Reeves, V. Beral, and J. Green. “Mobile Phone Use and Risk of Brain Neoplasms and Other Cancers: Prospective Study.” International Journal of Epidemiology 42:3 (2013), 792–802. doi:10.1093/ije/dyt072. The Million Women Study.

Carlberg, M., and L. Hardell. “Decreased Survival of Glioma Patients with Astrocytoma Grade IV (Glioblastoma Multiforme) Associated with Long-Term Use of Mobile and Cordless Phones.” International Journal of Environmental Research and Public Health 11:10 (2014), 10790–805.

De Iuliis, G. N., R. J. Newey, B. V. King, and R. J. Aitken. “Mobile Phone Radiation Induces Reactive Oxygen Species Production and DNA Damage in Human Spermatozoa in Vitro.” PLoS ONE 4:7 (2009), c64e046. doi:10.1371/journal.pone.0006446.

Fernández-Rodríguez, Claudio Enrique, and Alvaro A. de Salles. “On the Sensitivity of the Skull Thickness for the SAR Assessment in the Intracranial Tissues.” 2016 IEEE MTT-S Latin America Microwave Conference (LAMC), Puerto Vallarta, Mexico, December 2016. doi:10.1109/lamc.2016.7851256.

Hardell, L., and M. Carlberg. “Mobile Phones, Cordless Phones and Rates of Brain Tumors in Different Age Groups in the Swedish National Inpatient Register and the Swedish Cancer Register during 1998–2015.” PLoS ONE 12:10 (2017), e0185461.

INTERPHONE Study Group. “Brain Tumour Risk in Relation to Mobile Telephone Use: Results of the INTERPHONE International Case-Control Study.” International Journal of Epidemiology 39:3 (2019), 675–94.

Microsoft Support. “Safety Information.” 2019. Microsoft. https://www.microsoft.com/en-us/legal/compliance/environmental-compliance/documentation.

Noone, A. M., N. Howlader, M. Krapcho, D. Miller, A. Brest, M. Yu, J. Ruhl, Z. Tatalovich, A. Mariotto, D. R. Lewis, H. S. Chen, et al. “SEER Cancer Statistics Review, 1975–2015.” National Cancer Institute. 2018. https://seer.cancer.gov/csr/1975_2015/

Peper, Erik, Adam Burke, and Eliot J. Peper. “Captured by the Computer: A Psychophysiological Profile of Boys Playing Computer Games.” Applied Psychophysiology and Biofeedback 26:3 (2001), 241.

Philips, Alisdair, Denis L. Henshaw, Graham Lamburn, and Michael J. O’Carroll. “Brain Tumours: Rise in Glioblastoma Multiforme Incidence in England 1995–2015 Suggests an Adverse Environmental or Lifestyle Factor.” Journal of Environmental and Public Health 2018. doi:10.1155/2018/7910754.

SafeinSchool.org. “Is Wi-Fi Safe for Children? Beware of Health Risks.” March, 26, 2013. www.safeinschool.org.

Samsung. “Samsung Galaxy Tab 10 User Manual.” 2019. Samsung Group. https://www.samsung.com/us/support/owners/product/galaxy-tab-a-10-1-wi-fi.

Volkow, Nora D., Dardo Tomasi, Gene-Jack Wang, Paul Vaska, Joanna S. Fowler, Frank Telang, Dave Alexoff, Jean Logan, and Christopher Wong. “Effects of Cell Phone Radiofrequency Signal Exposure on Brain Glucose Metabolism.” Journal of the American Medical Association 305:8 (2011), 808–13.

World Health Organization. “Base Stations and Wireless Technologies Fact Sheet.” October 8, 2014. WHO. https://www.who.int/peh-emf/publications/factsheets/en/.

Recommended Reading

Kardaras, N. Glow Kids (New York: St. Martin’s Griffin, 2016).

Swingle, Mari K. i-Minds: How and Why Constant Connectivity Is Rewiring Our Brains and What to Do about It, 2nd edition. (Gabriola, Canada: New Society Publishers, 2019).

KIDS AND COMPUTERS

Andes, Linda J., Yiling J. Cheng, Deborah B. Rolka, Edward W. Gregg, Giuseppina Imperatore. “Prevalence of Prediabetes among Adolescents and Young Adults in the United States, 2005–2016.” JAMA Pediatrics, December 2, 2019. doi:10.1001/jamapediatrics.2019.4498.

Christakis, Dimitri A., Julian S. Benedikt Ramirez, Susan M. Ferguson, Shilpa Ravinder, and Jan-Marino Ramirez. “How Early Media Exposure May Affect Cognitive Function: A Review of Results from Observations in Humans and Experiments in Mice.” Proceedings of the National Academy of Sciences 115:40 (2018), 9851–58.

Davis, D. Disconnect: The Truth about Cell Phone Radiation, What the Industry Has Done to Hide It, and How to Protect Your Family (New York: Dutton, 2010).

Lin, L. L., Y. F. Shih, C. K. Hsiao, and C. J. Chen. “Prevalence of Myopia in Taiwanese Schoolchildren: 1983 to 2000.” Annals Academy of Medicine Singapore 33:1 (2004), 27–33.

Murphy, S. L., J. Xu, K. D. Kochanek, and E. Arias. “Mortality in the United States, 2017.” NCHS Data Brief No. 328, November 2018.

Peper, E., A. Burke, and E. J. Peper. (2001). Captured by the Computer: A Psychophysiological Profile of Boys Playing Computer Games. Proceedings of the Thirty Second Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Wheat Ridge, CO: AAPB. Also in: Applied Psychophysiology and Biofeedback. 26(3), 241.

Safeinschool.org. “iPad User Manual’s Safety Warning and Disclaimer. Have You Read It?” April 7, 2013. https://tinyurl.com/vymgqc2.

Safeinschool.org. “iPad Wi-Fi Radiation with Wireless Router On.” YouTube. March 7, 2013. https://tinyurl.com/sytgstb.

Safeinschool.org. “Radiation of iPad with Wi-Fi On But No Internet Connection.” YouTube. March 7, 2013. https://tinyurl.com/sxxkda7.

World Health Organization. “Base Stations and Wireless Technologies Fact Sheet.” October 8, 2014. https://tinyurl.com/y7wtgjn5.

Index

Please note that index links to approximate location of each term.

A

accidents, 79, 105, 119

acid stomach, 149

acupuncture, 135, 225, 227

ADHD (attention deficit hyperactivity disorder), 325

adrenaline, 23, 24, 28, 40–41, 62, 149, 176, 177, 178, 181, 216–18, 222, 224, 236

adrenal issues, 127, 151

affirmations, 32–33

alarm clocks, 126

alcohol, 150–51

Alzheimer’s disease, 20, 82, 154, 174, 179, 196, 219

Amoils, Steve and Sandi, 215, 237

amygdala, 25, 27–28

anger, 147, 150

Aristotle, 198

aromatherapy, 133

astronauts, 105–6

B

back problems, 5–6, 47, 176

balance

getting back into, 29

practicing dynamic, 332

promoting, for children, 324–29

balls, sitting on, 268, 269

Bates, Marilyn, 198

bed, working in, 312

binge-watching, 106–107

biofeedback, 97–98, 233–235

Blask, D. B., 125

blood sugar issues, 147–154, 219, 226

blue light, 103–104, 109, 124–125, 129–130, 286

bracing, 61

brain

blood flow to, 156

cancer, 317–321

neuroplasticity of, 197

stress and, 179

breaks

apps for, 53

changing environment for, 163

creating program for, 158–164

FIT and, 156–157

importance of, 156

meditative, 162

micro-, 52, 160–161

movement as, 163, 164

scheduling, 143, 157

sensory awareness, 162

stretch, 161–162

wiggle, 162

breathing

apps, 43–44

changes in, 38–39

deep, 40

holding, 39

importance of, 38–39

normal, 39

resonant frequency of, 40, 43

shallow, 7, 38, 40, 176

Breuning, Loretta Graziano, 198

bullying, 211

burnout

depression and, 222–223

illness and, 237

nutrient reserves and, 151

recovery from, 108–9, 223–27

sleep and, 222

stages leading to, 215–22

Burns, David, 209

C

calcium, 134

cancer, 119, 154, 317–21

carbs, 150, 151, 153–154

caregivers, 143, 195–197

Carlberg, Michael, 321

carpal tunnel syndrome, 6, 62, 64, 238, 267, 291, 293, 294

celebrating, 214

centered, remaining, 28

chairs

affordable, 266, 267

alternatives to, 267–269

choosing, 270–271

for home office, 311

optimizing, 260–263, 276

upgrading existing, 265

Chapanis, Alphonse, 243

children

changing lifestyle of, 117–120

EMF exposure and, 323–324

promoting balance for, 324–329

sleep and, 126–127

choice, importance of, 194–197

Christakis, Dimitri, 325

Christofferson, Travis, 154

Cinderella fibers, 50

circadian rhythms, 103–106, 109, 124–126, 130

Citizen temperament, 198–99, 200

coffee shops, working in, 306–7

Cohen, Sheldon, 237

complaining, 201

computer glasses, 284, 289–290

computer-related disorders. See also individual disorders

breaks and, 62, 158–159

frequency of, 2, 6, 244–245

history of, 102

holistic approach to, 10–11

computers. See keyboards; laptops; monitors; mousing

cortisol, 23, 41, 94, 104, 125, 179, 181, 218, 219, 222, 236–237

creativity, 140

Cuddy, Amy, 94–95, 96

D

dark, fear of the, 123–124

depression

brain chemistry and, 107–108

low blood sugar and, 150

posture and, 89–99

stress and, 222–223, 227

desks

ergonomic standards for, 274–275

for home office, 311

optimizing, 278

options for, 276–277

sharing, 304–305

sit-stand, 50–51, 258, 259, 272, 273, 274, 277, 311

detox soaks, 132–133

DHEA (dehydroepiandrosterone), 179, 180, 219

diabetes, 47

divorce, 212

dogs, walking, 172–173

dopamine, 71–72, 73, 107, 179

Doyle, Derek, 333

dynamic movement. See exercise

E

ear plugs, 132

EMF (electromagnetic fields), 140, 317–324

EMG (electromyograph), 7

endorphins, 72

energy

definition of, 192

drains and gains, identifying, 192–194, 196

exercise and, 51, 163–64

posture and, 91–93

reclaiming lost, 192–194

stress and, 181

time off and, 138–39

environment, changing, 163

ergonomics. See also individual furniture and equipment

checklist for, 348–49

as compromise, 245, 249–250

costs and, 251–254, 264

essentials of, 246

etymology of, 243

history of, 243–44

individual differences and, 245–248, 254

new workstyle and, 258–59

as only one component of the problem, 1, 8–9, 250–51, 255

quick start guide for, 278–79

teamwork and, 254–55

eSports, 313–317

estrogen, 134, 180, 182

evolutionary traps, 18–25, 46, 71, 73–75, 103–104, 351

exercise. See also individual types

awareness and, 169–70

benefits of, 41–42, 67, 139, 167, 175–176, 332

blood flow to the brain and, 156

breaks for, 163, 164

children and, 327

determining ideal, 165–167

energy and, 51, 163–164

finding time for, 139, 173–74

FIT and, 156–157, 169

frequency of, 167

high-level fitness and, 171–73

intermittent vs. long-duration, 49, 164

interval training, 170–171

motivation and, 170

outdoors, 166–167, 173

pain and, 168

parenting and, 173–174

prioritizing, 174–175

scheduling, 167–168

socializing and, 166

spontaneous, 168

starting, 167, 168–170

types of, 165, 172–173

exhaustion, 150, 217–220, 225–226

eyes, resting, 284

F

failure, turning, into success, 204–5

fake news, 75–76

family gatherings, 142–43

fast-twitch (type II) muscle fibers, 158

fats, 153

fight, flight, freeze response, 23–25, 33–34, 182–83

Fisher, Helen, 198, 212

FIT (Frequency, Intensity, and Time), 156–57, 169

fitness, high-level, 171–73

5G networks, 322

flight response. See fight, flight, freeze response

food choices, 133–134, 152–154

Free Spirit temperament, 199, 200

freeze response. See fight, flight, freeze response

G

gaming, 106–107, 313–317, 324–25, 326

Geddes, Linda, 105

genetic programming, influence of, 9, 11–13, 15–18. See also evolutionary traps

Gevirtz, Richard, 40

glare, minimizing, 287–288

glasses

blue light blocking, 130, 286

computer, 284, 289–290

Gottman, John, 41

graphical user interface (GUI), 244

gratitude, 202

Gross, Daniel, 110

H

habits, changing, 206–209

hangry, definition of, 147

Hansraj, Kenneth, 90

Harari, Yuval Noah, ix

Hardell, Lennart, 321

Harris, Michael, 180

headaches, 6, 155–56

heart rate variability (HRV), 43, 44

herbs

adaptogenic, 224–25

as relaxants, 134

Hicks, Esther and Jerry, 202

high-fructose corn syrup, 20

HIIT (high-intensity interval training), 170–71

Hippocrates, 198

holistic practitioners

determining competence of, 232

finding, 231–32

home, working at, 310–12

hotel rooms, 309

human computer interface (HCI), 244

Human Genome Project, 11

humor, 33

Hyman, Mark, 152

hypervigilance, 31, 35–37, 73

hypoglycemia. See blood sugar issues

I

imagery, changing habits with, 206–9

immediacy, culture of, 76–77

immune system, 47, 179–80

impulse control, practicing, 84

inflammation, 218–19, 226, 236–37

injuries

muscle tension and, 57–59

from phone use, 79

posture as risk factor for, 248–49

recovery from, 189, 229–39

shift work and, 105

insomnia. See sleep

insulin resistance, 150, 219, 226

internet, growth of, 70–71

Interphone Study, 320

interruptions, 77–78

interval training, 170–71

J

Jastrzębowski, Wojciech, 243

jet lag, 107, 110

Jung, Carl, 197, 198

K

Kabat-Zinn, Jon, 197

Kardaras, Nicholas, 325

Keirsey, David, 198

keyboards

choosing, 292

external, with laptops, 291, 303

hands hovering over, 60, 63

narrow, 293

keyboards (continued)

numberpads and, 279, 296

positioning, 279, 291–292

split, 294

key commands, 160

Kross, Ethan, 120

Kuo, Ming, ix

L

laptops, 90, 291, 299–312, 321

learning

passive, 80

quality of life and, 81–82

Lehrer, Paul, 40

LeShan, Lawrence, 197

lifestyle

changing aspects of, 111–13, 331

of children, 117–20

24/7, 101–10, 137–38

light

sleep and, 103–104, 124–25, 129–130

sun-, 103–104, 109, 124

therapy, 130–31

Littlehales, Nick, 110, 128, 131

love, romantic, 212

Lynn, Paul, 181

M

magnesium, 134

Mander, Jerry, 115

media. See also social media; individual media

addictive nature of, 70–73

binge-watching, 106–7

immediacy and, 76–77

setting limits to, 137–45

strategies for, 84–87

meditation, 42–43, 135, 162

meetings

scheduling, 159

standing, 52

walking, 52

melatonin, 104, 106, 110, 125, 134

microbreaks, 52, 160–61

Million Women Study, 320

mindfulness, 162

mistakes, 213

monitors

adjusting, 279, 281, 283–284, 286

computer glasses and, 284, 289–290

external, with other devices, 303, 311

font selection and, 282, 284

minimizing glare on, 287–288

multiple, 285–286

technologies for, 281

monkey mind, 210

mood swings, 149

Moore’s Law, 299

Moss, Don, 40

mousing, 295–98

multitasking, 77–78, 85–86

muscle fibers

Cinderella, 50

slow-twitch (type I) vs. fast-twitch (type II), 158

muscle tension

awareness of, 9, 66, 67, 161

building, 157–58

dynamic, 58–59

effects of, 7–8, 9, 55, 63–65

exercise and, 67, 176

experiencing, 8, 61

measuring, 7, 55

mental demands and, 62

role of, in injury, 57–59

strategies for, 66–67

Myers-Briggs Type Indicator (MBTI), 197

N

naps, 131

neck strain, 57–60, 90–91

neuroception, 40

neuroplasticity, 197

Nurturer temperament, 199, 200

nutrition

fitness and, 171

sleep and, 133–34

Nyingma exercise, 29–30

O

Oded, Yuval, 33

organic foods, 152–53

organ meat, 153

oxytocin, 40, 179, 182

P

pain. See also back problems; headaches

as early warning, 67

exercise and, 168, 176

referred, 63, 64–65

self-awareness and, 66

subclinical, 62

perfectionism, 62, 213

personality types, 197–201

phablets, 284, 299–312

phones

accidents and, 79

addiction to, 71–75, 119

as artificial environment, 120

as brain extenders, 80–81

cancer risk and, 317–21

children and, 323–24

external monitors with, 303

interruptions and, 77–78

language use and, 83

optimizing, 304

posture and, 90–91, 249

as problem, 83

reducing effects of, 84–87

reproductive health and, 321–23

suggestions for using, 318

pivoting, 201–2

Plato, 198

Pollan, Michael, 152

Porges, Stephen, 24, 31

posture

biofeedback, 97–98

mood and, 89–99

suggestions for, 96–97

theory diagram, 302

uncomfortable, as risk factor for injury, 248–49

precision medicine, 271

prediabetes, 150, 326

processed foods, avoiding, 20, 152

productivity, maximizing, 85

progesterone, 134

progress, tracking, 156–57

progressive muscle relaxation (PMR), 133

protein, 134, 153

pulse, checking, 43

Putnam, Robert D., 113

Q

qigong, 42, 188, 225, 227, 231

quality of life

deepening, 143

learning and, 81–82

R

referred pain, 63, 64–65

reframing

in action, 205–6

benefits of, 203

caregiving and, 196

celebrating strengths, 214

changing habits with imagery, 206–9

of internal dialogue, 197, 209–11

of past traumas, 211–14

turning failure into success, 204–5

relationships

nurturing, 139–40

reducing stress in, 41

relaxation, 41, 42, 67, 110, 132–33

religion, 142–43

repetitive strain injury (RSI), 9, 12, 53, 57, 59, 64, 160, 267, 293

reproductive health

female, 322–23

male, 321–22

reptilian brain, 25–27

rock climbing, 172

Rogers, Fred, 213

S

Sapolsky, Robert, 180

seasonal affective disorder (SAD), 131

self-talk, negative, 209–11

Selye, Hans, 41

semantic shift, 83

semitasking, 85–86

sensory awareness breaks, 162

serotonin, 179, 217, 218, 222

Shaffer, Fred, 40

Shakespeare, William, 198

Shaw, George Bernard, 247

shift work, 104–5

shoulder strain, 57–58, 90–91

Sinek, Simon, 72

sit-stand desks, 50–51, 258, 259, 272, 273, 274, 277, 311

sitting. See also chairs

active, 258, 267–69

circulation and, 48

effects of prolonged, 45, 47, 326

frequency of, 46–47

genetic programming and, 9, 11–12, 46

strategies for reducing, 51–53

sleep

amount of, 126–27

benefits of, 125–26, 139

cycles, 127–28

debt, 104–5

hygiene, good, 128–29

integrative therapies and, 135

interrupted, 126

light and, 124–25, 129–31

media and, 139, 141, 143

medication, 135

naps, 131

nonrestorative, 127

nutrition and, 133–34

prioritizing, 67

relaxants and, 132–33

sound and, 132

strategies for better, 128–36

stress and, 222

travel and, 133

slouching, 61, 92, 94–95, 98. See also posture

slow-twitch (type I) muscle fibers, 158

smartphones. See phones

Snowden, David, 81–82

socializing, 86–87, 113–16, 119–20, 166

social media

addiction to, 74–75

advantages of, 111–12

effects of, 6, 119–20, 139, 324–25

fake news and, 75–76

history of, 70–71

social media (continued)

illusory nature of, 114–15

setting limits to, 84, 85, 144

Stephens, Mark, 135

stools, 267

strengths

celebrating, 214

defining, 187–188

stress. See also burnout

appetite and, 149

awareness of, 184

chronic vs. short-term, 178–79

coping styles for, 182–83

depression and, 222–23

dynamic, 40–41

effects of, 9–10, 179–81

exercise and, 41–42, 176

external vs. internal, 184, 186

fight, flight, freeze response, 23–25, 33–34, 182–83

gender differences in, 181–82

human adaptation to, 177–78

hypervigilance and, 31, 35–37

identifying source of, 185–87, 237

imagination and, 37–38

injury recovery and, 236–38

managing, 27–30, 32–33, 41–44

physical signs of, 184

sleep and, 222

strategies for managing, 184–89, 191

transforming chronic, 223–27

work-related, 27

Stress Curve

stages on, 216–22

transforming chronic stress and, 223–27

stress immobilization syndrome, 248

stretch breaks, 161–62

subclinical pain, 62

success, turning failure into, 204–5

sugar, 19–20, 153–154

suicides, 119

sunlight, 103–104, 109, 124

supplements, 134, 172, 224

T

tables, 274–75, 276–77

tablets, 90, 284, 299–312

tai chi, 29, 42, 139, 166, 174, 227, 231, 332

Tarthang Tulku Rinpoche, 29

Teitelbaum, Jacob, 134

temperaments, 197–201

tendonitis, 67, 238, 291, 293, 313–17

testosterone, 94, 95, 180, 181

texting, 83

Thinker temperament, 199, 200

thoughts

negative, 209–11

posture and, 92–94

Toy, Kevin, 313–17

traumas, reframing past, 211–14

travel, 107, 110, 133, 308–9

trigger points, activated, 63–65

TV, 48, 70–71, 106, 115, 117, 120, 124, 129, 324–325

Twenge, Jean, 119

Twitter, 83

U

unplugging, 137–45

V

Vedantam, Shankar, 189

visualization, 32, 33, 206–9

vitamin D, 124

W

Wahls, Terry, 152

Waldorf schools, 328

Walker, Matthew, 128

walking meditation, 42–43

weight gain, 181, 217

weight training, 172

white noise, 132

Widerstrom, Jen, 198

Wi-Fi, 140, 308, 310, 317–24

wiggle breaks, 162

Wilson, E. O., ix

workstyle

adrenaline-driven, 62

creating dynamic, 48–51

identifying, 187

new, 258–59

work tasks, alternating, 49, 159–60

writing, benefits of, 185

Y

yoga, 29, 40, 42, 72, 86, 96, 129, 135, 139, 157, 166, 168, 169, 174, 176, 225, 227, 231

Z

Zuckerberg, Mark, 70

About the Authors

Erik Peper, PhD, is an international authority on stress management, biofeedback, lifestyle, and holistic health, and professor at the Institute for Holistic Health Studies at San Francisco State University. He is President of the Biofeedback Foundation of Europe and past President of the Association for Applied Psychophysiology and Biofeedback (AAPB). For his contributions to the field of workplace health, he received the 2004 California Governor’s Safety Award and in 2013 received the Biofeedback Distinguished Scientist Award from AAPB in recognition of career and scientific contributions. He is author of numerous books, including Make Health Happen, Fighting Cancer: A Nontoxic Approach to Treatment, Healthy Computing with Muscle Biofeedback, and Biofeedback Mastery, and coauthor of more than two hundred articles. He has served as trainer to thousands of clinicians and educators in Europe, Asia, and the United States and as behavioral scientist for the United States Olympic Rhythmic Gymnastics team. He has been featured in media such as ABCNews.com, GQ, Glamour, Men’s Health, The San Francisco Chronicle, Shape, Women’s Health, and Medium.com. His research interests focus on self-mastery with biofeedback, strategies to optimize health, illness prevention, and the effects of posture and breath work. Erik Peper has a biofeedback practice and publishes the blog The Peper Perspective: Ideas on Illness, Health and Well-Being (www.peperperspective.com).

Rick Harvey, PhD, is professor at the Institute of Holistic Health Studies at San Francisco State University, with a degree in Health Psychology from the University of California, Irvine. Over the past two decades, he has participated extensively in research on computer-related injuries and stress psychophysiology. He has served as an epidemiologist for Maternal, Child, and Adolescent Health (MCAH) in Orange County, California and supervised the Biofeedback and Stress Management Program at UC Irvine. He has been president of the Association for Applied Psychophysiology and Biofeedback (AAPB). For his ongoing contributions and teaching in the field of psychophysiology, he was the recipient of the 2019 Educator Award from the Biofeedback Federation of Europe (BFE). He has taught internationally in Europe, Asia, and across the United States. His current research focuses on stress-reduction interventions, teaching psychological courage and hardiness, tobacco cessation, and health promotion interventions for high-risk youth.

Nancy Faass, MSW, MPH, founder and director of Health Writers’ Group (www.healthwritersgroup.com), is a writer and editor in San Francisco who has participated on more than fifty books by publishers that include Harper/Quill, McGraw-Hill, Jones & Bartlett, Healing Arts, New World Library, and others. For more than two decades, she has worked collaboratively with clients to develop books in trade publishing, textbooks, white papers, blogs, manuals, and web content on holistic health and integrative medicine. She has provided extensive editorial services for journals that include Spine, Pain Medicine, and Townsend Letter. A graduate of UC Berkeley School of Public Health, Faass has also worked on books for professionals, such as Complementary Medicine in Clinical Practice, and resources for consumers such as Boosting Immunity.

About North Atlantic Books

North Atlantic Books (NAB) is an independent, nonprofit publisher committed to a bold exploration of the relationships between mind, body, spirit, and nature. Founded in 1974, NAB aims to nurture a holistic view of the arts, sciences, humanities, and healing. To make a donation or to learn more about our books, authors, events, and newsletter, please visit www.northatlanticbooks.com.

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