Editorial Type: research-article
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Online Publication Date: 14 May 2024

WHAT ABOUT THIS?: Quick Somatic Rescue Techniques when Stressed

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Article Category: Research Article
Page Range: 18 – 26
DOI: 10.5298/982312
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When threats are perceived, our thoughts and body respond almost immediately with defense reactions that may negatively affect us and others we know. Described are approaches that can interrupt negative stress responses and allow us to become calmer and less reactive by utilizing a set of somatic and breathing practices that assist in raising self-awareness as well as moderating the triggers and interrupting the cascades of stress reactions. Each of the specific practices can be introduced quickly, even in situations in which mental health first aid is indicated. For example, the practices introduce the S.O.S 1™ technique, an adapted Nyingma stress reduction exercise, and several breathing exercises, such as box breathing, sniff and sniff breathing, humming, and toning. The various practices are aimed at reducing or stopping over-reactive thoughts and body responses as well as increasing a sense of safety and control that allows you to think more clearly about difficult situations.

Keywords: stress management; box breathing; self-soothing practice; somatic practices; respiration

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

—Dalai Lama XIV

Left figure from: https://upload.wikimedia.org/wikipedia/commons/4/43/Woman_Stressed_At_Work_Illustration.jpg Right figure from: https://iconscout.com/free-illustration/relaxing-mind-2080822/

Citation: Biofeedback 52, 1; 10.5298/982312

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

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

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

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

Many approaches exist that allow us to become calmer and less reactive. General categories include techniques of cognitive reappraisal, seeing the situation from the other person’s point of view, and labeling your own feelings and emotions. Practices that are beneficial include mindfulness meditation, distraction techniques using benign humor (versus gallows humor), listening to music, taking a time out while implementing a variety of self-soothing practices, or incorporating slow breathing (e.g., heart rate variability and/or box breathing) throughout the day. Simple questions are raised: how long will the agitation last, how much damage will the agitation cause to myself and to others, and how can I remember to use beneficial techniques sooner?

We may respond differently to stressful life circumstances. For some people, a tend and befriend stress response is possible (e.g., Cohen & Lansing, 2021; Taylor et al., 2000). This response appears to be mostly mediated by the hormone oxytocin acting in ways that soothe or calm the nervous system as an analgesic. These neurophysiological mechanisms of soothing with the calming analgesic effects of oxytocin have been characterized in detail by Xin et al. (2017):

[T]here are several mechanisms for oxytocin to produce analgesia by actions on the central and peripheral nervous system, including directly inhibiting spinal neurons which receive sensory information (Breton et al., 2009; Jo et al., 1998), exciting inhibitory GABA interneurons in the spinal cord (Breton et al., 2008; Condes-Lara et al., 2009a; Rojas-Piloni et al., 2007), and receiving direct projections from hypothalamic oxytocin neurons (Saper et al., 1976; Swanson and McKellar, 1979), reducing Ad/C-fibre afferent signaling and ascending nociceptive input (Breton et al., 2008; Condes-Lara et al., 2009a). Additional mechanisms involve the engagement of the endogenous opioid (Yang, 1994; Yu et al., 2003) and cannabinoid (Russo et al., 2012) systems modulating pain perception. (p. 58)

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

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

Citation: Biofeedback 52, 1; 10.5298/982312

The fight/flight response triggers a cascade of stress hormones or neurotransmitters (e.g., hypothalamus-pituitary-adrenal cascade) and produces body changes, such as the heart pounding, quicker breathing, an increase in muscle tension, and sweating. There is more detail on mechanisms of action than space permits here; however, for interested readers, some key parts of the stress response cascade begin when the hypothalamus produces corticotrophin-releasing factor, the pituitary produces adrenocorticotrophin hormone, and the adrenal glands produce adrenaline, which can increase heart rate; cortisol, which in excess can suppress immune function; and aldosterone, which can regulate blood pressure among other functions (Hendry et al., 2024; Hu et al., 2023).

Our body mobilizes itself to protect itself from danger. Our focus is on immediate survival and not on what will occur in the future (Sapolsky, 2004). It is as if we are facing an angry lion, which is a life-threatening situation, and we feel threatened and unsafe. Rather than sitting still, a quick way to interrupt this fight/flight response process is to complete an alarm reaction, such as by moving our muscles (e.g., simulating a fight or flight behavior) before continuing with slower breathing or other self-soothing strategies. Many people have experienced that their body tension reduces and that they feel calmer when they do vigorous exercise after being upset, frustrated, or angry. Similarly, many athletes have reported that they experience a reduced frequency and/or intensity of negative thoughts after an exhausting workout (Thayer, 2003; Liao et al., 2015; Basso & Suzuki, 2017). The implication is to consider the role of physical activity in moderating stress reactions rather than recommend that people exhaust themselves in order to address stress responses.

Self-Awareness of Stress Reactions

Before initiating a response to reduce a stress reaction, the person needs to be aware that they have reacted. The concept of self-awareness is complex as described by Berkovich-Ohana et al. (2019):

“The concept of self is highly ambiguous and wide-ranging, involving different aspects of the self across a large number of disciplines, including embodied, experiential, affective, intersubjective, cognitive, narrative, and extended aspects (Gallagher, 2013; Strawson, 2000). Thus it may be best construed as a multidimensional construct including somatosensory, agentive, narrative and social components…” (p. 357).

Further details of the brain regions associated with self-awareness have been described by Lou et al. (2017), as follows:

The functional anatomy of the two core hubs of self-awareness, the medial prefrontal/anterior cingulate and medialparietal/posterior cingulate cortices, has been analyzed in detail by Amodio and Frith (2006); Fleming et al. (2010); Cavanna and Trimble (2006); Peer et al. (2015). … Awareness of the body, is linked to gamma-butyric acid (GABA) composition in the insula as determined by magnetic resonance spectroscopy (Wiebking et al., 2014; Damasio, 2000; Orfei et al., 2008; Heydrich & Blanke, 2013). Likewise, in self-generated movements activity in supplementary motor regions is linked to the paralimbic circuitry of self-awareness (Nguyen et al., 2014). Finally, the so-called the “default mode network” of idleness is characterized by a high degree of self-referential thinking (Gusnard et al., 2001; Salomon et al., 2014; Davey et al., 2016; Luber et al., 2012) … This change reflects the brain’s capacity to shift allocation of resources according to changing needs (Lou et al., 2011 a,b,c). (p. 769)

Although many questions may be raised about attentional, awareness, and consciousness processes, a simplified, general understanding of awareness is used in this article, in which paying attention, raising awareness, and consciously experiencing stress reactions precedes the intention to interrupt an escalating cascade of physical, behavioral, and psychological responses to difficulties.

What to Do when Stressed and Sympathetically Aroused

Awareness (e.g., in the various forms described by others in the previous paragraphs) that one is reacting is the first step in interrupting the escalating process. After one becomes aware, the body’s arousal can continue to be reduced and thought patterns can continue to be changed using any, many, or all of the techniques discussed in this article. The self-regulation skills presented in this article are ideally overlearned and automated so that these skills can be rapidly implemented to shift the dominant sympathetic aroused state to a more parasympathetic state. Examples of skills shown to shift from sympathetic nervous system overarousal to parasympathetic nervous system calm include techniques of autogenic training (Schultz & Luthe, 1959), the quieting reflex developed by Charles Stroebel, MD, or, more recently, rescue breathing, which was developed by Richard Gevirtz (Stroebel, 1985; Peper & Gibney, 2003; Gevirtz, 2014). Below are concepts that underlie the suggestions.

  1. Psychophysiological principle: “Every change in the physiological state is accompanied by an appropriate change in the mental-emotional state, conscious or unconscious, and conversely, every change in the mental-emotional state, conscious or unconscious, is accompanied by an appropriate change in the physiological state” (Green et al., 1970, p. 3).

  2. Posture evokes memories and feelings associated with the position. When the body posture is erect and tall while looking slightly up, it is easier to evoke empowering, positive thoughts and feelings. When looking down, it is easier to evoke hopeless, helpless, and powerless thoughts and feelings (Peper et al., 2017).

  3. Healing occurs more easily when relaxed and with feelings of safety. Feeling safe and nurtured enhances the parasympathetic state and reduces the sympathetic state. Use memory recall to evoke past experiences when you felt safe (Peper, 2021).

  4. Interrupting thoughts is easier with somatic movement than by redirecting attention and thinking of something else without somatic movement.

  5. Focus on what you want to do. Attempting to stop thinking or ruminating about something tends to keep it present (e.g., do not think of pink elephants. What color is the elephant? When you answer, “not pink,” you are still thinking of pink). A general concept is to direct your attention (or have others guide you) to something else (Hilt & Pollak, 2012; Oded, 2018; Seo, 2023).

  6. Skill mastery takes practice and role rehearsal (Lally et al., 2010; Peper & Wilson, 2021).

  7. Use classical conditioning concepts to facilitate shifting states. Practice the skills and associate them with aromas, memories, sounds, or touch cues. Then, when a situation occurs, use these classically conditioned cues to facilitate the regeneration response (Peper & Wilson, 2021).

Coping when Highly Stressed and Agitated

  1. Complete the alarm/defense reaction with physical activity1

    1. Acknowledge that you have reacted and have chosen to interrupt your automatic response.

    2. Check whether the situation is actually a threat. If yes, then do anything to get out of immediate danger (yell, scream, run away, dial 911).

    3. If there is no actual physical threat, leave the situation and perform vigorous physical activity to complete your alarm reaction, such as going for a run or quickly walking up and down stairs. As you do the exercise, push yourself so that the muscles in your thighs are aching, as that focuses your attention on the sensations in your thighs. In our experience, an intensive run for 20 minutes quiets the brain, whereas it often takes 40 minutes when walking somewhat quickly.

    4. After recovering from the exhaustive exercise, explore new options by which to resolve the conflict.

  2. Complete the alarm/defense reaction and evoke calmness with the S.O.S 1™ technique (Oded, 2023)

    1. Acknowledge that you have reacted and have chosen to interrupt your automatic response.

    2. Squat against a wall (similar to the wall-sit that many skiers practice). While tensing your arms and fists as shown in Figure 2, gaze upward, as it is more difficult to engage in negative thinking while looking upward. If you continue to ruminate, scan the room for an object of a certain color or feature to shift visual attention, and be totally present on the visual object.

    3. Do this set of movements for 7 to 10 seconds or until you start shaking. Then, stand up and relax your hands and legs. While standing, bounce up and down loosely for 10 to 15 seconds as you become aware of the vibratory sensations in your arms and shoulders, as shown in Figure 3.

    4. Swing your arms back and forth for 20 seconds. Allow the arms to swing freely, as illustrated in Figure 4.

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

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

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

Figure 2.Figure 2.Figure 2.
Figure 2. Defense position wall-sit to tighten muscles in the protective defense posture (Oded, 2023).

Citation: Biofeedback 52, 1; 10.5298/982312

Figure 3.Figure 3.Figure 3.
Figure 3. Bouncing up and down to loosen muscles (Oded, 2023).

Citation: Biofeedback 52, 1; 10.5298/982312

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

Citation: Biofeedback 52, 1; 10.5298/982312

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

Citation: Biofeedback 52, 1; 10.5298/982312

Figure 6.Figure 6.Figure 6.
Figure 6. Blood volume pulse increases as the person relaxes and feels safe and calm.

Citation: Biofeedback 52, 1; 10.5298/982312

Coping When You Can’t Get Away

(Adapted from Peper et al., 2020)

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

  1. Become aware that you have reacted.

  2. Excuse yourself for a moment and go to a private space, such as a restroom. Going to the bathroom is one of the only acceptable social behaviors by which to leave a meeting for a short time.

  3. In the bathroom stall, do the 5-minute Nyingma exercise, which was taught by Tarthang Tulku Rinpoche2 in the tradition of Tibetan Buddhism, as a strategy for thought stopping (see Figure 7). Stand on your toes with your heels touching each other. Lift your heels off the floor while bending your knees. Place your hands at your sides and look upward. Breathe slowly and deeply (e.g., belly breathing at six breaths per minute) and imagine the air circulating through your legs and arms. Do this slow breathing and visualization next to a wall so that you can steady yourself if you need to. Stay in this position for five minutes or longer. Do not straighten your legs; keep squatting, despite the discomfort. In a short time, your attention will be captured by the burning sensation in your thighs. Continue. After five minutes, stop and shake your arms and legs.

  4. Follow this practice with slow abdominal breathing to enhance the parasympathetic response. Be sure that the abdomen expands as the inhalation occurs. Breathe in and out through the nose at about six breaths per minute.

  5. Once you feel centered and peaceful, return to the room.

  6. After this exercise, your racing thoughts will most likely have stopped, and you will be able to continue your day with greater calm.

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

Citation: Biofeedback 52, 1; 10.5298/982312

Figure 8.Figure 8.Figure 8.
Figure 8. Boiling water (photo modified from: https://www.facebook.com/photo/?fbid=388991500314839&set=a.377199901493999).

Citation: Biofeedback 52, 1; 10.5298/982312

What to do when Ruminating, Agitated, Anxious, or Depressed

(Adapted from Peper, Harvey, & Hamiel, 2019)

  1. Shift your position by sitting or standing erect in a power position with the back of the head reaching upward to the ceiling while slightly gazing upward. Then, sniff quickly through nose, hold, and again sniff quickly. Then, slowly exhale. Be sure that your abdomen constricts as you exhale. Then, sniff again as your abdomen gets bigger, hold, and sniff one more time, letting the abdomen get even bigger. Then, slowly exhale through the nose to an internal count of six (adapted from Balban et al., 2023). When you sniff or gasp, your racing thoughts will stop (Peper et al., 2016).

  2. Continue with box breathing (sometimes described as tactical breathing or battle breathing) by exhaling slowly through your nose for four seconds, holding your breath for four seconds, inhaling slowly for four seconds through your nose, holding your breath for four seconds, and then repeating this cycle of breathing for a few minutes (Röttger et al., 2021; Balban et al., 2023). Focusing your attention on performing box breathing makes it almost impossible to think of anything else. After a few minutes, follow this with slow, effortless diaphragmatic breathing at about six breaths per minute. While slowly exhaling through your nose, look up. When you inhale, imagine the air coming from above you. Then, as you exhale, imagine feeling the air flow down and through your arms and legs and out your hands and feet.

  3. While gazing upward, elicit a positive memory or a time when you felt safe, powerful, strong, and/or grounded. Make the positive memory as real as possible.

  4. Implement cognitive strategies, such as reframing the issue, sending goodwill to the person, seeing the problem from the other person’s point of view, and asking whether this problem is worth dying over (Peper, Harvey, & Hamiel, 2019).

What to Do When Thoughts Keep Interrupting

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

  1. Box breathing (Röttger et al., 2021; Balban et al., 2023).

  2. Humming, also known as bee breath (Bhramari Pranayama; Abishek et al., 2019; Yoga, 2023). Allow the tongue to rest against the upper palate. Sit tall and erect so that the back of the head is reaching upward to the ceiling, and inhale through your nose as the abdomen expands. Then, begin humming while the air flows out through your nose. Feel the vibration in the nose, face, and throat. Let the humming last for about seven seconds. Then, allow air to blow in through the nose. Then, hum again. Continue for about five minutes.

  3. Toning. Inhale through your nose and then vocalize a single sound, such as Om. As you vocalize the lower sound, feel the vibration in your throat, chest, and even going down to the abdomen. Let each toning exhalation last for about six to seven seconds. Then, inhale through your nose. Continue for about five minutes (Peper et al., 2019).

Many people report that when they practice these skills the moment they become aware that they are reacting, they experience a significant decrease in their stress levels as well as fewer symptoms, such as neck and holder tension and high blood pressure. They also feel increases in tranquility and the ability to communicate effectively. Implementing these practices does not resolve the conflicts; however, they allow you to stop reacting automatically, thereby allowing you a time out and giving you the ability to be calmer, which allows you to think more clearly. When calmer, problem solving is usually more successful. As phrased in a popular meme, “You cannot see your reflection in boiling water. Similarly, you cannot see the truth in a state of anger. When the waters calm, clarity comes” (author unknown).

Additional resources are listed below. Please share these resources with friends, family, and co-workers.

See the following blogs for more detailed information.

Stressor squat instructions:

https://peperperspective.com/2017/10/06/are-you-out-of-control-and-reacting-in-anger-the-role-of-food-and-exercise/

Toning instructions:

https://peperperspective.com/2021/11/22/healing-from-paralysis-music-toning-to-activate-health/

Diaphragmatic breathing instructions:

https://peperperspective.com/2022/04/03/a-breath-of-fresh-air-breathing-and-posture-to-optimize-health/

https://peperperspective.com/2017/06/23/healing-irritable-bowel-syndrome-with-diaphragmatic-breathing/

https://peperperspective.com/2023/03/20/breathing-informative-youtube-videos-and-blogs/

Reduce stress with posture and breathing:

https://peperperspective.com/2019/10/19/reduce-stress-anxiety-and-negative-thoughts-with-posture-breathing-and-reframing/

Conditioning:

https://peperperspective.com/2019/02/15/relive-memory-to-create-healing-imagery/

https://peperperspective.com/2021/08/12/improve-learning-with-peak-performance-techniques/

Copyright: ©Association for Applied Psychophysiology & Biofeedback 2024
Figure 1.
Figure 1.

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

Figure 2.
Figure 2.

Defense position wall-sit to tighten muscles in the protective defense posture (Oded, 2023).

Figure 3.
Figure 3.

Bouncing up and down to loosen muscles (Oded, 2023).

Figure 4.
Figure 4.

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

Figure 5.
Figure 5.

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

Figure 6.
Figure 6.

Blood volume pulse increases as the person relaxes and feels safe and calm.

Figure 7.
Figure 7.

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

Figure 8.
Figure 8.

Contributor Notes

Correspondence: Erik Peper, PhD, Institute for Holistic Health Studies, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132. Mailing address: 2236 Derby Street, Berkeley, CA 94705, email: epeper@sfsu.edu; Web: www.biofeedbackhealth.org; blog: www.peperperspective.com
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