Osteopathic Journals and Research by Darren Chandler

 

 RSS Feed

  1. Involuntary motion soft tissue techniques: Fascial Unwinding, Pandiculations and Muscle Repositioning

    Fascial Unwinding

    Minasny (2009) found fascial unwinding to involve two apects:

    • Passively moving the patient in response to sensations of movement.
    • Inducing involuntary movement by using an initiation or induction technique.

    Induction techniques initiates fascial unwinding that results in the patient responding with spontaneous expressions of movement in either a rhythmic or chaotic pattern.

    The induction process is initiated by lifting and holding certain body parts to remove the influence of gravity as to overcome reactive proprioceptive postural tone. When the effects of gravity are removed, any strain patterns held in the tissues are more easily felt. The therapist follows any hint of movement without directing or forcing it. This involves the practitioner being largely passive but constantly aware of feedback from the patient's tissues (Minasny 2009).

    Pandiculations

    Schleip (2017) described another proprioceptive stimulating approach to produce involuntary movements called pandiculations. This was from the patient performing slow continuous resisted movement in a concentric and eccentric fashion whilst their soft tissues are being worked upon. This is usually repeated for sixty to ninety seconds followed by a brief isometric contraction of the antagonistic muscles.

    Muscle Repositioning

    Bertolucci (2010) described a technique called Muscle Repositioning that also worked on pandiculations. This author found involuntary movements to be produced as a result of internal shear forces among myofascial compartments. These shear forces are produced from the practitioner applying precise and sustained firm pressure at an oblique angle which produces a counter pressure generated from the inertia of the tissues.

    The resultant involuntary movement happens in small increments (pandiculation), which become larger towards the end of the manoeuvre as body segments unite into a block. After the manoeuvre the patient often feels a burning sensation.

    Somatic Experiencing 

    Payne et al (2015) described the theory of Somatic Experiencing. The sympathetic nervous system may get “stuck” in a state of excess activation; this results in altered muscular activity disturbing the proprioceptive feedback that results in a failed reciprocal activation of the parasympathetic nervous system. This sympathetic-parasympathetic nervous system imbalance impacts on the neuroendocrine axis.

    In Somatic Experiencing rebalancing the nervous system can be achieved by intense muscular effort and manual techniques producing involuntary spontaneous movements of the body such as gentle shaking and subtle postural changes. This is often accompanied by feelings of fear, sadness, or relief. It accounts for shaking and crying after an intense bout of sympathetic arousal and also, possibly, tonic immobility.

    Therefore proprioceptive feedback is integral to allow the autonomic nervous system to reset to baseline. By drawing the patient's attention to the proprioceptive and kinesthetic (somatic) markers of this “release” process it enables a spontaneous rebalancing of the nervous system.

    Proprioception 

    Proprioception and involuntary motion

    Ideomotion is the proposed mechanism for involuntary motion in fascial unwinding (Minasny 2009) and cranial osteopathy (Mason 2008); refer below 'Ideomotor theory' and 'Ideomotion and fascial unwninding'

    Ideomotor actions are unconscious involuntary movements caused by prior expectations, suggestions, or preconceptions (Minasry 2008). Hence:

    Ideation: thinking about or activating the mental representation of a perceived outcome and experiences --> motion: behaviour expressed through involuntary motor action. 

    An example of an ideomotor activity is closing your eyes to go to sleep. An individual's representation (i.e. their ideation) of closing their eyes to go to sleep maybe the anticipation and mental representation of darkness, the closure of heavy eyes and uncosciousness. This leads to the non-deliberate, intuitive motor response (i.e. motion) of the individual closing their eyes (Wirth et al 2018).

    Whilst all ideomotor responses look intuitive, some have to be learnt. For instance an ideomotor response would be an emotion e.g. positivity (ideation) triggering a motor response in the form of adopting a particular posture e.g. upright posture (motion). This would have been learnt when young through observation and role play. This ideomotor repsonse is bi-directional so when older and the association with posture and emotions are 'cemented in' to form a ideomotor reflex, activey changing a posture, in a particular situation can intern be therapeutic leading to a change of emotions.

    The body's ability to preform these involuntary ideomotor actions are based, amongst other things, on proprioceptive feedback (Ondobaka & Bekkering 2012). Proprioception is not just centred around the awareness of the positioning of your body in space but the learning and emotions that accompany this (Liutsko et al 2016, Fuchs & Koch 2014 & Abraham et al 2020); refer below 'Proprioception and learning' and 'Proprioception and emotions'.

    Therefore proprioceptive information, through learming and emotions, has a mental representation of the specific actions that had caused them. These learnt emotional mental representations form sensory anticipations that can trigger automatic ideomotor actions (Wirth et al 2016).

    For example when performing a lumbar roll if a patient has a negative emotional representation of the technique causing tension and anticipation this can heighten proprioceptive feedback. This anxiety and proprioceptive feedback can trigger both voluntary tightness in the paraspinal muscles and a involuntary learnt ideomotor reflex repsonse to such anxiety and vulnerability in the form of neck extension, facial muscle tension and hand and feet clenching. With the ideomotor reflex being bi-directional addressing these learnt ideomotor motor responses i.e. the neck extension, facial muscle tension and hand and feet clenching should reflexly both reduce anxiety and relax the paraspinal muscles for a more efficient technique. 

    Much like with the emotional representation of sleep triggering the automatic motor response of closing the eyelids the learnt emotional and motor repsonses to proprioception are manifested through involuntary ideomotor movements (Ondobaka & Bekkering 2012). It is also why manual stimulation of proprioceptors has been associated with exciting the ideomotor reflex manifested with the involuntary motor movements in myofascial release (Minasny 2009) and cranial osteopathic techniques (Mason 2008).

    What is proprioception

    Proprioception means perception of ourselves, or more exactly, perception of the relative positions of the parts of our body (Liutsko et al 2016). 

    Fascia is the richest sensory organ in the human body as a vast majority of sensory nerve endings in musculoskeletal tissues originate in it (e.g. perimysium and endomysium). Muscular-tendinous expansions insert into the fascia that transmit mechanical tensions to it. This in turn activates free nerve endings and other fascial receptors that contribute to accurate sensing of joint range of motion and positioning. Fascial stiffness has been linked with decreased proprioception and chronic sympathetic activation (Abraham et al 2020).

    All this afferent information acts as “an anchor for self-awareness” (Liutsko et al 2016) as we perceive our self-awareness, feelings, mood, stress, energy and disposition from our physical bodies as a representative of all aspects of our physiological condition (Abraham 2020).

    Abraham (2020) identified sensory-proprioceptive information (or feedback) from fascia to include body contour and physical proportions; this information forms a mental representation of the body and its parts in space and in relation to each other (i.e. body schema). Disorders in body schema are reflected in connective tissue patterns.

    Emotions and body states are closely interrelated, and modifications of one lead to changes in the other. Proprioception “encodes” these moods, feelings and attitudes so that have a bidirectional facilitation interference with movement. "happy movement <--> happy emotions".

    This is why not only body sensations, but also body postures, gestures and expressions are inherent components of emotional experience that influence our evaluation of people, objects and situations, as well as memory recall (Fuchs & Koch 2014). 

    This is exemplified by how the following movements and postures effect behaviour and emotions:

    • Approach movements have a bidirectional facilitation interference with positive moods, feelings and attitudes such as being excited, alert and determined (Liutsko et al 2016). 

    During an approach movement (e.g. arm flexion or receptive movement of the hands) an individual has a more positive evaluation of imagery and target objects (Fuchs & Koch 2014). 

    • Avoidance movements have a bidirectional facilitation interference with negative moods, feelings and attitudes such as being upset, guilty, and jittery (Liutsko et al 2016).

    During an avoidance movement (e.g. arm extension or unreceptive movement of the hands) an individual has a more negative evaluation of imagery and target objects (Fuchs & Koch 2014).

    • When people stand or sit for 7 min in a “power position” (different forms of extension of the body), they perform better in subsequent job interviews (Fuchs & Koch 2014).
    • Shorter movements are associated with Inhibited people, while broader movements are associated with excited people (Liutsko et al 2016).

    This association of emotion with proprioception and movement can also be compounded by other sensory inputs such as emotive language e.g. “love” and “hate” that are related with approach and avoidance gestures respectively (Liutsko et al 2016). Similiar metaphors can also be used in visualisation or motor imagery (Abraham et al 2020).

    So when individuals are able to adopt or produce emotion-specific postures, facial expressions or gestures they tend to experience the associated emotions, which effects their behaviour, preferences, judgement and attitudes toward objects or people.

    Conversely, when an individual’s expressive movements are inhibited, this impairs their experience and processing of the associated emotions (Fuchs & Koch 2014). Mason (2008) found clinically this may manifest itself as isometric muscle contraction “holding yourself tight" or "holding tensions in”. 

    There is also a bidirectional correlation with emotion and muscular tension and postural changes. Studies cited by Fuchs & Koch (2014) highlighted:

    • When slumped, individuals recall more negative life events; conversely more positive events are recalled when sitting upright.
    • Activation of the smiling muscles (by asking participants to hold a pen between their teeth) causes individuals to judge cartoons funnier than when smiling is inhibited by holding the pen between their lips.

    The link between motion and movement is not only experienced by the individual but also by the observer. This can develop ‘kinaesthetic empathy where an observer perceives someone to move in a way that resonates with their own kinaesthetic representation of these movements. 

    Therefore someones expressive behaviour affects the intensity of emotions experienced by not only the individual, but also the observer. This can be seen when experiencing emotions from someone's facial expressions or looking at professional dancers, musicians and sportsmen. This can also ead to congrugent motor responses in the observer e.g. reciprocating to anothers facial expressions.

    Developing kinaesthetic empathy from observation further reinforces our own personal value on proprioception for learning and developing emotional expression and emotional intelligence.

    Proprioception and learning

    When starting to learn a new skill, we rely more on abstract learning. This involves using concentrated attention and deliberate motor movements to observe and master the action we have been tasked with learning. We can only gain feedback on this deliberate movement, as to develop a perception or mental representation of it once we've completed and analysed the movement. An example of this would be when we first learn to write and we assess the size and smoothness of the lines once we've deliberately and consciously moved the pen.

    With repeated practice we then learn on a proprioceptive level. This is where we start to look like we're operating on autopilot acquiring automatic or “embodied” knowledge (Liutsko et al 2016). Weimer et al (2001) attributed proprioceptive deficits as attributing to the "clumsiness" witnessed in Aspergers and is associated with these patients nonverbal learning.

    Our perceptions or mental representations from proprioceptive feedback determine how we perform a task. An example of this would be observing how our writing unconsciously changes over the years once we can write fluently without conscious thought or how our emotions when for example writing an angry letter effect our proprioceptive feedback to determine non-conscious motor reponses in the muscles determining subtle changes in handwriting and pen pressure.

    Embodied knowledge is the knowledge we obtain from all of our sensory, motor, and affective patterns. We process all this information to provide structure to our understanding so that we can engage with our world. This is different from an abstract intellectual grasping of concepts and their relations (Johnson 2015).

    Proprioception is ideal for learning and processing this automatic or embodied knowledge (Liutsko et al 2016). This is because proprioception is key to bodily resonance, be it in the form of sensations, postures, expressive movements or movement tendencies (Fuchs & Koch 2014).

    By using mimetic reproduction, from observing day-to-day movement, actions and expressions, proprioception is integral to learning cultural habits and the know-how associated with practical experience and professional skills (Liutsko et al 2016).

    This process of learning forms and shapes development in a child when playing with toys. A child fuses movement and proprioception with emotion when they play with a favourite toy to create emboded imagery.

    A child will identify with the toys qualities, movement and expression. They then emotionally and physically engage with the toy by moving it in an expressive manner transfering all this neural input to internally represent aspects of their own ego identity (Liutsko et al 2016).

    It's not until five years old that a child can transfer behavior control from external to internal speech and inhibit their own responses (although they can inhibit their responses before this in response to external command). Therefore up until five a child has a blank cheque to fuse unhibited expression of movement with learning (Greenwald 1970).

    This form of learning using all of our sensory, motor, and affective patterns is not only exclusively dependent upon proprioception. Many subconscious thoughts, emotions and perceptions play an influence in the process of observing and learning in this fashion. For example Fuchs & Koch (2014) identified studies showing how bodily felt warmth i.e. thermal heat from holding a hot drink, directly translates to impressions of emotional warmth. This can effect observations and perceptions during intuitive learning.

    Proprioception and emotions

    “The term “emotion” is derived from the Latin emovere, “to move out,” implying that inherent in emotions is a potential for movement, a directedness toward a certain goal (be it attractive or repulsive) and a tension between possible and actual movement” (Fuchs & Koch 2014). 

    This is mirrored with the use of such language towards emotion where people describe being “moved” or “touched” or a “sinking feeling” or being “uplifted”.

    Proprioception plays an important role in the construction of movements, formation of movement skills and in regulation of muscle tone. Proprioception also contributes to speech function or speech kinaesthesia and to general physical well-being and “sense of cheerfulness” (Liutsko et al 2016).

    As the richest sensory organ in the body, fascial stiffness, from its contractile properties, fluid dynamics and myofascial relations has been associated with emotional stimuli. This could be as fascia’s efferent nerve endings account for more than 50% of its total nerve supply and are associated with a sympathetic response i.e. vasodilation. Sympathetic nerves are also located outside the vicinity of blood vessels questioning what their function maybe (Abraham et al 2020).

    The correlation between proprioception and emotion can be reflected by its neurological links with:

    • Facial feedback: skeletal muscle afferent signals from facial expressions regulate emotional experience and behaviour.
    • Visceral feedback: visceral feedback from, for example, respiratory, heart function and the gut, are also correlated to emotional experience and behaviour.

    This proprioceptive and interoceptive feedback from the body is integrated with more cognitive information in order to guide one's behaviour particularly with regards to every day decision-making (Fuchs & Koch 2014). 'Emodied cogntion' defines the bi-directional nature and how fundamentally potent the perception and representation of actions are to bodily and emotional experiences.

    The relationship with emotions and bodily functions (including proprioception) where one can influence and manifest the other is illustrated in the quote: 

    “We do not shiver because we are scared of the lion, but we shiver as this is what we feel as our fear” (James 1884, as cited in Fuchs & Koch 2014).

    To extend this concept further other people can tickle you but you can't tickle yourself. Therefore how we process the perception of our emotions determines why what we feel as a tickle when someone else tickles us is different to what we feel as a tickle when we tickle ourselves. Consequently the tickle itself doesn't produce reflex bodily functions e.g. laugher and drawing away movements, but how we feel about, or process the tickle does.

    How we feel about and neurologically process the information to determine how tickly something is is determined by how close the match is between the expected response and actual response. By tickling ourselves we remove the anticipation of the unknown causing the cerebellum to diminish activitation in the somatosensory cortex (Simpson 2001). This reflexly determines the motor reaction to this processed afferent stimuli. Could this open the scope for mindfulness practice in addressing fear avoidance behaviour to alter the perception of proprioceptive and emotional feedback which will in turn modify their motor responses?

    Therefore, feeling something and feeling oneself are inextricably bound together. This comes back to our the fundamental definition of proprioception by Liutsko et al (2016) of “the perception of ourselves”.

    This emotion-somatic connection is bidirectional because just as an emotion (e.g. fear) will produce a somatic response (e.g. trembling) bodily (somatic) feelings produce an emotional response. For instance, being afraid is not possible without feeling oneself tremble, tense up, have palpitations, etc.

    Other bodily systems are of course involved in this whole body systemic process e.g. smell, taste, auditory stimuli etc.

    Any disturbances in life, stress, trauma and illnesses effects the proprioceptive state that both reflects in and is related to physical, emotional and cognitive functions (Liutsko et al 2016).

    Liutsko et al (2016) identified examples of personality symptoms with disturbed proprioceptive function:

    • Autism: 80% of subjects with Asperger Syndrome displayed motor dyspraxia. Weimer et al (2001) identified proprioceptive deficits, rather than motor deficits,  as explaining the incoordination observed in Asperger Syndrome 
    • Clinically avoidant personality traits showed significantly poorer motor performance.
    • Down’s syndrome scores were significantly lower for both gross and fine motor skills, as well in running speed, balance, strength and visual motor control.
    • Bipolar disorder: demonstrates altered postural control.
    • Dysfunctions of both proprioceptive and sensory integration of proprioception and vision in personality disorders, aggressive behaviour and prison inmates.

    Our bodies response to an emotional stimuli is its voice describing its “embodied appraisal” of a situation (Fuchs & Koch 2014); therefore proprioception has a critical role in listening to this appraisal and reorganizing the subsequent recovery of these neuromotor systems (Liutsko et al 2016).

    Involuntary motor reactions in response to involuntary motion soft tissue techniques

    Examples of involuntary motor reactions are:

    • Isometric contraction of the cervical erector spinae during a suboccipital inhibition technique. This results in the practitioner’s hands being pressed into the table by the involuntary extension of the subject’s head and upper cervical spine. The cervical region may show a greater responsiveness than other body parts due to its richer proprioceptive innervation (Bertolucci & Kozasa 2010).
    • Eyelid flickering (Minasy 2009).
    • Horizontal eye movements (Minasy 2009).
    • Tremors (Minasy 2009).
    • Clonic and tonic appendicular movements (Minasy 2009).
    • Rising from a supine to a seated position (Minasy 2009).

    Ideomotor theory

    "The act comes first, the word proceeding from it as its concretized efflorescence" . Corporeal Words: Mikhail Bakhtin's Theology of Discourse Alexandar Mihailovic (1997). 

    In sensorimotor learning one interprets the sensory world and responds to it with the motor system (Makin et al 2016). With sensorimotor learning it's not until we've performed the motor action that we see, understand and gain feedback on what the effects of them actions are. Therefore the movement is not guided by the perception of an action, because the perception can only be gained once the action has been performed and analysed, and the movement does not seem involuntary as it is being performed in a very deliberate conscious manner.

    In an ideomotor activity when people perform a movement and observe its subsequent effect, they acquire a bidirectional action-effect association (Vogel et al 2020). This means, as opposed to movement derived from sensorimotor learning, that eventually, merely thinking of an outcome triggers an automatic, seemingly involuntary, associated action (Sun et al 2020). In other words the ideomotor action is born from a central idea releasing, triggering and giving life to the teed up muscular system.

    This is why visualisation (motor imagery) has been shown to positively affect motor and cognitive performance and other behavioral outcomes e.g. anxiety, motivation, and confidence. It does this by eliciting brain activation similar to that during physical execution (movement, proprioception, pain, and body schema) to improve interoception and potentially even the physical structure of fascia as a sensory and motor organ (Abraham et al 2020).  

    This bi-directional response-outcome (R-O) association (Sun et al 2020) can be summarised as:

    • Initially to achieve a desired response one learns:

    Behaviour expressed through voluntary motor movements --> response --> perceived outcome. 

    • A learning phase ensues where a motor act triggering a bodily or environmental effect (Massen & Prinz 2008) becomes hard wired in the brain. This then results in the sequence of events being able to be performed in reverse:

    Ideation: thinking about or activating the mental representation of a perceived outcome and experiences --> motion: behaviour expressed through involuntary motor action. 

    Therefore in ideomotion focusing on and anticipating an outcome, e.g an emotion or environmental goal, will, enhance motor learning. In order for this process to occur two criteria must be met:

    • Clear goal. There has to be a clear idea or representation of what is being willed or intended. This goal has to resonate with the individual (Massen & Prinz 2008) as a compatible rewarding stimulus.
    • Blind positive association. All antagonistic impulses and thought should be removed (Mason 2008 & Massen & Prinz 2008).

    If these two preconditions are fulfilled the internal representations of what is intended has the power to evoke corresponding actions. This is because actions are represented through what their perceived to do and represent (Massen & Prinz 2008). Therefore ideomotor actions are intended to satisfy these perceptions and mental representations rather than be grounded in conscious abstract thinking.

    Maquestiaux et al (2020) found ideomotion can be facilitated and encouraged when a task is ideomotor compatible. This is characterised by the individual recognising a high level of similarity between the stimulus and the associated response (e.g. seeing an arrow point to the left and then pressing a left key).

    Conversely involuntary ideomotor activities can be voluntarily overruled and inhibited. This may occur when an expression of movement is culturally or socially unacceptable in which case it may become inhibited or suppressed. Clinically this may manifest itself as isometric muscle contraction (Mason 2008) “holding yourself tight" or "holding tensions in”. One can speculate if this can be transferred from practitioner to patient during a treatment i.e. if the practitioner is in a state of tension could this cause the patient to inhibit the free expression of their ideomotion?

    This mechanism of ideomotor action has been used to explain various instances in which the environment triggers behaviours in an automatic fashion.  For instance:

    • Mimicry (Sun et al 2020).
    • Behaviour from affordances e.g. pressing a button that looks like it should be pressed (Sun et al 2020).
    • Goal-directed behaviour and action priming (Sun et al 2020).
    • Body language, facial expression or body posture (Mason 2008).
    • Yawning (Mason 2008).
    • Postural correction (Mason 2008).
    • Closing your eyes to go to sleep (Wirth et al 2018).

    Ideomotion and fascial unwinding

    Ideomotor actions are unconscious involuntary movements that are performed by a person. It may be caused by prior expectations, suggestions, or preconceptions (Minasry 2008).

    Ideomotor action has two important characteristics (Minasry 2008):

    • The patient is not aware of causing the movements, and therefore the movements are ascribed to an external force or power.
    • The movement feels unnatural, and thus the external forces perceived are usually regarded as being mystical or paranormal in nature.

    Minasy (2009) ascribed ideomotion as the motion experienced by patient and practitioner during fascial unwinding. Mason (2008) also attributed it to the palpatory phenomenon described when performing osteopathy in the cranial field. It is proposed to work through three mechanisms (Minasy 2008):

    • Stimulation of fascial mechanorecpetors to produce reflex motor effects.
    • Suggestion or guiding of movement in a partiuclar direction from the practitioner’s technique.
    • Promoting deep relaxation by ‘switching off’ tensions from the conscious mind. Stimulation of the fascial mechanoreceptors and suggestion of movement from the practitioner promotes ideomotion by working at a subconscious level. Whilst the motor movement from this subconscious processing is performed voluntarily by the patient (although it seems involuntary) and they are conscious of the movement the overriding tensions from the conscious mind that can inhibit this movement are ‘switched off’.

    Cranial osteopathic techniques may possibly stimulate proprioceptors with direct intracranial effects. 

    Schueler et al (2013 & 2014) found branches from the trigeminal nerve that innervate the dura mater and regulate bloodflow intracranially also innervate extracranial soft tissues. These nerves, in the rat containing proprioceptive fibers (Schueler et al 2014), run a course originating intracranially to then traverse the cranium via the sutures and emissary canals to terminate extracranially. Extracranially these nerves innervate the connective tissue of the temporomandibular joint, periosteum and cervical muscles. Noseda et al (2019) proposed, not only can activation of extracranial muscle nociceptors cause headaches via their intracranial branches innervating the dura but also, in reverse, activation of intracranial dural nociceptors can give rise to extracranial muscle tendernes

    To initiate or facilitate fascia unwinding two conditions must be met (Minasy 2009):

    • The practitioner must posses sensitivity and fine palpation skills.
    • The patient must be able to relax and “let go” of their body.

    Mason (2008) broadened the definition of ideomotion for the treatment of musculoskeletal disorders. This definition included the use of subconscious motor movements necessary to reach a state of comfort. This is achieved by removing the inhibition and suppression of instinctual motor patterns from pain or tension in order to facilitate and encourage ideomotor patterns to emerge (McCarthy et al 2007, Mason 2008). This can be achieved by regulating proprioceptive feedback.

    References

    Massen C and Prinz W (2008). Movements, actions and tool-use actions: an ideomotor approach to imitation (2008). 

    Bertolucci L F (2010). Muscle Repositioning: Combining Subjective and Objective Feedbacks in the Teaching and Practice of a Reflex-Based Myofascial Release Technique

    Sun D, Custers R, Marien H, and  AartsIdeomotor H (2020). Action: Evidence for Automaticity in Learning, but Not Execution 

    Mason J (2008). The use of ideomotor therapy in the treatment of chronic neck pain: A single systems research design

    Schleip R (2017). Fascia as a sensory organ: clinical applications 

    Maquestiaux F, Lyphout-Spitz M, Ruthruff E, ArexisIdeomotor M (2020). Compatibility enables automatic response selection

    McCarthy S, Rickards L, Lucas N (2007). Using the concept of ideomotor therapy in the treatment of a patient with chronic neck pain: A single system research design. 

    Vogel D, Rudolf M, and Scherbaum S (2020). The impact of the verbal instruction and task characteristics on effect-based action control

    Bertolucci LF, Kozasa EH (2010). Sustained Manual Loading of the Fascial System Can Evoke Tonic Reactions: Preliminary Results 

    Minasny B (2009). Understanding the Process of Fascial Unwinding

    Makin H, Hwang EJ , Hedrick NG, Komiyama T (2016). Circuit mechanisms of sensorimotor learning

    Liutsko L, Tous JM, Maldonado JG (2016). How are you feeling? Proprioceptive keys of emotional intelligence

    Fuchs T & Koch S (2014). Embodied affectivity: on moving and being moved

    Payne P, Levine P & Crane-Godreau M (2015). Somatic experiencing: using interoception and proprioception as core elements of trauma therapy.

    Johnson M (2015). Embodied understanding

    Wirth R,  Pfister R, Brandes J, Kunde W (2018). Stroking me softly: Body-related effects in effect-based action control

    Ondobaka S & Bekkering H (2012). Hierarchy of Idea-Guided Action and Perception-Guided Movement

    Abraham A, Franklin E, Stecco C, Schleip R (2020). Integrating mental imagery and fascial tissue: A conceptualization for research into movement and cognition 

    Simpson M (2001). Why can't you tickle yourself?

    Noseda R, Melo-Carrillo A, Nir R, Strassman A, Burstein R (2019). Non-Trigeminal Nociceptive Innervation of the Posterior Dura: Implications to Occipital Headache

    Schueler M, Messlinger K, Dux M, Neuhuber WL, De Col R. (2013). Extracranial projections of meningeal afferents and their impact on meningeal nociception and headache

    Schueler M, Neuhuber W, Col R, Messlinger K (2014). Innervation of Rat and Human Dura Mater and Pericranial Tissues in the Parieto‐Temporal Region by Meningeal Afferents

    GREENWALD A (1970). SENSORY FEEDBACK MECHANISMS IN PERFORMANCE CONTROL: WITH SPECIAL REFERENCE TO THE IDEO-MOTOR MECHANISM

    WEIMER A, SCHATZ A,  LINCOLN A, BALLANTYNE A, TRAUNER D, (2001). ``Motor'' Impairment in Asperger Syndrome: Evidence for a Deficit in Proprioception 

  2. Introduction

    Emotion not only affects the way people think and act but also determines judgement and information processing (Gong et al 2019). When in a better place the individual is more likely to process positive rather than negative information. Conversely, when in a worse place the individual is more likely to process negative rather than positive information.

    Many people misinterpret their own and other peoples’ emotional reactions, inappropriately express emotional outbursts or act negatively under various pressures. This has harmful consequences to themselves, others and to society as a whole (Drigas & Papoutsi 2018).

    Anyone can become angry-that is easy. But to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way-this is not easy.

    —Aristotle, The Nicomachean Ethics

    Emotional Intelligence (EI) is the ability to positively identify, understand and regulate emotions in oneself and others. It can then inform the individual how to use this information to guide one’s thinking and actions.

    EI attempts to bridge emotion and cognition. Individuals with developed EI have the ability to understand their own feelings and that of others whilst enabling them to use their emotions to positively direct thoughts and behaviour (Drigas & Papoutsi 2018).

    At a fundamental level EI provides the individual with a better inner world to cope with the outside world (Drigas & Papoutsi 2018). 

    Characteristic traits of Emotional Intelligence

    EI consists of four skill dimensions (Gong et al 2019):

    • Perception, assessment and expression of emotions.
    • Facilitation of thought using emotions i.e. the ability to harness emotional information into one’s thinking.
    • Understanding emotions and emotional knowledge and information.
    • Regulation and management of emotions for personal and interpersonal development. 

    Gilar-Corbi et al (2019) found EI is characterised by:

    • Adaptability.
    • Assertiveness.
    • Emotional perception of oneself and others. This will help predict success by managing behaviors and relationships (Drigas & Papoutsi 2018).
    • Emotional expression.
    • Management of oneself and others.
    • Self-regulation is concerned with how you control and manage yourself and your emotions, inner resources, and abilities. People with high levels of EI are more capable of regulating their emotions to reduce stress.
    • Impulsiveness. EI helps to productively manage impulses.
    • Relationships.
    • Self-esteem.
    • Self-motivation.
    • Social awareness.
    • Stress management.
    • Empathy.
    • Happiness.
    • Optimism.

    Psychological capital is the fundamental psychological element of the individual that has a positive impact on performance (Gong et al 2019). It also correlates both to EI and an individual's resistance to change. These traits are:

    • Self-efficacy i.e. an individual's belief in their capacity to execute behaviors necessary to perform.
    • Hope.
    • Optimism.
    • Tenacity.

    Torkoman et al (2020) defined self-esteem as an individuals’ subjective emotional response towards themselves. In order to develop self-esteem, a sense of self-worth is required, by positively embracing challenges.

    Developing EI and psychological capital makes an individual aware of their actions and behaviours. This empowerment facilitates an embracement and completion of personal goals and challenges which develop self-esteem.

    Given the emphasis on developing insights into one's own and others' emotions in EI, Birks and Watt (2007), offered it as a defining feature in standards of excellence in clinical care including:

    • Patient-centred care.
    • Quality and accuracy of history taking and diagnosis.
    • Tailoring treatments and lifestyle advice to the individual patient.

    Emotional Intelligence and burnout

    Gong et al (2019) found employees with higher levels of EI can adjust their perception of their work environment as well as the emotional stimuli from the environment. From a broader perspective EI can be very important for both personal and social functions in life. Individuals with a high level of EI can achieve:

    • Suitable solutions more smoothly at work.
    • Reasonably apply emotional resources.
    • Access social support via communication and interaction with other people. This reduces the possibility of failure and depersonalization which is in itself a symptom of burnout.

    All of these attributes can effectively reduce the chance of burnout. Therefore optimizing EI is a key factor in preventing burnout both in the workplace and with relationships outside of work. Be it in happiness or success emotional intelligence (EQ) matters just as much as intellectual ability (IQ) (Drigas & Papoutsi 2018).

    Employees with high level of EI perform well and have a higher level of satisfaction with their jobs. They are also more likely to build a good social support system. This reduces the chance of depersonalization, where an individual distances from themselves and others, which is one of the characteristic traits of burnout.

    Efstathia et al (2016) found trainees in the Intensive Care Unit with lower EI had higher rates of burnout. These authors found a positive correlation with high levels of EI and high rates of job satisfaction, compassion, and communication skills.

    Developing Emotional Intelligence

    Gilar-Corbi et al (2019) found training interventions improved some dimensions of EI:

    • Ability to positively perceive, understand and accept an individual's own and others emotions.
    • Self-reliance.
    • Achievement of personal goals.
    • Stress mangement.
    • Development of a positive attitude.
    • Control and management of emotions.

    Drigas & Papousi et al (2018) developed the pyramid of Emotional Intelligence. Progressing through each of the seven levels in the pyramid is an attempt to develop EI through personal growth. This is achieved by developing skills in perception, evaluation and management of emotions, both within yourself and others.

    From the bottom of the pyramid up these seven stages, that are to continually reflect and improve upon, rather than 'master' are:

    • Self awareness.
    • Self management.
    • Social awareness; empathy; discrimination of emotions.
    • Social skills.
    • Self actualization.
    • Transcendence.
    • Emotional unity.

    Self awareness

    Self awareness is knowing yourself so you can accurately self-assess your own strengths and weaknesses. It shows you possess a clear perception of your personality, including your strengths, weaknesses, thoughts, beliefs, motives and feelings.

    A lack of self awareness is not knowing yourself. It is characterised by understanding yourself in a way that impedes your ability to self-manage and makes it difficult, if not impossible, to know and respond to other peoples feelings.

    Self awareness has its roots in an individual’s personal values and ego identity. It is the reflection of these qualities that determines the perspective or view point from which an individual perceives and evaluates themselves and their emotions. Therefore developing self awareness involves removing this facade to allow a fundamental shift in perspective.

    As developing self awareness involves developing the ability to change the thoughts and perceptions the individual has of their personality this will lead to a change of emotions which will eventually lead to a change in action. 

    Self management

    Self management involves the individual taking responsibility for their own behaviour and well-being.

    When feelings through self awareness have been recognized and accepted, self management enables you to manage them better.

    This in turn leads to greater flexibility, becoming more extroverted and receptive whilst at the same time being less defensively critical of situations and less reactionary to other people’s attitudes.

    Social awareness; empathy; discrimination of emotions

    Once an awareness has been cultivated of the ability to understand and positively control ones own emotions, the next step in the pyramid is to recognise and understand the emotions of the people around you.

    Social awareness refers to the way people handle relationships and awareness of others feelings, needs, and concerns. Empathy enables the understanding of feelings and thoughts of others from their own perspective.

    Being socially aware means that you understand how you react to different social situations and effectively modify your interactions with other people so that you achieve the best results. This leads to a continual improvement of social skills and personal development.

    Social skills

    Once empathy and social awareness has been achieved so the individual can tune into another person’s feelings and understand how they feel and think about things social skills can be developed.

    Social skills are skills needed to handle and influence other people’s emotions. This effectively helps manage interactions successfully.

    Self actualization

    Self actualization is the realization of personal potential, self-fulfilment, pursuing personal development and fulfilling experiences.

    This is a continual process of ‘becoming’, rather than reaching a state of ‘perfection’.

    Self actualization is a measure of personal commitment to life by contributing to it the individuals most important personal gifts and qualities.

    Transcendence

    People who have reached self-actualization will sometimes experience a state referred to as “transcendence”. In the level of Transcendence, one helps others to self actualize, find self-fulfilment, and realize their potential. Quite a lot of these individuals are middle age who skip the first few steps of the pyramid and spend a lot of time philosophising on Facebook.

    Self-transcendence is the experience of seeing yourself and the world in a way that is not impeded by the limits of an individual’s ego identity. These people have since reluctantly deleted their Facebook account. It involves an increased sense of meaning and relevance to others and to the world.

    Emotional Unity

    Emotional unity is the final level of the pyramid of EI.

    In a symbiotic world, what you do for yourself, you ultimately do for another. All it takes is to see the spark of life, the miracle in everything and to be more optimistic.

    Developing EI using the pyramid of emotional intelligence: metacognition

    Cognitive processes uses existing knowledge and generates new knowledge.

    Metacognition is more self reflective. It is the ability to monitor and reflect upon one’s own performance, learning processes and capabilities.

    Metacognition in Emotional Intelligence means that an individual perceives and self reflects on their own emotional skills. Metacognition includes a variety of elements and skills such as metamemory*, self-awareness, self-regulation, and self-monitoring.

    *metamemory: knowing how good your memory is and in what ways you best remember information.

    References

    Gilar-Corbi R, Pozo-Rico T,  Sánchez B, Castejón J (2019). Can emotional intelligence be improved? A randomized experimental study of a business-oriented EI training program for senior managers 

    Drigas A, and Papoutsi C. (2018). New Layered Model on Emotional Intelligence 

    Birks Y and Watt I. (2007). Emotional intelligence and patient-centred care 

    Efstathia M. Vlachou E, Damigos D, Lyrakos G, Chanopoulos K, Kosmidis G and Karavis M (2016). The Relationship between Burnout Syndrome and Emotional Intelligence in Healthcare Professionals 

    Gong Z, Chen Y, and Wang Y (2019). The Influence of Emotional Intelligence on Job Burnout and Job Performance: Mediating Effect of Psychological Capital 

    Torkaman M, Farokhzadian J, Miri S & Pouraboli B (2020).The effect of transactional analysis on the self-esteem of imprisoned women: a clinical trial.