If You're Well, You're Wealthy!  
Introducing . . . Intuitive Energy Assessment
What is Energy Medicine?
Trigger Point Therapy is a Fine Art
Musicians and Dancers
Intuitive Energy Assessment with Sharrel
Joseph studying "The Psychology of Movement for Musicians"
Sharrel's Intuitive Massage

Long Articles

Integrative Bodywork

Stress and Rest: Toward a Scientific Basis
for Stress Management Methods

If You're Well, You're Wealthy!

Some say that health is our greatest wealth. With health we have freedom and comfort and clarity. Pain and various types of dysfunction rob us of our capacities for work and play and possibly even the ability to communicate with our loved ones. They strip us of much of what it means to be alive, creative, productive, and interactive, making it hard to enjoy life.

There are things beyond our knowledge and beyond our control, but it is clear that there is much that we can do to take control of our own wellbeing, and assure greater health. At Touchstone we practice what we preach— exploring the pathways to lifelong health and happiness. And we want to share our findings with you. You can benefit from our decades of experience and accelerate your own progress.

Our approach to wellbeing is based on recognition of the inherent recuperative capacities of the human body and psyche. Both Sharrel and Joseph have been offering professional massage services for over 20 years , recognizing the healing potential of caring touch. We also offer group and private Yoga lessons, workshops on the postural basics of pain-free living, and methods of achieving deep relaxation for calming the mind and restoring one's energy. Our two newest offerings are the mini-retreat, which is a 3-hour sampler of our best in body/mind centering pratices, and Sharrel's Intuitive Energy Assessment service which is based on a subtle and systematic intuitive method.

We hope you will enjoy and benefit from this newsletter, and that you will take advantage of one or more of the services we offer.

PULL QUOTE: "there is much we can do to take control of our own wellbeing."   
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Introducing . . . Intuitive Energy Assessment

Sharrel recently completed a nine-month training program through the Stillpoint School of Advanced Energy Healing, based in Walpole, NH. She earned the title "Certified Intuitive Healer," and is now offering a service called the Intuitive Energy Assessment.

If you are experiencing symptoms which defy explanation, Sharrel's Intuitive Energy Assessment can shine light on the spiritual and emotional influences behind your physical symptoms. In one two or three sessions she can help you clarify the less easily seen aspects of your growth process and to give you concrete tools for moving forward.
There is an art to wholistic living.

A good way to cultivate this art is to consider, when we are faced with unpleasant symptoms, what the spiritual and emotional roots of these challenges might be. When we track the interconnections between body, mind, heart and spirit, we start to reweave the threads of the self and begin to feel whole again. That's what an Intuitive Energy Assessment is all about.
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What is Energy Medicine?

When you were a child, did someone who cared about you give you chicken soup when you were sick? And did you feel better? Is it really the bandaid on a scraped knee that makes it "all better" or is it the caring in the hand that put it there?
Energy Medicine is an emerging field in the healing arts. It is based on the observation that there are forces that are important to the healing process that cannot be directly perceived by our ordinary senses, or directly explained by our current level of scientific understanding.

What do we mean by "energy?" Since this is an area of awareness that is new to our culture, there really is no established vocabulary, so the word ‘energy' is used as an approximation. You probably have a sense of what we mean. Think of it this way: have you ever felt the ‘energy' of someone looking at you from behind; or felt the ‘energy' of lightness when a distressed person leaves an otherwise peaceful gathering; or felt the ‘energy' of suspension surrounding a sleeping child?

Energy Medicine, though it can be usefully employed in clinical practice, is not well understood scientifically, and various aspects are now being systematically researched. Dr. Larry Dossey is among those leading the way in this emerging field. In his book Reinventing Medicine he documents many studies which require us to rethink some of our fundamental beliefs about health care. We are now entering what Dr. Dossey calls Era III medicine. It is time to weave a sound fabric of collaboration between the vast knowledge of technical medicine and the vast knowledge of the soul.

You may already be aware of some of the modalities that are part of this field, such as Acupuncture, Reiki, Craniosacral Therapy, and Therapeutic Touch. Sharrel's Intuitive Energy Assessment is also part of this field. To learn more about Sharrel's new service, read about it at our website www.touchstonewellness.com, or give us a call.

PULL QUOTE: It's time to weave a sound fabric of collaboration between the vast knowledge of technical medicine and the vast knowledge of the soul.  
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Trigger Point Therapy is a Fine Art

A trigger point is a common and reversible condition of muscle and other soft tissue that causes pain and dysfunction. It is roughly the same as what you may think of as a ‘knot' in a muscle. Trigger point pain may be felt right at the ‘knot', or it may be referred some distance from the trigger point and felt elsewhere. A tension headache is an example of this: the problem exists in the shoulders, neck or jaw, but it is perceived in the head, eye or cheek.

Many other common pain problems can be traced to trigger points, and they often elude diagnosis. But trigger points refer pain in predictable and not random patterns, and they can be located through skillful palpation of the likely areas.
Trigger points can be treated by several methods, including injections and cryotherapy. Joseph utilizes a method of manual therapy involving massage and static pressure, and also training clients in the voluntary release of tension. This method is effective with a wide range of somatic conditions, and can also often be useful as an adjunct treatment of visceral conditions involving pain.  
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MUSICIANS AND DANCERS who use the same muscles repeatedly, and under pressure, often find they are slowly edging off course physically and experiencing pain. At Touchstone , we can help you get back on course, maximizing your possibility of per-formance with ease. 
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INTUITIVE ENERGY ASSESS-MENT WITH SHARREL
If your current search for wellbeing is discouraging you, even a single one hour session may open promising doors for you. There is usually a simple way to get started in a positive direction if we can only see what it is. That's what this service is designed to give you: simple, positive clues. Phone appointments can be arranged, if that makes it easier. 
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Joseph studying "The Psychology of Movement for Musicians": As part of his Individualized Major Program at I.U. (on the Psychophysiology of Relaxation), Joseph's class this semester includes training in the Feldenkrais "Awareness Through Movement" technique, as well as the science behind it. Joseph has specialized in massage for musicians for over ten years.
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Sharrel's Intuitive Massage: In over twenty years of professional practice, Sharrel's soulful and skillful bodywork has set a regional standard. She provides an important resource for those wishing to reclaim and befriend the body.
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Integrative Bodywork

This is an important moment in human thought. Practitioners in, what have been traditionally thought of as distinct disciplines, are venturing across boundaries and discovering common ground neither had previously imagined existed. As with the technological "leap in consciousness "represented by the emergence of computers, so too are 'leaps' occurring in many arenas. I find myself in such an arena. I think of it as Traumawork (Hakomi, Rosen, Ruebenfeld etc.) and have been developing an approach to working with recovery from childhood trauma, which I call Touchstone Integrative Bodywork. T.I.B. is an overlap between hands-on therapies, psychotherapy and medicine and would probably fit well under the umbrella of what is now being referred to as Energy Medicine. It is a program for treating the attention.

When trauma occurs as a result of childhood psychological, sexual, emotional or physical abuse, the impact of each disturbing event is registered in the child at all levels. It is appropriate that recovery be approached at all levels as well. The collective expertise of the medical, psychotherapeutic and bodywork communities are needed to untangle the knot of trauma. Deep listening is called for if such collaboration is to be cultivated. I am writing this article to attract collaboration with other professionals who wish to expand and deepen their work with explorations of this nature.

In this article I will be sharing some of my thoughts on the nature of trauma and of hypervigilance in adults who have been traumatized in childhood. I will also be introducing you to the basic theoretical construct, which underlies Touchstone Integrative Bodywork.

When the flow of events surrounding a child are developmentally appropriate and comfortable, all the child's physical functions are rhythmic, the breath is even and each event is experienced completely: physically, emotionally and psychologically. There is no residual dissonance nor preoccupations resulting from completely experienced events and the attention is fully coherent, congruent and focused. But when something occurs which is not developmentally appropriate, incomprehensible or frightening, the child will hold the breath and constrict some part (s) of the body. The incomprehensible event is then held in abeyance for a later time when it can be experienced completely i.e. on all levels. Only when it has been completed will the constriction release fully so the breath can be restored at that site. For many (perhaps most) children the time for this completion process never comes - the safe conditions are not presented. Each such "held" and incomplete experience I refer to as a trauma. If the site of the constriction can be located, roughly corresponding to physical symptoms, and if safety exists for the completion of the material held in abeyance there, a therapeutic event can occur, the breath can return fully and healthy rhythmic functioning can be restored.

The common neuroses which occur as the result of childhood trauma can be seen, energetically, as the configurations of "held" or incomplete events; as the patterns of breath, the patterns of constrictions and the ways one adapts to these patterns. These patterns are highly complex and unique to each individual. The implications of this perspective can have far reaching effects for medical professionals whose patients are calling to them for more holistic consideration. And for psychotherapists, developing the T.I. B. mode of observation may offer a breath of fresh air to client's who are saying "We're all talked out" but who clearly need further care.

Hypervigilance is a mode of perception in the common neurotic child, which makes it possible for all of the creative survival strategies we call neuroses to be functionally effective. The hypervigilent individual is intensely watchful of every gesture, facial expression, word and shift in group dynamic so as to maximize his/her choices at each moment in an effort to achieve safety. I see three necessary conditions for the quality I'm calling safety to exist for a growing child: 1. Knowledge of basic principles of psychological, emotional and physical development must be known to the caregivers. Some families pass this down. Most do not. 2. The mind, heart and actions of the caregiver must be in alignment with what he/she perceives as "meaning". And 3. Love must be present as a palpable energetic resource. When these conditions do not exist the individual does not feel safe psychologically, emotionally or, perhaps, physically and must be continuously vigilant in order to maintain a sense of workability in the overall shaping of his/her life. For those who are fortunate enough to grow up in a healthy situation, it is possible to sustain a centered focus of attention which moves from experience to experience as it makes sense to them, taking pauses when needed for clarification and synthesis. But for the unsafe individual, hypervigilence becomes possible when orderly, sequenced intake of information is not an option for the developing psyche. He/she senses that safety must be achieved strategically and the expansion and diversification of the attention provides more options. The traumatized individual's perception of his/her mental and emotional processes becomes diverse and thereby is able to observe incoming stimuli more quickly, in greater detail and in complex patterns perceived as of value for survival. Conceptual, spatial and temporal perceptions may be fragmented to varying degrees depending on the nature, intensity and frequency of the disturbing influence(s). Each fragment then perceives somewhat independently. In individuals who have experienced extreme abuse the independence of the fragments becomes pronounced enough that they begin to fail to recognize each other as coexisting within the same individual (D.I.D.) But even in less extreme cases, the fragments are surprisingly capable of reorganizing incoming stimuli in ways that are out of sequence in time and/or space thus distortions begin to noticeably effect behavior. The varieties of creative strategies are endless and we survive.

I see three distinct stages of the recovery process. The first stage I refer to as The Gathering of the Parts. It is at this stage that the primary focus inT.I.B. is to create the psychological, emotional and physical conditions, which will constitute "safety" for the client to disclose all the material, of which he/she is aware, which is upsetting. The process of creating such safety can be challenging and sensitive work, especially considering that the client may have no idea what safety might even mean. This awareness can be nurtured by honoring the client's requests and also honoring all aspects of his/her process-even those aspects over which the client holds a harsh judgment. It can be freeing for both the therapist and the client to realize, that in this stage of the recovery process it is not necessary to make sense of the material, which is emerging while safety is becoming established. The client may remember experiences after being triggered by touch, by a song, by a scent or a sensation. Such triggered memories can be seen as puzzle pieces. The pieces of many puzzles coexist in the hypervigilant mind: the "dreams" puzzle, the "images from TV" puzzle, the "stories overheard" puzzle, the "events witnessed" puzzle, the "actual violations" puzzle and many other puzzles. With intense, repeated and/or prolonged terror, many puzzle pieces are jumbled up together. It isn't necessary to know which puzzle pieces go where in order to make progress in the direction of centering the attention in the body or "reclaiming< homebase". The appearance of a memory is a fact in itself and must be embraced and processed and put aside until a time comes when whole patterns begin to emerge at a more advanced stage of recovery.

The second stage of recovery I call: Centering and Organizing. Hypervigilance, while fundamental to survival, becomes a problem in itself as the individual recovering from childhood trauma progresses to more advanced stages of wellbeing. From my experience, I believe it is safe to say that once a hypervigilant mode of perception has been "achieved" by an unsafe individual the range of options which that represents, continue to be available to that individual for life. This condition can be seen as an asset when the diversified and specialized components of the attention have been centered and organized sufficiently. At this point in the recovery process, the person will be likely to be valued as a responsible "multi-tasker". But in terms of satisfaction in living, it is important that the client learn to clearly hold the reigns so that the habitual brilliance of hypervigilance does not propel him/her through the days with little opportunity for conscious choices.

The body is the appropriate nexus for centering the attention since the body is the intersection of time and space (humanity's primary sequencing paradigms) for each individual. For survivors of sexual and physical abuse, the body is also the sensed danger site. So to center the attention at the sensed danger site and renegotiate the individual's psycho/emotional orientation to the body calls for skills in overlapping arenas. For centering and organizing all the parts, which have been gathered in Stage 1, I use an expanded version of the Body Electronics concept of extended point holding. While the careful negotiations between me and my client are going on (i.e. while I am touching them and coaching their authenticity in response), we will usually discover a point where heat is pouring out noticeably. At this point there is usually charged content as well: the client begins to accelerate in inner awareness - alternating between clarity and rather chaotic attempts at distraction. I, then, become the physical focuser (by continuing to hold the point or points on the body) and the psychological focuser (by gently guiding the monologue back to the "point") In this way the client is able to connect the body with the option to remain psychologically/emotionally centered. I support the client in holding the reigns on the pacing of such processes by instructing them in the "3 gears"concept: He/she can engage the process of releasing suspended energies and the process of dawning awareness by intentionally breathing to the point I am holding. This breathing work engages but only accelerates slightly. That would be first gear. Second gear accelerates the dynamic more by giving the body permission to move freely. For some people this means no more than turning onto one side and curling up into a ball. For others, it might mean organic movements which indicate a specific developmental stage (knowledge of developmental movement in invaluable in T.I.B.). For some, it might mean standing up (it can get very tricky to hold a point at times). If the client feels ready, he/she might shift to third gear and free the voice. This may be no more than a sigh, a full volume cry or anything in-between. I never dictate which gear to choose. The client will make much better progress if the power to choose remains in his/her own hands. And no amount of dramatics must be allowed to cause the T.I.B. practitioner to lose focus of whatever "point" first emerged.

The second stage is a dramatic model of the, much quieter, third stage. I call Stage Three: Relocating the Sense of Self. The suspended energies have been released. The body is no longer the "sensed danger site" but has become "homebase". The hypervigilant mode of perception is valued when needed but no longer holds the reigns. Now is the time to create steady rhythms, practice deep breathing and to meditate. Meditation is an advanced form of point holding. Practiced in any of it's hundreds of forms, it makes it increasingly palpable to "be yourself" and to begin to create, which is the fruit of recovery and what any healthy being does easily.

The amount of time involved in each stage will be as variable as are neuroses. And each individual must be in charge of the management of the coming through and going beyond trauma. With support of collaborated efforts in the emerging field of Traumawork, I believe that anyone can find their way if they persist. I invite such collaboration in Touchstone Integrative Bodywork.
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STRESS AND REST:
TOWARD A SCIENTIFIC BASIS
FOR STRESS MANAGEMENT
METHODS

For I460
with
Anton Neff

Joseph E. Boike

4/02/04

TABLE OF CONTENTS

Introduction
Defining Stress
The Stress Response
Stress Management
Stress and Rest
Sleep
Comparing Sleep to Other Forms of Rest
Rest and Lying Down
         Lying Down Removes the Need for Postural Effort
         Lying Down Favors Reduction in Motor Activity
          Lying Down Favors Diaphragmatic Breating
         Lying Down Reduces Nocioceptive Stimuli
Rest and Closing the Eyes
         Appearance of Alpha Brainwaves
           Closing the Eyes Quiets the Brain
           Closing the Eyes Rests the Retinas
           Closing the Eyes Facilitates Proprioceptive Awareness
Rest and Regulating the Breath
         Elevated Respiratory Rate is an Element of the Stress Response
           Slowing the Breath Requires Less Energy
Unfinished Business
Conclusion
References

INTRODUCTION

Managing stress is a complex problem involving not only psychological and physiological issues, but profound sociological and philosophical issues as well. The impact of stress on human health and quality of life also has weighty economic implications. Stress is an issue that cuts to the core of the real-life challenges facing our present culture. How will we balance the need for increased effectiveness in our work and broader lives with quality-of-life needs that are at the root of human happiness? Science offers a wide range of insights into how the human organism is affected by 'stress,' but applying these insights is a complex problem unto itself.

This present paper represents an effort to review psychophysiological research bearing on stress management. There is abundant research evidence that stress is involved directly or indirectly in the etiology of a long, almost exhaustive, list of current human ailments. Much is known about how to ameliorate stress and its effects in our lives. Clearly, the antidote to too much 'stress' has always been rest of one form or another. The specific purpose of this paper is to explore, in the face of soaring stress-related morbidity, the role of rest as an intelligent response to stress. In particular I want to investigate the effects of three simple voluntary behaviors, for any light they may shine on the apparent effectiveness, in practical stress management, of states of induced low arousal through a deep relaxation protocol.      Table of Contents

DEFINING STRESS   

'Stress' is one of those words that defies simple definition. Is 'stress' the environmental pressures impinging upon an organism, or is 'stress' the organism's responses (adaptive or maladaptive) to those environmental pressures? What does it mean to be 'stressed,' and does it mean the same to be 'overstressed?' 'Stress' has too many meanings for one word, and becomes, by itself, almost senseless. It wants descriptors in order to be useful, and standing alone, it may signify only a general domain of thought. In casual everyday parlance, the meaning of 'stress' can usually be intuited from the context in which it is used, but for the purposes of technical discussion, this usage needs to be more precise. Although Hans Selye is often credited with having introduced this term into physiology from engineering, it is suggested that Walter Cannon, by whom Selye was deeply influenced (Selye, 1976), used this same term earlier (Sapolsky, 1998, p. 9).

In engineering, stress is the degree of disintegration that takes place in a physical structure when subjected to some degree of 'load' or pressure. Whatever Cannon and Selye may have intended by the use of this term, it is not currently used in strict analogy to the engineering meaning. If anything, it is more often used, in loose contexts, to refer to the external pressures or 'load' than to the subsequent physiological response (the 'general adaptation syndrome'-Selye, 1976, p. 38), and almost never to the subsequent disruption of physiology (i.e., the emergence of pathology) or the disruption of human happiness, which would be the strict analogs of 'stress' in the engineering application.

To avoid this confusion it seems best to more or less junk the word 'stress' and differentiate it into two words: A stressor is an environmental pressureupon an organism, and a stress-response is the set of changes, adaptive or maladaptive, that occur within that organism in response to any given stressor or set of stressors. One of Selye's major contributions to the field of physiology is the recognition that the stress-response of organisms, including the human, is a fairly standard set of physiological changes that can be triggered by almost any stressor. He referred to this set of changes as the 'general adaptation syndrome' or G.A.S. (The nature of the stress-response will be detailed starting on page 9)

Taking the clarification process further, stressors come in many forms. There are physical stressors such as heat, cold, evaporation, gravity, physical injury, infection, toxic exposure, etc. There are psychological stressors such as threat, pain, worry, expectation, inner conflict (indecision), etc. It is tempting to distinguish 'emotional stressors' as another category, including interpersonal conflict, low self-esteem, repressed emotions, helplessness (loss of control), etc. But others might want to call them 'psychosocial stressors,' and since permutations could go on indefinitely, it is probably best to stay, in the main, with the dichotomy of 'physical' and either 'psychological' or 'mental.'

The next important distinction relates to the temporal extent of the stressor. There are acute stressors and there are chronic stressors. 'Acute' and 'chronic' are themselves slippery terms, because they imply that a seamless continuum (time) can be meaningfully divided into a two-value system (short and long). But if we can accept the idea that there is a very fuzzy line (in fact, a purely imaginary line) dividing 'acute' from 'chronic,' then we definitely can derive value from this distinction.

Acute stressors are short-term or episodic stressors, such as being stopped by a policeman for speeding, or getting caught in a cold downpour on a brief walk home, or (for some organisms) being pursued by a predator. This is the kind of stressor that the body is designed to handle very well. The acute stress-response, which includes varying forms of the 'fight-or-flight response' and the 'general adaptation syndrome' facilitates self-preservation under the pressure of acute stressors.

Chronic stressors are those that persist indefinitely, or at least for an extended period of time. Examples of chronic stressors are: 1) forevermore worrying that a policeman is going to stop you, or 2) being permanently cast out into the elements for socioeconomic reasons, such as war or insolvency (the fear of being cast out, whether well-founded or ill-founded can also become a chronic stressor), or 3) being endlessly pursued, for example, by the public and the press, as are celebrities of all types. Many of the complex psycho-socio-emotional stressors that people are subject to today are 'chronic stressors.' This is where the problem occurs because chronic stressors can lead to a chronic stress-response, and the body's adaptive physiological 'strategies' become destructive rather than helpful, leading to pathological changes in the organism.

The real trap is that psychological stressors can be made chronic by the agencies of memory and imagination, because the body responds with more or less the same stress response to stressors that are vividly imagined or remembered as to 'real' stressors (Guyton & Hall, 2000, p. 706b; Sapolsky, 1998, p. 7, p. 213). For example, if you close your eyes and imagine, in a detailed and realistic way, being in the Alaskan wilderness and accidentally startling a mother Grizzly bear with two cubs, with an ensuing chase or fight, you will likely find your body actually begins to gear up a stress response: your heart rate will increase, as will your overall muscular tension levels and your respiratory rate. Other less-perceptible changes are also likely to occur, including elevation of blood pressure, increased production of adrenal catecholamines and decreased production of insulin. These same sorts of changes occur when we remember a traumatic episode we experienced, or when we imagine some situation we anticipate, such as an engagement to speak before an audience, or to confront an employer on a difficult issue. A person can become fixated on such stressful images or memories, and repeat them indefinitely in the mind, to the point that they become more of an attitude or "thinking style" (Wilhelm, et. al., 2001, p. 526) rather than just passing thoughts. As a result, a low-grade background stress-response becomes more or less habitual.

'Overstressed' is not a technically accepted term, but points to a very important fact about stress: we all need some degree of exposure to a wide variety of stressors in order to be optimally functional and healthy. For example, the gravitational field of Earth is a constant physical stressor, but it is one that the body depends on. With the advent of prolonged space flight where it has been discovered that, for astronauts long outside the gravitational field that exists close to the earth's surface, there is a steady and certain loss of both bone and muscle tissue (NIAMS, 1992). We need stressors in our experience in order to keep ourselves 'keened' in a variety of ways. So, the term 'overstressed' distinguishes from those levels of stressor-exposure that are normal and beneficial, and refers to the condition in which the stress response to a particular chronic stressor or set of chronic stressors has persisted so long that pathological changes are taking place within the organism. As discussed above, the primary agency of such changes is long-term inappropriate (maladaptive) hyperactivity of some aspects of the neuroendocrine system, i.e., sustaining a physiological stress response beyond any usefulness to the organism.

We all have periods of acute physical stressors to deal with in our lives, though (for the socioeconomically fortunate) far fewer such periods than our ancient ancestors might have experienced. The body's stress response on such occasions is 'intelligent' and survival-oriented. The problem lies with the chronic stressors, especially the psychological ones, because our nervous system gears up this same stress response machinery for remembered, anticipated and imagined stressors as for real ones. One of the most important tasks of stress management training is to help people learn to consistently and effectively manage their thought processes and emotional processes, so they can steer clear of psychological patterns that produce a chronic stress response at a physiological level. Now, let's take a closer look at the nature of the stress response.       Table of Contents

THE STRESS RESPONSE     

The stress response is an emergency response, suited well to do-or-die survival situations. It is perhaps best characterized as a biological strategy for mass mobilization and concentration of physiologic energy (Sapolsky, 1998, p. 56) and other resources, for a maximal response to environmental demands and threats. It is the turbocharger, the overdrive, the power booster that is built into our biologic mechanism in order to give us extraordinary capabilities for dealing successfully with rare, short-lived and extreme challenges. Secondarily, the stress response also includes measures to minimize damage, or delay the effects of damage, and facilitate the processes of repair.

Alternatively called the alarm response, the fight or flight response or the sympathetic mass discharge (GH, p. 706), the stress response has a secure niche in the evolutionary panorama. It is just the thing for those occasional acute physical stressors. But outside the context of immediate challenges to survival, it is a highly inefficient way to conduct the systemic business of an organism, and is insidiously damaging to the health of the organism when sustained as a predominant mode of operation (Fried, 1989; Selye, 1976; Sapolsky, 1998, Wilhelm, et. al., 2001).

The stress response is primarily mediated through two channels under the influence of the hypothalamus: through the actions of the sympathetic nervous system; and, via the pituitary gland, through the hormones of the adrenal glands. These two branches of the stress response have very similar effects upon target organs, but the effects via thesympathetic pathways are swift and short-lived, compared with the effects via the endocrine pathway which are slightly delayed but much longer lasting. Although it was originally thought that the phenomenon that we now call the stress response was a two-valued all-or-nothing response, more recent investigations indicate that the response is to some degree both graded and tailored to the challenge (as it is perceived by the organism) at hand.

There are many elements to the stress response. The following list describes the organism's global stress response, what Selye referred to as the 'general adaptation syndrome.' Here is a compilation of every list I could find:

1. Increase the sympathetic outflow and reduce the parasympathetic outflow

2. Epinephrine and norepinephrine are released from the adrenal medullae

3. Abolition of alpha brainwaves, as part of sharpening senses for acute surveillance of the surrounding environment

4. Overall metabolic rate is accelerated (up to 100% increase over normal)

5. Heart function increases, to facilitate rapid circulation of oxygen, glucose, and other substances essential to optimal function

6. Arterial blood pressure increases, insuring maximal penetration of nutrients into target tissues

7. Ventilatory function increases, to maximize the oxygen supply, and assure proper elimination of carbon dioxide

8. Overall muscle tone increases, poising in readiness for quick action

9. Overall vasoconstriction in striate muscles, which can be overridden locally by any muscle that is called into action. This brilliant strategy sends resources precisely where they are most needed, and simultaneously minimizes blood loss from injury.

10. Decrease in serum insulin, to maximize serum glucose to power the striate system, and richly feed the brain for heightened memory, sensory processing, coordination and other control functions

11. Increased glycogenolysis in liver and muscles, again to maximize free glucose

12. Release of free fatty acids and glycerol from fat cells to add to available energy supply

13. Dilation of the eyes, to allow maximum visual input

14. Perspiration at palms, to maximize grip

15. Increased production and release of cortisol and minor glucocorticoids by the adrenal cortex, for a variety of functions including glucose and fat liberation

16. Increased rate of blood coagulation, to minimize blood loss in case of injury

17. Inhibition of vegetative functions such as digestion, tissue remodeling, etc.-they are put "on hold" for later

18. Repressed activity of the immune system-germs can wait a little while

19. Dryness of mouth, probably associated with inhibition of GI tract

This list puts into perspective just how serious the organism is about maximizing its response capability. For anyone with any sense of physiology, there is a palpable sense of excitation just reviewing such a list. It is a beautiful phenomenon to imagine in action, as the gazelle spots the lion, and instantly its whole body is charged with the energy and attributes of countless eons of survivor-progenitors, the energy and attributes to survive.

Of course, some of us in the human race are running into difficulties with the stress response. The rate of evolution of our culture has outstripped our biological evolution, and this response is being inadvertently triggered in a wide variety of circumstances where it is not appropriate or helpful, and it does not favor survival in the long run. For many of us survival is no longer about hunting and being hunted. Our survival is both much easier and much more difficult than that. Physical toil is not often necessary, and our daily goals and objectives are removed by several orders of abstraction from primitive survival goals. Nevertheless, these abstract goals and objectives can take on symbolic survival value, and herein lies the problem.

Let's take for example, a production line worker who awakens late one morning-actually for the third morning in two weeks-and hops into his pickup, and zips off to work. He is hoping that the traffic lights are not going to be red, because he can make it to work 'on time' only if everything goes smoothly. Inevitably, he comes to an intersection where the traffic light has turned red. To a stray dog running through the intersection, this red light means nothing at all. And to many of the other drivers, though it has meaning for them, it's probably no big deal. But to our production line worker, this red light could mean things like the loss of his job, failure to meet his mortgage payment, a negative sense of himself as a provider for his family, and more. And so, all because of a configuration of electrified wires inside glass and metal, hung securely some 25 feet in the air, this man's heart starts racing, his palms sweat on the steering wheel, and he feels tense and agitated. The beauty of the gazelle's fine tuned biological response to the appearance of the lion is not present in this situation of the man. These physiological adaptations do not help him in the least to meet the abstract survival challenges he is facing. In fact these adaptations are counterproductive-maladaptive.

I do not think it is exaggeration to say that we are at an important evolutionary juncture. We are faced with the challenge of learning to voluntarily circumvent, modify and/or otherwise nullify the effects of this stress response that is part of our biological heritage. Phylogenetically, maybe there is no need to make the effort, and we can just rely on natural selection to sort out those of us who naturally fit this lifestyle well enough to survive. But for those of us who want to stack the deck in our favor, there is the concept of stress management. 
Table of Contents       

STRESS MANAGEMENT    

Stress management has three distinct domains:

1. There is wide range of efforts we can make to reduce stressors in our lives. For example, we can: dress warmly when the temperature is low, eat a nutritionally sound diet, resolve interpersonal conflicts promptly, know our priorities, cultivate a positive outlook, and set out early for all of our appointments!

2. We can learn to modify our stress response when we notice that it is being activated. This involves exercising voluntary control over certain aspects of physiology. Biofeedback research has demonstrated the remarkable range of physiological functions that can be controlled voluntarily (Miller, 1989), but really a couple basic techniques are sufficient for most stress management purposes, namely regulation of breath and regulation of skeletal muscle tension. By keeping the breath slow, steady and full, and the skeletal musculature relaxed, we can turn off, or at least turn down, any maladaptive stress response (Fried, 1989, p. 323).

3. Since we will be imperfect in applying 1 & 2, we will sometimes be subjected to stressors and will experience a stress response that goes beyond the mere salutary, requiring recovery and restitution, which typically involves rest in some form.      Table of Contents

STRESS AND REST     

When a bridge is critically overloaded, permanent and irreversible changes occur in the molecular structure of the materials from which the bridge is constructed. This is stress in the classic sense of the engineer. In the living organism stressors are disruptive of the normal physiological processes and possibly disruptive of physical structure as well, but the living organism has the ability to restore itself, and this process of correction generally involves some kind of rest. For instance, after 4 minutes of maximal exercise, a full hour is required to fully restore the oxygen reserves normally maintained in the body; and after 2 hours of exercise sufficient to deplete body glycogen stores, a minimum of 48 hours is required to replenish those reserves (GH p. 971, figs. 84-2 & 84-3). After a bone is broken, if it is held immobile for several weeks, it will generally be mended by processes of bone repair.

Figure 1. Hypothetical Plot of Acute Stressor (a) and
(b) an Overwhelming Stressor

Because a psychologically triggered stress response will tire our systems the same as a stress response that is physically triggered, one of the key issues involved in stress management is how we can most effectively 'rest' ourselves (or not tire ourselves as rapidly). There is a great deal of focus on advanced stages of pathological change in the organism subjected to chronic stressors, but one of the earliest and subtlest signs of breakdown in the organism's stress response is simple tiredness. It stands to reason that responding to tiredness by resting in a timely and appropriate manner is perhaps one of the simplest and most effective strategies for stress management. This approach was elegantly-if unpopularly-applied in a workplace setting almost 100 years ago by Frederick Taylor. Taylor taught industrial workers how to quadruple their productivity in a given day without any sense of undue exertion, through the application of appropriate rest-work rhythms during their work shift (Taylor, 1911).

Tiredness is a major stress-related problem, and many people feel chronically tired, overwhelmed and exhausted (Fried, 1989, p.310). Tiredness is not necessarily the same as sleepiness, and surely tiredness can be psychologically and/or physiologically triggered. It is obvious that the human organism requires rest to feel energetic and unencumbered by physical and social demands, but it is far from clear what constitutes effective rest under various conditions.       Table of Contents

SLEEP     

Sleep is the most obvious form of rest, and it is clear that we all need sleep. One recent study shows that both the quantity and quality of sleep impact overall health, and further, that quality of sleep is correlated with socioeconomic status! (Moore, et. al., 2002) Yet, highlighting how deeply in the dark we are scientifically with regard to the nature of effective rest, the functional value of sleep is not scientifically known at present (GH p. 961b). Two quotes from a prominent text on neural science: "Several ideas have been advanced, but they all have been challenged by contrary evidence or shown to have limited generality." and, "Because we feel refreshed after sleep, the idea that sleep is restitutive is intuitively appealing, but precisely what may get restored during sleep has not been identified (Kandel, et. al., p. 944b)." It is telling of the degree of mystery in which we are steeped.

Of course there are many things that are known about sleep. One thing that is known about sleep is that sufficient sleep deprivation results in death (in 2-3 weeks in lab rats-KSJ p. 944b). But it does not appear that sleep deprivation causes any noticeable effects on the well-being of the visceral organs (GH p. 691a). However, no reference is made to whether this lack of effects includes the condition of skeletal muscle. It is clearly recognized that one of the elements of sleep, especially REM-sleep, is that muscle tone is totally lost (KSJ, p. 943a) or exceedingly depressed (GH p. 689b). This is crucial, in part, because in REM-sleep the brain is active with imagery that includes motor patterns that would be executed if not for the inhibition of motor tone. In waking states muscle tone is increased (GH p. 691b), and it seems likely that the inhibition of muscle tone must be part of the restfulness of sleep.

Another thing known about the function of sleep is that the central nervous system is the part of the body 'machinery' that suffers most dramatically and most rapidly from sleep deprivation (KSJ p. 944b, GH p. 691b). Prolonged periods of wakefulness tend to result in deterioration of mental performance, though there is some indication that ample motivation can reverse the deficits. (KSJ p. 944, G. p. 691) During sleep electrical activity within the brain (as monitored by electrodes placed on the scalp) synchronizes, indicating that large portions of the neuronal population are firing in a slow simultaneous rhythm. This creates the hallmark "brainwave" characteristic of sleep, labeled the delta waveform, which is a low-frequency (below 3.5 cps-G. p. 692a) sinusoidal pattern. These delta brainwaves are believed to be an intrinsically cortical phenomenon, and indicate that the cortex is liberated, during sleep, from the activating influences of the thalamus and lower brain centers (G. p. 692b). It is not apparent whether there are restorative properties attributable directly to the synchronous neuronal firing during slow wave sleep, however it is reasonable to suspect there are, since sleep is restorative and this slow synchronous rhythm is essential to sleep. (See p. 27 for more on brainwaves.)

Another documented change that occurs during sleep is that the sympathetic nervous system is quieted, with the result that arterial blood pressure falls, pulse rate decreases, and skin vessels dilate. Parasympathetic activity increases correspondingly (G. p. 691b). One source suggests that these changes are entirely due to tonic increase in parasympathetic outflow, and there is very little or no decrease in sympathetic outflow during slow wave sleep (Parmeggiani, 1989, p. 7). Also the metabolic rate is about 15% less during sleep than during quiet wakefulness (KSJ, p. 944b). Since total respiratory volume is tightly linked to metabolic rate (GH p. 818), the ventilatory volume decreases during sleep. Also, during slow-wave sleep, breathing becomes very regular: the respiratory rate slows and the tidal volume increases slightly. (Parmeggiani, 1989; p.6)      Table of Contents

COMPARING SLEEP TO OTHER FORMS OF REST  

It is estimated that, for about 33% of the U. S. population, sleep is disrupted or insufficiently restful (KSJ, p. 954a). Of these, some 10 million receive prescription drugs to help them sleep (Murray, 1994; p. 147). Therefore understanding what is restful about sleep and how best to get rest is important in practical stress management. If we don't really understand the function of sleep, how can we maximize the value of sleep, and how can we determine what other forms of rest are also effective and when to apply them-aside from sleep, what constitutes rest?

In light of the uncertainty about the functional value of sleep, it is worthwhile to review the physiological effects of 3 simple actions or conditions that are typically associated with sleep: closing the eyes, lying down and regulating the breath (or rather, allowing the breath to be regulated by subconscious internal mechanisms). What is the net physiological effect of sustaining these three conditions even in the absence of true sleep? It is likely that many of the benefits of sleep can be acquired by methods other than sleep itself, and thus may serve as tools for managing stress, through providing much needed rest. These same methods may also be effective in improving the quality of sleep itself.      Table of Contents

REST AND LYING DOWN  
   
Lying down reduces the demand on a terrestrial organism in several ways. These include cessation of the need for postural effort, increase in ease of diaphragmatic breathing, the disinclination to motor activity, and reduction of nocioceptive stimuli associated with weight bearing.        Table of Contents

Lying Down Removes the Need for Postural Effort  

The most obvious difference a person experiences between lying down and any upright terrestrial posture is that there is virtually no need to balance and brace in Earth's gravitational field. Most of us give little thought to what effort is involved in sitting, standing and locomotion. Yet maintaining any upright position requires on-going muscular exertion. It also requires on-going neurological management involving the highest brain centers, though usually in unconscious ways. Relaxed upright postures increase basal metabolic rate about 33% over 'awake lying still' conditions (See Table 1). In addition to the added demands on the system of skeletal muscles, upright positions require active processing of sensory information from skin, joints, and the muscles themselves, as well as from special sense organs such as the inner ear and the eyes. Afferents from all these sensors are continually monitored by the brain and integrated to generate appropriate commands to the skeletal muscles to maintain balance, even as we move or our support moves under us (as on a boat). It all happens so effortlessly; for example, we are rarely aware of the role of the visual system in maintaining standing balance, until we try single-footed balance in a darkened room, and then try it again with ample lighting.

Table 1. Energy Expenditure During Different Types
of Activity for a 70-Kilogram Man
(Adapted from Guyton & Hall, Textbook of Medical Physiology, p. 820)

So-called 'postural muscles' are involved in tonic contractions to brace various joints of the body in positions that support any given posture that we can put ourselves into. Some muscles are more equipped for this function than others (G. p. 75), but no muscle is completely immune to the effects of long-term steady-state contraction (Lundberg, 2003). There is an increase in metabolic activity to produce and sustain the contractile function, and there is a simultaneous decrease in blood perfusion in the muscle tissue, especially when sustained contraction is more than 30% of maximum effort (Simons, et. al., 1999).

The magnitude of the impact of allowing the skeletal muscle system to rest is underscored when we consider that skeletal muscle accounts for 40% of the mass of the body (Lockhart, 1969, p. 144). Lowering the arousal of this much of the body is has a powerful influence over the body as a whole. Although it is customary to view the skeletal muscle mass as so many hundreds of individual named muscles, in many ways the striate mass is a unitary organ. Though distinct muscles or muscle groups are readily used independently of one another in fine and gross motor activity, when it comes to motor tone, the striate system seems to be regulated as a whole. This is apparent in the process of inducing deep relaxation: it is difficult to profoundly relax one part of the striate system without relaxing all of it. And once relaxed, it is difficult to activate any of the striate mass without at least slightly disturbing the rest of it. Activation of one muscle tends to spill over into surrounding muscles as well. As will be seen below, the diaphragm is one striate muscle that is an exception to this tendency, as it remains normally active even during REM sleep, while almost all the rest of the striate mass loses its tone entirely, under inhibition of motor neuron activity by control centers in the pons and medulla (KSJ, p. 943a).

Lying down removes the necessity of all anti-gravitational exertion and balance. Muscles are allowed to relax, and the nervous system is free to become quiet. This reduction in demand is reflected in the lower metabolic rate for lying down. However, it is abundantly clear that a person can maintain unnecessarily elevated levels of muscle tension even in recumbent resting positions, in relation to psychological stressors, the presence of pain, and possibly even as a habit pattern (Lundberg, 2003; Simons, 1999, p. 24). One important question with regard to non-restorative sleep is whether or not a person actually relaxes the skeletal musculature. This same question applies to non-sleep rest. Cessation of purposeful activity is not synonymous with cessation of activation of motor units. Clearly there are methods that offer promise for reducing muscle tension, such as progressive relaxation and meditation. These methods provide valuable non-sleep rest, and may also reduce the difficulty in falling asleep and staying asleep.      Table of Contents

Lying Down Favors Reduction in Motor Activity     

When in upright postures we are more apt to be active. Most of the time this is the whole point of being in the upright postures, because they make activity much easier and more effective. But when attempting to rest, upright postures are disadvantageous because they incline us toward activity. Often people seek rest in upright, open-eyed activities, and whereas these are useful for mental distraction and refreshment, they do not offer maximal metabolic rest not skeletal muscle rest. Some 7% of a person's daily energy usage is consumed in postural shuffling, shifting, fidgeting, etc., (GH p. 821a). The point here is not that a person gains rest by saving calories, but rather that the metabolic demand on an organism is an index of other less quantifiable forms of demand, such as tiring of the nervous system. Lying down quiets the substantial machinery of the sensory/motor portions of the brain that are dedicated to maintaining posture and orchestrating movement. Lying down allows these areas to rest and restore optimal reserves and thereby become less reactive, less 'irritable' in the classic sense.      Table of Contents

Lying Down Favors Diaphragmatic Breathing    

Nowhere in the literature have I found a comparative analysis of the energy demand of diaphragmatic breathing vs. chest breathing. However diaphragmatic ventilation is apparently more efficient than intercostal ventilation. This is evidenced in that the diaphragm has been provided with special arrangements to operate in ways that are independent of the rest of the striate muscle mass. As already mentioned, in REM sleep the overall skeletal muscle tone is entirely lost as motor neurons are actively inhibited by the action of nerve centers in the pons and medulla (KSJ, p. 943a). Yet the diaphragm and striate muscles of the airway are not subject to this general inhibition. So, when all other striate muscle loses its tone, for the diaphragm it's business as usual, drawing air into the lungs. (The air is expelled passively by tissue elasticity.)

Even in non-REM sleep and quiet awake states it is the diaphragm that powers most of the breathing, involving intercostals on inspiration to a small degree or not at all (GH p. 432a). It makes sense that the organism would rely on the diaphragmatic mechanism for ventilation during periods of low physical activity, because the intercostal mechanisms work against all the same forms of elastic resistance that the diaphragm must work against, plus the additional resistance of the cartilage-and-bone ribcage. The intercostal mechanism orchestrates the use of dozens of muscles, versus the single diaphragm, and there is no indication that the intercostal mechanism has the same degree of independence from the remainder of the striate mass that the diaphragm appears to have. Therefore, during non-sleep rest as well as in times of higher metabolic demand, use of the intercostal groups for ventilation is likely to raise overall arousal levels, and reduce the restorative properties of the rest, whereas relying on the diaphragm may minimize the co-stimulation of other striate musculature.

In addition, recumbent positions favor diaphragmatic breathing, whereas upright postures make it more challenging. This is due to the double-roles of certain muscles of the lumbopelvic junction: especially the quadratus lumborum and the psoas. These muscles are intimately associated with the function of the diaphragm, and they are also involved in maintaining upright postures (Lockhart, 1969, pgs 181, 235). While serving in their postural roles, tension in these muscles cannot help but reduce the efficiency of diaphragmatic ventilation, increasing resistance to diaphragmatic excursion and reducing the contractile 'stroke' of the diaphragm during the ventilatory cycle. This displaces more of the responsibility for achieving sufficient ventilatory volume onto the intercostals musculature, which raises the ribcage, and which inherently works against the greater resistance of a bony framework and gravity. Lying down, the abdominal walls are permitted to relax entirely, better accommodating diaphragmatic movement, thereby allowing musculature of the chest wall to relax. This quiets the brain centers even further because the control of diaphragmatic function is likely a simpler motor volley than control of the wide array of muscles involve in lifting the ribcage (GH p. 435b). Also because, in recumbent positions, we are less active and have a lower metabolic rate, the overall ventilatory demand is reduced, further reducing the metabolic demand.

The more deeply restful a person becomes, the slower and deeper the breath becomes, such as in the progressive stages of sleep onset (Parmeggiani, p.6). Related to this is the fact that the sympathetic-adrenal stress response tends to shallow the breath (KSJ, p.960b) and thereby increase the respiratory rate. Shallowing of the breath in the stress response is no doubt caused in part by the increase in striate tension throughout the body (including the torso) that is associated with readiness for quick, powerful actions. The question arises whether the voluntary establishment of a slower, deeper breath could in any way invoke a reduction in sympathetic stimulation, or an increase in parasympathetic dominance. Clearly, if a person is in an alarmed state that has no present functional value, simply lying down will not quiet the system completely, but it will take some of the immediate load off the CNS. When followed by closing the eyes and voluntarily regulating the breath, this could produce a significant shift in automomic tone (Wilhelm, 2001). In the section on regulating the breath we will see that voluntary establishment of slow, regular breathing also invokes the reduction of sympathetic dominance through reestablishment of normal arterial PCO2 levels.     Table of Contents

Lying Down Reduces Nocioceptive Stimulation     

One further way in which lying down induces rest is that unloading the musculoskeletal system reduces the stimulation of nocioceptors associated with chronically tight muscles and joint dysfunction (Mense, 2001). Pain was found to induce reflex tension in nearby muscles, in the case of arthritis and trigger points. Although there are cases to the contrary, musculoskeletal pain is commonly intensified upon weight bearing. Pain creates powerful disturbances within the CNS, and such disturbance opposes rest. Quieting pain thus quiets both the somatic tissues and the CNS. Clinical experience suggests that reduction of pain also allows for easier breathing. One source emphasizes the pain-breath link even under anesthesia: "In fact, provided spontaneous respiration is present at all, it is almost impossible to avoid a ventilatory response to a painful stimulus, no matter how deep the anesthesia. The same phenomenon is observed in sleep." (Nunn, 1977, p. 30.)     Table of Contents

REST AND CLOSING THE EYES      

Appearance of alpha brain waves

The really interesting thing about closing the eyes is that the electroencephalogram (EEG) reveals that a sinusoidal brainwave ensues almost immediately, even though the subject is fully awake. The EEG, developed by H. Berger in the 1920's (Hilgard, 1987, p. 334) reveals cortical electrical activity that varies in relation to psychophysiological states (see Table 2 below). The signal detected by the EEG reflects a summation of the firing of vast populations of neurons in the cortex of the brain. The 'firing' of neurons is a wavelike depolarization followed by a repolarization. Since wave phenomena can be additive or cancellatory, the EEG signal is not a simple measure of total neuronal activity, but a reflection of the degree of synchrony in neuronal activity combined with the amount of neuronal activity. The waveforms break into two types: synchronous and asynchronous; the synchronous waveforms are further subdivided into three types, related to states of consciousness.

Table 2. Electroencephalographic Brainwave Types
(Based on Guyton & Hall, Textbook of Medical Physiology, pgs. 692-3)

In the wakeful, active state of consciousness, the EEG reveals a predominantly asynchronous beta waveform. The synchronous sinusoidal brainwaves are typical of sleep states, and represent the simultaneous activation of millions of cortical neurons, but the act of closing the eyes almost immediately shifts the cortical activity into the slow, synchronous alpha brainwaves (GH p. 692b). Overall brain activity is greatly increased when the eyes are open, and these higher levels of brain activity result in asynchrony, which shows up as significantly reduced amplitude of the EEG signal, even though there is more neuronal activity. REM sleep also shows the asynchronous pattern of beta waves.       Table of Contents

Closing the Eyes Quiets the Brain       

Closing the eyes brings the EEG into an alpha waveform, and one might hypothesize that the synchrony of neuronal firing in sleep is somehow related to the restorative effects of sleep, and that because closing the eyes can produce a similar synchrony, simply closing the eyes could have some of these same restorative effects. Far more certain however is that closing the eyes is restful because it dramatically reduces brain activity, resting that part of the body that seems to need rest most, and significantly reducing overall metabolic load (GH p. 692b). At rest, the brain accounts for 15% of the total body metabolism, even though the brain constitutes only 2% of the body mass (GH p. 714b), meaning that at-rest brain tissue demands energy at 10 times the rate of muscle tissue at rest. (I have not been unable to locate any figures on how the metabolic demand of the brain goes up as it becomes more active, nor have I found any graded list of organism activities that increase brain activity, comparable to Table 1.) The synchrony of neuronal firing in the eyes-closed condition may be no more than an artifact of the reduction in overall brain activity, or it may have certain restorative properties of its own.
     Table of Contents

Closing the Eyes Rests the Retinas      

Closing the eyes naturally reduces the activity of the photoreceptors of the retinal tissue, and retinal tissue is even more metabolically demanding than brain tissue (of which the retina is arguably a part). Adult retinal tissue consumes oxygen at 2 times the rate of the brain cortex, and produces large quantities of lactate even with adequate supply of oxygen. (Moses, 1975) Clearly, the visual system is one of the most energy intensive systems of the body to operate, because of the high demand of the significant parts of the brain involved in visual function, and the even higher demand of the visual sensory receptors themselves. It is perhaps no wonder that the hallmark sign of tiredness is heaviness of the eyelids, and that the gateway between sleep and waking states is at the eyelids.      Table of Contents

Closing the Eyes Facilitates Proprioceptive Awareness       

Closing the eyes, like lying down, puts a damper on gross physical movement simply because, (for most people) we depend heavily on the visual sense to direct our motor activity. Vision is the dominant sensory mode, which is reflected in the large amount of brain activity associated with visual function. As a result, activity of the visual system can relegate other sensory channels to lower levels of conscious awareness. Therefore closing the eyes has the effect of making input from other sensory modalities more accessible to conscious awareness.

In the absence of the dominant visual activity, the conscious mind can better perceive subtle proprioceptive information. This is of special importance for achieving effective rest, because there can be meaningful feedback to the conscious mind as to the degree of tension in the skeletal muscles. Experience indicates that proprioceptive information is always available to conscious awareness, but is usually buried under the tumult of other sensory data, especially the visual. Once we can tune into this proprioceptive information consciously we have a feedback loop sufficient for the voluntary release of subtle levels of tension that are either a 'residue' from muscular activity, or the result of contents of the mind that are emotionally charged (Wilhelm, et. al., 2001, p. 526). Recent research suggests that the tension residue that persists after purposeful action is complete may reflect persistent activity in Type I slow twitch muscle fibers of a given muscle (Lundberg, 2003). It is abundantly demonstrated in electromyographic biofeedback (Stoyva, 1989; Norris and Fahrion, 1993) that when there is conscious awareness of tension in the body, there is the possibility of letting it go. Therefore, bringing subtle proprioceptive sensation to conscious awareness can facilitate rest, especially after appropriate training. Along with regulating the breath, the ability to let go of muscular tension is perhaps the most useful tool for deactivating elements of the stress response.

As a side note, it is indicated that the mental act of visualizing an object recruits activity in the brain in more or less the same way as actually viewing the object with eyes open (KSJ, p. 394b). Two questions arise: what does the act of visual imagination do to overall brain activity, and is such activity reflected in any diminution in alpha brainwave patterns (toward beta), as would occur in actually opening the eyes?       Table of Contents

REST AND REGULATING THE BREATH     

There are distinct characteristics to the quality of breathing when a person is sleeping that are different from when the person is awake. Namely, the breathing becomes more regular (except in REM sleep), the respiratory rate decreases and the tidal volume increases (Parmeggiani, 1989, p. 6). In other words, a person's breath gets deeper, slower and more rhythmic as they shift into a sleep state. Parents with young children become adept at reading these signs; so do massage therapists. What is the role these alterations in breath play in the restfulness of sleep? Is there an advantage for stress management in teaching people to voluntarily slow their respiratory rate when they are attempting to relax?      Table of Contents

Elevated Respiratory Rate is an Element of the Stress Response  

Increased ventilation is an element of the fight-flight response, preparing the body for vigorous action; but in the absence of any such vigorous action, the elevated ventilatory rate soon causes arterial PCO2 levels to drop, a condition called hypocapnia. CO2 circulates in the blood as carbonic acid, and it plays a crucial role in determining the pH of the blood. Blood pH in turn influences a host of physiological processes, not the least of which is the dissociation rate of hemoglobin (Hb) and oxygen. Hypocapnia results in an increased pH; increased ph results in a decreased rate of Hb-O2 dissociation. This decreased Hb-O2 dissociation rate results in a reduced availability of oxygen to the tissues of the body. Chronic hyperventilation (where hyperventilation means ventilation in excess of metabolic demand), with its resultant hypocapnia, is implicated in anxiety disorders including panic disorder (Wilhelm, et. al., 2001), and may serve as an underlying mechanism in many of the pathological developments associated with chronic stress response (Fried, 1989). It is certainly counterintuitive that excessive breathing would lead to "tissue air hunger," but the pathway seems clear:

Decreased Arterial PC02		Increased pH (Alkalosis)		Decrease Hb-O2 dissociation rate
Hyperventilation				Tissue Hypoxia

Although there are many theoretical details that are not understood about the effects of prolonged low-grade hyperventilation and it relations to various stress pathologies, it is clear that reducing the respiratory volume is a final common pathway for clinically treating many of these conditions. Typically this involves reducing the respiratory rate* while holding the tidal volume constant or even allowing it to deepen slightly, as happens in sleep. Most crucial of all seems to be establishing a steady rhythm to the breathing, because respiratory instability often leads to hyperventilation (Wilhelm, et. al., 2001, p. 525). Also, for reasons already stated earlier, diaphragmatic breathing is essential to effectively reduce overall arousal, and to achieve the depth and stability that are characteristic of healthy breathing habits.      Table of Contents

Slowing the breath requires less energy     

In the Yoga literature, in the general practice of clinical stress management and in various modalities of the complimentary-alternative medicine (CAM) field, there is frequent emphasis on the importance of proper breathing, in order to manage stress and body tension and to promote overall health. All the time we are telling people to breathe. Because breathing is associated, in the minds of many, with the supply of oxygen to the body tissues, it is generally assumed that improper breathing results in insufficient oxygen in the system. However, GH indicates (p. 480a) that regulation of oxygen and carbon dioxide in the bloodstream is so precise that it virtually never varies¥, even as metabolic demand increases dramatically in strenuous exercise. However, it is an entirely different matter at the cellular level, where the availability of oxygen can vary to the extent that it has a determining effect on the respiratory pathways that are utilized in the cells for the generation of energy. Aerobic pathways are preferentially used when there is ample oxygen, and anaerobic pathways are used when there is not ample oxygen, as in prolonged strenuous exertion. Maximal exertion, with its anaerobic metabolism, can only be tolerated for short periods of time before the system becomes exhausted, thus after only 4 minutes of maximal exercise, a full hour is required to restore the oxygen reserves normally maintained in the body (GH p. 971).

During quiet respiration, the breathing mechanisms require only 3-5% of the total energy used by the body, but this requirement may increase as much as 50 times during heavy exercise, making sufficient respiration one of the main limitations to extraordinary physical performance (GH, p. 436). GH also notes (p. 479b) that during strenuous exercise the oxygen demand increases up to 20 times. Therefore it can be deduced that the efficiency of ventilation becomes significantly reduced at high volumes.

But how does this play out at low volumes associated with the shallow rapid breathing characteristic of the stress response? Is there any basis for assuming that slowing the breath requires less energy? Are there any physiological effects known to be associated with shallow rapid breathing vs. slower, deeper breathing? Two factors come into play. First, the rapid respiratory rate would increase airway resistance just the same as in rapid deep breathing. Slower breathing meets less airway resistance, and is therefore more efficient. Second, the shallowness of breath in a stress response is partly due to the increase in overall striate tension, which adds resistance to the excursion of the diaphragm (because of increase tension in the abdominal wall), making diaphragmatic breathing, in this case, no more efficient than chest breathing. Wilhelm, et. al. (2001, p. 535) have found that symptom reduction in clinical anxiety was strongly related to reduction of respiratory rate. These same authors capture my sentiments when they state, at the outset of their report: "we are in the early stages of gathering a scientific database in this fascinating mind-body research area." (p. 514)

Some additional questions have come to mind along the way, and here is what I have found:

• Is down-regulating the respiratory rate a way to down-regulate the heart rate? Wilson and Mitchell (1995) have shown that reducing static tension in highly glycolytic (Type IIb) muscles has the effect of down-regulating cardiovascular rate. Since widespread static muscle tension is a common component of the stress response, and slowing the breath appears to be effective in undoing the stress response, down-regulating the breath could down-regulate heart rate.
  
  
• Does the breath serve as a principle rhythm in the body to which other functions will entrain? Miyamoto, et. al. (1989) report that there is a significant tendency of the respiratory rhythm to entrain to stepping rhythm during locomotion, when the stepping rhythm is the controlled variable. However, these investigators did not report any attempts to observe stepping rhythm with respiratory rate being the controlled variable.
  
  
• Is there any basis to the ubiquitous observation that the voluntary regulation of breath (rate, tidal volume and drive source, i.e., chest vs. diaphragm) provides a calming influence on the rest of the system? This has been addressed in the observations of the hypocapnic phenomenon (Fried, 1989; Wilhelm, et. al., 2001), where down-regulation of the respiratory rate, while allowing tidal volume to increase slightly, favors greater ventilatory stability. This stability tends to correct any hypocapnia, with a resultant reduction of muscle tone. It is quite likely that there are other pathways that also link these two variables, not the least of which are psychological factors, such as conditioned association.
  
  
• Is there any basis for the utility, apparent in wellness training, of coupling the timing of cognitive self-direction to release muscular tension (locally or globally) with the exhalation phase of the breath cycle? No information found on this topic.

It is clear from several references in GH (pgs. 432a, 474a, 475a) that the body is designed to rely primarily on action of the diaphragm to maintain resting respiratory function. Stimulated by "inspiratory ramp signals" from the dorsal respiratory group of the medulla oblongata, the diaphragm performs smooth and gradual contractions to cause inspiration; exhalation is achieved solely by the elastic recoil of the diaphragm, lung tissue and abdominal wall and contents. It is only at elevated respiratory rates that muscular effort comes into play: from the rectus abdominus and the external intercostals adding power to the exhalation, and the internal intercostals assisting the diaphragm with inspiration. Since the thoracic wall is inherently less compliant than the abdominal wall (especially when relaxed), these elevated tidal volumes come at a higher price. So, at rest, diaphragmatic breathing is natural, and neurologically simpler to achieve.

Clearly, we are all subject to making, almost automatically, judgments about the interoceptive information we receive on an on-going basis. When our eyes open wide and our heart-rate soars we may be inclined to interpret this as fear; and by the same token, when we are breathing in a slow and easy rhythm, we may well perceive ourselves as relaxed and peaceful. There perceptions are influential in shaping subsequent psychophysiological responses. Breathing is at the interface of voluntary and involuntary, mind and body. We are more consciously aware of this function than most involuntary physiological functions because we can control it.     Table of Contents

UNFINISHED BUSINESS:      

REST AND FOCUSING THE MIND

• Research on meditation

MUSCLE TENSION AND VOLUNTARY CONTROL

• Why muscle tension persists after cessation of purposeful motor commands
  
  
• Role of Type I slow muscle fibers
  
  
• Voluntary control in deep relaxation may reflect deactivation of these Type I fibers
  
  
• Research the EMG rates identified in studies reviewed @ Allostatic load notebook, and compare with EMG studies done in biofeedback showing initial resting levels in first-time trainees. Also compare these values with known values of 'resting tone.'
  
  
• Compare and contrast 'resting tone' with 'tension residue.'
  
  
• VCR, used in pauses in activity and at the end of the day, as a method for minimizing accumulation of tension     Table of Contents

CONCLUSION        

It is significant for all stress management that we understand that "mental or physical stress usually excites the sympathetic nervous system." (GH, p. 706b)

There is a vast literature bearing on the topics I have investigated, and this study represents only a beginning to a proper review of that literature. There is a tendency for such a review, done over a short time course, to be somewhat haphazard and incomplete, and my emphasis on the use of textbooks-Guyton and Hall, and Kandel, Schwartz and Jessell-has been in part to help increase the comprehensiveness of my approach. I also needed these texts to get me into the ballpark with general physiology of the topics.

As indicated by the outline elements at the end of this review, there are still major areas of this research project that did even get touched. What are the psychophysiological findings of the growing body of research on meditation and the other mind/body methods of self-regulation that I utilize in my stress management training programs? The time limitations are all that have prevented my exploration of these topics, and clearly I now feel more adequately prepared for these explorations because of this present work.

In light of these considerations, my formal conclusions must be conservative. I have sampled a wide variety of literature relating to the three simple voluntary behaviors: lying down, closing the eyes and regulating the breath to imitate the respiratory patterns associated with stage 4 slow wave sleep. Based on this sample, there is good evidence that all three of these behaviors have physiological effects that could contribute significantly to voluntary reduction of arousal associated with the stress response, especially if there is a supporting cognitive framework in place.     Table of Contents

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