Introduction

Mindfulness is a widely practiced technique with innumerous variations that has its origins in various major belief systems around the world. While attention to bodily sensations has been mainly studied in seated meditation and mindfulness practices within contemplative science, Movement-based Embodied Cognitive Practices (MECPs) like Yoga, Qigong, and Tai Chi also emphasize interoceptive, proprioceptive, and kinesthetic awareness. These awareness practices are also essential to the effectiveness of modern somatic education/therapeutic techniques like the Alexander Technique and Feldenkrais Method (Posadzki, 2009; Schmalzl et al., 2014).

Almost all cultures around the globe have their own versions of contemplative movement systems. These systems include shamanistic dances, Christian liturgical gestures, Eastern spiritual practices, and modern Western somatic practices. However, the first hurdle in studying these systems is creating a classification system that accurately reflects the systems and is suitable for scientific investigation. Yoga, Qi gong, and Tai Chi are forms of mindfulness embedded with a rich history of traditional belief systems. Studying these practices can present challenges for Western scientists due to their non-dualistic view of the mind and body (Schmalzl et al., 2014).

It is not necessary to follow any religion or philosophy to practice mindfulness, especially modern derivatives which are mostly devoid of overt metaphysical assumptions. At the same time, mindfulness and its variants seem to have the ability to alter your perceptions and assessment of reality, at least in relation to one’s “self” and therefore might influence/reveal basic metaphysical assumptions about the nature of being. The potential for this to occur not as a result of acceptance of a new ideology, but merely from interoceptive, proprioceptive, and kinesthetic awareness (paying attention to one’s self), is fascinating.

Research

In recent years, cognitive neuroscience has shifted its focus from viewing the mind as separate from the body and solely computational, to a more embodied and situated view of the mind. This new perspective, which aligns closely with traditional belief systems associated with mindfulness, suggests that mental functions cannot be fully understood without considering the physical body and environment in which they occur. MECPs are rooted in concepts of embodiment, movement, and contemplation, primarily through the enactive approach to cognition. Consciously initiated movement, as opposed to externally evoked or purely passively imposed motion, is intrinsic to the sense of agency and aids in the development of the sense of self. MECPs are typically described as ‘holistic’ and have an intrinsic worldview that is non-deterministic and often non-dualistic. In MECPs, conscious volition is presupposed, and the mind-body is seen as one (Schmalzl et al., 2014).

The false dichotomy of physical and nonphysical, mind and body, pervades medicine and causes many problems in conceptualization of disease, particularly with regards to so-called ‘mental illness’ (Mehta, 2011). Psychological disorders are associated with a wide variety of distortions of time perception, the practice of mindfulness may be effective by virtue of its effect on our relationship with time (Adshead, 2013). Multiple randomized trials have been conducted on mindfulness-based interventions for psychosis. Additionally, there have been various trials on interventions that include mindfulness exercises such as acceptance and commitment therapy and compassion-focused therapy (Böge, 2021).

Today MECPs are often practiced exclusively as part of exercise and general health remines. Remarkably, these variations of mindfulness have the potential to make a significant impact on people’s lives by decreasing stress, pain, anxiety, depression, blood pressure, and cortisol levels, as well as increased energy, sleep quality, immune function, awareness, clarity, calmness, and happiness (Martin, 2018).

The Alexander Technique (AT) is a secular MECP that teaches individuals to identify, understand, and modify habits that affect their movement and posture. AT can also be described as a phenomenological study of the interaction between one’s biology and psychology. AT practice observes and modulates the relationship between volitional cognitive behavior, somatosensory awareness, and regulation of muscle activity in postural support and movement. It is typically taught in one-on-one sessions, where the teacher uses gentle physical touch and verbal instruction to convey the principles and skills of the technique. The AT takes a holistic approach, considering the mind and body as indivisible (Kinsey et al., 2021).

Research on the AT generally has focused on three main areas: biomechanical changes associated with learning the technique, its effects on musicians’ performance quality and anxiety, and health outcomes related to specific conditions such as chronic pain and Parkinson’s symptoms. While most studies have focused on physical outcomes such as pain reduction, balance improvement, and changes in gait and posture, some have also reported psychological benefits such as increased relaxation and confidence (Kinsey et al., 2021).

Kinsey et al. (2021) reviewed the literature for psychological benefits and found that, “AT lessons may provide a significant way to improve mental wellbeing and increase agency,” adding, “Further work should seek to widen its application beyond the traditionally perceived areas of movement, posture, and pain.” The authors cited effects such as changes in mood, sense of self, cognitive processes, confidence, and emotion and explored how these outcomes are generated. While acknowledging the interconnectedness of physical and psychological processes, the review adopted a dualist approach to distinguish between physical and non-physical outcomes pointing to the inherent difficulties in studying mind-body practices (Kinsey et al., 2021).

Free Will has been defined in multiple, conflicting ways. According to Baumeister et al. (2010) it can be defined as a psychological capacity subsuming self-control, effortful choice, planning, and initiative. These capabilities are useful for making human social life and culture possible, but they depend on a limited resource and therefore often fall short of optimal levels. Religion may be helpful to individuals and society in part because it supports both the exercise of free will and the belief in it (Baumeister et al., 2010). MECPs may serve a similar function.

Interestingly, belief in free will was found to be associated with a conservative worldview, including such facets as authoritarianism, religiosity, punitiveness, and moralistic standards for judging self and others. The common element appears to be a strong sense of personal responsibility. However, there was evidence for distinct correlates of scientific and fatalistic determinism reinforces the need for treating them separately (Carey & Paulhus, 2013). Wisniewski et al. (2019) showed that people’s beliefs about free will are closely linked to their beliefs about dualism, with dualism being a stronger predictor of free will beliefs than other related concepts.

In a study by Caspar (2017), fatalistic determinism was positively correlated with religiosity of participants; suggesting that the more people are engaged in religious practices, the more they believe in fatalistic determinism and the inevitability of their future. This is consistent with the widespread view that people engaged in religious practices believe that their destiny depends on God’s will. It is therefore possible that people can intuitively reconcile free will with scientific determinism, but not with fatalistic determinism (Caspar, 2017).

Genetic/scientific determinism can be described as the attribution of the formation of traits to genes, where genes are ascribed more causal power than what scientific consensus suggests. Belief in genetic determinism is an educational problem because it contradicts scientific knowledge and is a societal problem because it has the potential to foster intolerant attitudes such as racism and prejudice against sexual orientation (Gericke et al., 2017).

According to Tarr (2008), looking at the Alexander Technique from an ethnographic perspective is fascinating because it is a bodily practice that is difficult to put into words. Although words may be used during Alexander lessons, they refer to bodily movements and sensations, making it a form of embodied knowledge. Ethnographers have only recently started to focus on the physical aspects of their subjects in their writing. Dance ethnographers have struggled with representing body movements and have used movement notation systems like Rudolph von Laban’s, which require specialized knowledge to read and decode. There are also concerns about the accuracy of such representations in capturing the sense of movement. Additionally, it is crucial to consider the meaning of movement for those involved in it, which movement notation systems cannot provide (Tarr, 2008).

Tarr (2008) adapts some of Csordas’s ideas of cultural phenomenology, namely somatic modes of attention, to various concepts in the Alexander Technique. Csordas argued that somatic modes of attention are not innate or biological but are shaped by cultural factors. These modes of attention involve practices such as mental rehearsal of athletic movements, health consciousness and dietary practices, and dance. Identifying and understanding these modes can provide new insights into embodiment and interpersonal relationships. Alexander Technique lessons fit within this framework as a method of attending to and with bodies in the presence of a teacher and can be seen as an example of a culturally constituted somatic mode of attention. Tarr (2008) also discusses Bourdieu’s theory of “habitus” and how studying the Alexander Technique ethnographically can shed light on the processes of “understanding with the body.”

There have been multiple studies led by Dr. Rajal Cohen of the University of Idaho that quantitatively measured differences in axial tone, postural sway, postural uprightness, and step initiation; before and after verbal AT instruction among PD sufferers and healthy individuals (Cohen et al., 2015; Cohen et al., 2020). These findings support other evidence that ‘thinking’ (conscious autosuggestion, etc.) has distinct, measurable psychophysical outcomes. Changes in tone from AT-based instructions suggest that executive function can influence tone and body schema (Cohen et al., 2015; Cohen et al., 2020). This process may be related to what movement scientists call kinesthetic motor imagery, although such studies mostly examine the mental representation of overt movement rather than mental representations of desired postural states.

Further evidence of potential perceptual/belief effects of cultivating interoceptive and proprioceptive awareness comes from a systematic review of available literature on the AT and musicians by Klein et al. (2014). In most of these studies, AT was found to be effective in reducing performance anxiety. It is worth noting that other MECPs, such as yoga, have also been shown to positively influence performance anxiety in musicians (Klein et al., 2014; Schlinger, 2006). Additionally, a study of people with chronic lower back pain found significant differences before and after AT lessons in their constructs of intention, perceived risk, direct attitude, and behavioral beliefs providing more evidence of non-physical outcomes from AT lessons (Kamalikhah et al., 2016).

Discussion

There is an overarching theme in the relevant literature of mind-body unity (non-dualism) and the interconnectedness of physical and psychological processes. The focus on embodiment and the situated view of the mind is often discussed in the context of mindfulness practices and the AT. AT and MECPs generally emphasize the importance of conscious volition and the sense of agency that arises from it. Greater sense of agency after practice of MECPs is a theme in the literature that begs the question, “Does belief in free will arise from feelings of agency?”

Following from the first theme there is a theme of physical practices having effects on psychological state and vice versa. According to Sathyanarayana Rao (2009), “Perceptual shifts are the prerequisites for changing the belief and hence changing the biochemistry of our body favorably.” Ironically researchers inevitably adopt a dualistic approach to distinguishing between physical and non-physical outcomes, which is antithetical to the idea of mind-body unity is emphasized in MECPs in the first theme. Related to the prior theme is another prevalent one in the literature, namely the inadequacy of language to express the information/knowledge acquired by MECPs.

References

Adshead. (2013). The time of our lives: Psychological disorders, time perception and the practice of mindfulness. European Journal of Psychotherapy & Counselling, 15(2), 139–150. https://doi.org/10.1080/13642537.2013.795337

Baumeister, R., Bauer, I. M., & Lloyd, S. A. (2010). Choice, Free Will, and Religion. Psychology of Religion and Spirituality, 2(2), 67–82. https://doi.org/10.1037/a0018455

Böge, K., Thomas, N., & Jacobsen, P. (2021). Is mindfulness for psychosis harmful? Deconstructing a myth. The British Journal of Psychiatry, 218(2), 71-72. https://doi.org/10.1192/bjp.2020.165

Carey, J. & Paulhus, D. L. (2013). Worldview Implications of Believing in Free Will and/or Determinism: Politics, Morality, and Punitiveness. Journal of Personality, 81(2), 130–141. https://doi.org/10.1111/j.1467-6494.2012.00799.x

Caspar, E. A., Verdin, O., Rigoni, D., Cleeremans, A., & Klein, O. (2017). What Do You Believe In? French Translation of the FAD-Plus to Assess Beliefs in Free Will and Determinism and Their Relationship with Religious Practices and Personality Traits. Psychologica Belgica, 57(1), 1–16. https://doi.org/10.5334/pb.32

Cohen R., Gurfinkel, V. S., Kwak, E., Warden, A. C., & Horak, F. B. (2015). Lighten Up: Specific Postural Instructions Affect Axial Rigidity and Step Initiation in Patients With Parkinson’s Disease. Neurorehabilitation and Neural Repair, 29(9), 878–888. https://doi.org/10.1177/1545968315570323

Cohen, Baer, J. L., Ravichandra, R., Kral, D., McGowan, C., & Cacciatore, T. W. (2020). Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults. Innovation in Aging, 4(2), igz056–igz056. https://doi.org/10.1093/geroni/igz056

Gericke, N., Carver, R., Castéra, J., Evangelista, N., Marre, C., El-Hani, C., (2017) Exploring Relationships Among Belief in Genetic Determinism, Genetics Knowledge, and Social Factors. Sci & Educ 26, 1223–1259 https://doi.org/10.1007/s11191-017-9950-y

Kamalikhah T., Morowatisharifabad M. Rezaei-Moghaddam F., Ghasemi M. Gholami-Fesharaki M. Goklani S. (2016) Alexander Technique Training Coupled With an Integrative Model of Behavioral Prediction in Teachers With Low Back Pain Iran Red Crescent Medical Journal doi: 10.5812/ircmj.31218

Kinsey D., Glover L., Wadephul F., How does the Alexander Technique lead to psychological and non-physical outcomes? A realist review, European Journal of Integrative Medicine, Volume 46, 2021, ISSN 1876-3820, https://doi.org/10.1016/j.eujim.2021.101371

Martin, A.C. (2018). An Introduction to Mindfulness through Yoga, Tai Chi, and Meditation. International Journal of Health, Wellness & Society, 8(3), 11–20. https://doi.org/10.18848/2156-8960/CGP/v08i03/11-20

Mavilidi, M., Pesce, C., Benzing, V., Schmidt, M., Paas, F., Okely, A. D., & Vazou, S. (2022). Meta-analysis of movement-based interventions to aid academic and behavioral outcomes: A taxonomy of relevance and integration. Educational Research Review, 37, 100478–. https://doi.org/10.1016/j.edurev.2022.100478

Mehta. (2011). Mind-body Dualism: A critique from a Health Perspective. Mens Sana Monographs, 9(1), 202–209. https://doi.org/10.4103/0973-1229.77436

Nadelhoffer, Shepard, J., Nahmias, E., Sripada, C., & Ross, L. T. (2014). The free will inventory: Measuring beliefs about agency and responsibility. Consciousness and Cognition, 25, 27–41. https://doi.org/10.1016/j.concog.2014.01.006

Posadzki P. (2009). Qi Gong exercises through the lens of the Alexander Technique: A conceptual congruence. European Journal of Integrative Medicine, 1(2), 87–92. https://doi.org/10.1016/j.eujim.2009.04.001

Schlinger, Marcy (2006) Feldenkrais Method, Alexander Technique, and Yoga—Body Awareness Therapy in the Performing Arts Physical Medicine & Rehabilitation Clinics V.17,4 P865-875

Tarr, J. (2008). Habit and conscious control: Ethnography and embodiment in the Alexander Technique. Ethnography, 9(4), 477–497. http://www.jstor.org/stable/24047911

Tarr, Jennifer (2011) Educating with the hands: working on the body/self in Alexander Technique Sociology of Health & Illness Vol. 33 No. 2 ISSN 0141–9889, pp. 252–265 doi: 10.1111/j.1467-9566.2010.01283.x

Schmalzl, L., Crane-Godreau, M., & Payne, P. (2014). Movement-based embodied contemplative practices: Definitions and paradigms. Frontiers in Human Neuroscience, https://doi.org/10.3389/fnhum.2014.00205

Sathyanarayana Rao, T. S., Asha, M. R., Jagannatha Rao, K. S., & Vasudevaraju, P. (2009). The biochemistry of belief. Indian journal of psychiatry, 51(4), 239–241. https://doi.org/10.4103/0019-5545.58285

Wisniewski, D., Deutschländer, R., & Haynes, J.-D. (2019). Free will beliefs are better predicted by dualism than determinism beliefs across different cultures. PloS One, 14(9), e0221617–e0221617. https://doi.org/10.1371/journal.pone.0221617

In an interview published in Outside, “This is Your Brain on Adventure” by Florence Williams (2009) describes a group of BASE-jumpers in western Colorado and examines why some people are drawn to extreme sports and others are not. The author observes the group as they prepare to jump, noting the differences in their personalities and backgrounds; highlighting Ted Davenport, a champion extreme skier and BASE-jumper, as an example of someone who feels called to live on the edge.

Williams (2009) also touches on the science behind thrill-seeking behavior and the role genetics play in a person’s inclination towards risk-taking. The author interviews neuroscientist Russell Poldrack and observes Ted, as he undergoes an fMRI brain scan while playing a risk-tolerance-testing video game. The article discusses the three major emotional ingredients to risk-taking – desire for adventure, relative disregard for harm, and impulsivity – and how they relate to each other in determining the level of risk-taking behavior. The article also highlights the role of the ventral striatum, a part of the brain known to be one of the centers of the reward pathway, in providing a sense of novelty and pleasure to adventurers.

A similar group to BASE-jumpers are Mountaineers. Mountaineer adventure tourists experience a range of emotions, including contrasting emotions, flow, and peak experiences. Although mountaineering has become a popular form of adventure tourism, there is a lack of research on the participants. Pomfret (2006) contributed a theoretical framework of mountaineer adventure tourists by analyzing previous research on mountaineering, mountaineers, adventure, recreation, and tourism. The framework considers a range of factors, including push elements like risk and mastery, pull elements like the natural mountain environment and conditions, personality attributes such as sensation seeking, and lifestyle factors like previous mountaineering experience (Pomfret, 2006). 

Csikszentmihalyi defines happiness as a state of consciousness called “flow”, which occurs during structured activities that require a skill level slightly higher than one’s current abilities. This creates a challenge that motivates the person to focus their energy and attention on the task at hand, resulting in a seamless and empowering experience. The experience of flow is influenced by both objective conditions and the person’s interpretation of those conditions, including their awareness of challenges and their perception of their own skills. In addition to challenging activities, flow is also facilitated by clear goals and immediate feedback, which keep the person fully engaged in the present moment (Choi, 2018). 

However, human consciousness is constantly bombarded by external stimuli and can struggle to maintain order. To make flow experiences easier, Csikszentmihalyi suggests a psychic exercise or brooding of a personal trait, while Husserl proposes a radical method of reduction called transcendental-phenomenological reduction. Husserl’s method involves suspending one’s general judgment of the world and seeing it as a phenomenon derived from the consciousness of the self as the transcendental Ego. While originally designed for epistemological purposes, Husserl’s phenomenology can be aligned with positive psychology to explore happiness studies (Choi, 2018).

It is plausible that Husserl would not reject the idea of using transcendental phenomenology as a foundation for positive psychology and deep hermeneutics in happiness studies. In this sense, deep hermeneutics could be seen as a part of this type of reduction, allowing us to uncover hidden corners of the world through rich discoveries provided by empirical science. In his later phase, Husserl expanded the scope of intentional experiences to include not only the cognitive, but also the aesthetic and instinctual. Additionally, he made an ontological distinction between the transcendental sphere and the factual world, arguing that the former grounds or constitutes the latter and can also ground any sciences belonging to the latter. Therefore, it is reasonable to assume that Husserl would agree that transcendental phenomenology can provide a foundation for positive psychology (Choi, 2018).

When seeking out adventurous opportunities, individuals might believe that they will gain a sense of accomplishment, or grow personally from new experiences. They may also believe that by taking risks and pushing their boundaries, they will become more confident and resilient. Ultimately, the benefits of risk-taking and adventure-seeking will vary from person to person, but can include increased happiness, satisfaction, and personal fulfillment.

References

Williams, F. (2009) This is Your Brain on Adventurelink Outside https://www.outsideonline.com/health/training-performance/your-brain-adventure/

Pomfret, G. (2006). Mountaineering adventure tourists: a conceptual framework for research. Tourism Management (1982), 27(1), 113–123. https://doi.org/10.1016/j.tourman.2004.08.003

Choi, K. (2018). Transcendental Phenomenology and the Way to Happiness: Husserl’s Reply to Csikszentmihalyi. JBSP. Journal of the British Society for Phenomenology, 49(2), 126–138. https://doi.org/10.1080/00071773.2018.1431007

The Suzuki Violin Method often claims it can improve memory, attention span, and cognitive development generally; leading to improved academic performance. It also claims to enhance creativity, self-discipline, and perseverance. It is important to note, however, that while these claims are often made, the research on the specific benefits of the Suzuki method is still limited. Additionally, the benefits of music education may vary depending on individual factors such as the child’s age, learning style, and level of commitment (Scott, 1992).

A study by Gouzouasis et al. (2007) found a consistent pattern over three years that showed strong and significant connections between participation in music and academic achievement. Interestingly, the study found a greater correlation between music participation and math and biology achievements than between music participation and English. These findings support previous research that links music-related skills with mathematical abilities and intellectual capacities in general. The study suggests that music participation can benefit students in ways that enhance their academic achievement, particularly in math and biology. While the study doesn’t make causal claims, it offers a plausible explanation for the relationship between achievement in music courses and academic success. The study also demonstrates that the relationship is specific to music, and not applicable to all fine arts. This suggests that non-music fine arts education may tap into different domains of our capacity, similar to Gardner’s multiple intelligence theory (Gouzouasis et al., 2007). 

Hallam (2010) provides a strong case for the benefits of active engagement with music throughout the lifespan. In early childhood there seems to be benefits for development of perceptual skills which affect language learning and subsequently impact on literacy. Opportunities to coordinate rhythmically and improve fine motor skill are presented by learning to play an instrument. Music also seems to improve spatial reasoning, one aspect of general intelligence which is related to some of the skills required in mathematics (Hallam, 2010). 

Motivation and endurance for problem solving depends on self-esteem, self-efficacy and aspirations. Engagement with music can enhance self-perceptions, but only if it provides positive learning experiences which are rewarding. This means that overall, the individual needs to experience success. This is not to say that there will never be setbacks but they must be balanced by future aspirations which seem achievable and self-belief in attaining them (Hallam, 2010).

In a study by Bolduc et al. (2021), music training in kindergarten improved the development of inhibition control compared to motor training and no special training groups. Additionally, although both the music and motor programmes targeted the development of phonological processing, children in the music programme scored higher on this ability (Bolduc et al., 2021).

Music and the arts should be valued for their intrinsic beauty and power. The fact that there is empirical evidence to support the benefits of music involvement for general academic achievement and desirable social and motivational personality characteristics is just icing on the cake.

References:

Bolduc, J., Gosselin, N., Chevrette, T., & Peretz, I. (2021). The impact of music training on inhibition control, phonological processing, and motor skills in kindergarteners: a randomized control trial. Early Child Development and Care, 191(12), 1886–1895. https://doi.org/10.1080/03004430.2020.1781841

Hallam S. (2010). The power of music: Its impact on the intellectual, social and personal development of children and young people. International Journal of Music Education, 28(3), 269–289. https://doi.org/10.1177/0255761410370658

Gouzouasis, P., Guhn, M., & Kishor, N. (2007). The predictive relationship between achievement and participation in music and achievement in core Grade 12 academic subjects. Music Education Research, 9(1), 81–92. https://doi.org/10.1080/14613800601127569

Scott L. (1992). Attention and Perseverance Behaviors of Preschool Children Enrolled in Suzuki Violin Lessons and Other Activities. Journal of Research in Music Education, 40(3), 225–235. https://doi.org/10.2307/3345684

Zotero Library

https://www.zotero.org/groups/2389008/alexander_technique_studies/library

An independent open-source project to collect AT studies and provide open access to them.

Alexander Technique Science

www.alexandertechniquescience.com

This site is devoted to improving scientific understanding of the Alexander Technique (AT)—its principles, practices, reported and demonstrated benefits, and terminology. The content ranges from descriptions of direct experiments on the effects of AT lessons to focused explanations of relevant current science to rigorously researched history of the work. We reference recent peer-reviewed publications wherever possible.

As scientific methods, models, and cross-disciplinary research improve, science is becoming increasingly relevant to AT. Current science is quite exciting and has a lot to contribute to our understanding of AT. Scientists are also now studying AT directly. There is evidence supporting some of AT’s possible mechanisms and claimed benefits.

The Society of Teachers of the Alexander Technique

https://alexandertechnique.co.uk/

The Society of Teachers of the Alexander Technique (STAT) was founded in the UK in 1958 by teachers trained by FM Alexander. There are currently over 2500 teaching members of STAT and its Affiliated Societies world-wide.

The American Society for the Alexander Technique

https://www.amsatonline.org/aws/AMSAT/pt/sp/home_page

The American Society for the Alexander Technique (AmSAT) is the largest professional association of certified Alexander Technique teachers in the United States. AmSAT is an educational, nonsectarian, nondiscriminatory organization incorporated in New York as a general not-for-profit corporation. AmSAT’s mission is to establish the Alexander Technique as a basic and recognized resource for health, productivity, and well-being.

AmSAT maintains the nation’s highest standards for teacher training, certification and membership and maintains affiliation with similar credentialing bodies worldwide. Since its formation in 1987, over 1000 teachers have completed the rigorous training process to earn AmSAT certification.

The American Center for the Alexander Technique

www.acatnyc.org

Founded in 1964, The American Center for the Alexander Technique was a world-class institute built on the teachings of F.M. Alexander. From 1967 to 2018, ACAT ran the first and most prestigious teacher certification program in the United States, training over 300 individuals.

Alexander Technique International

https://www.alexandertechniqueinternational.com/

ATI Teachers are committed to ‘a high standard of teacher certification’ as well as continuing education. The certification process evaluates each teacher individually and emphasizes ‘quality of teaching over quantity’ of hours trained.

The Complete Guide to the Alexander Technique

alexandertechnique.com

The ‘Complete Guide to the Alexander Technique’ calls itself ‘the most comprehensive source’ for information about the Alexander Technique on the web.

Introduction

The Alexander Technique (AT) is a holistic educational method that helps individuals change inefficient or faulty habits, reducing potentially harmful stress (allostatic load) & tension accumulation. This is accomplished by observing and altering how one conceptualizes responses to stimuli with the aid of an AT teacher.

The AT is known to affect postural tone and movement coordination (Cacciatore et al., 2011; Preece et al., 2016); however, the AT is not a passive treatment (Williams, 2018). While movement is a focus in learning the AT, it is generally taught as an educational system rather than movement therapy (Woods, 2020). AT can also be described as a phenomenological study of the interaction between one’s biology and psychology (Mindbody). AT practice observes and modulates the relationship between volitional cognitive behavior, somatosensory awareness, and regulation of muscle activity in postural support and movement.

The most recent systematic review of AT trials is Woodman & Moore (2011) which identified AT in the treatment of Parkinson’s Disease (PD) associated disability and chronic back pain as promising areas of research. According to the Mayo Clinic, “Back pain is a leading cause of disability worldwide and its origins are often unclear.” Education is universally recommended as first-line treatment for acute and persistent back pain but it attracts little attention; the vast majority of back pain episodes do not require surgery or long-term powerful analgesics (Moseley, 2019).

Parkinson’s disease (PD) is a progressive neurological disease that includes a range of symptoms related to control of posture (Doherty et al., 2011). Medication sometimes alleviates some Parkinsonian motor symptoms, but it does not cure them and may make aspects of postural control worse (Contin et al., 1996). According to the National Health Service (UK), “lessons in the Alexander Technique may help one carry out everyday tasks more easily and improve feelings about Parkinson’s disability.” The primary symptoms of PD are muscular rigidity, slowness, tremor, and postural instability.

Studies of the AT on persons with PD disability and back pain illustrate the potential bio-psychological effects of cultivating interoceptive and proprioceptive awareness through AT lessons (Stallibrass et al., 2002; Little et al., 2008; Cohen et al., 2015). Further evidence comes from a systematic review of a number of trials that found AT lessons improve performance anxiety in musicians (Klein et al., 2014).

The main hypothesis here is that the mechanisms of action and effects of the AT can be, at least partially, explained by known biological/cognitive mechanisms. However, explaining phenomena like back pain and improvements in it from mind-body practices is, in itself, problematic. While clinical research advocates using the biopsychosocial model (BPS) to manage back pain, there is still no clear consensus on the meaning of this model in physiotherapy and how best to apply it. Biological, psychological, and social factors may be inadequate to address complexities of people with back pain, and a reworking of the model may be necessary (Mescouto et al., 2022). A phenomenological approach may be needed in addition to the BPS to make sense of the meaning of the experience of back pain and/or the treatments for it (Stilwell & Harman, 2021).

History

The AT has been used for over 125 years in a wide variety of educational and medical settings, however, a comprehensive neurophysiological model theory of biological mechanisms of action underlying the AT’s effects has only recently been proposed by Cacciatore, Johnson, & Cohen (2020). Current theories, including this paper, rest heavily on the work of Dr. Timothy Cacciatore’s and Dr. Rajal Cohen’s rigorous research and numerous peer-reviewed publications about or related to the AT. The prior vagueness in the definitions of the AT originated from the complexity of underlying systems and generally unsophisticated techniques in describing psycho-physical activity/behavior. Improvements in the ability to observe and record psychomotor and brain behavior generally have made such a model viable only recently relative to the age of the AT. The situation was similar for many of the early psychotropic drugs that were discovered somewhat serendipitously with no clear explanation for their purported mechanisms of action (Carey et al., 2020).

Dr. David Garlick, a physiologist and medical research scientist at the University of New South Wales, laid the groundwork for current theories of AT mechanisms in the 1980s. He stressed that the awareness of inter-relationship of muscle and mental states (body schema) as one of the most important effects of the AT. Garlick’s research included various types of postural analysis, the majority of which was published in The Lost Sixth Sense (1990). The “sixth sense” in this context refers to underdevelopment and/or malfunctioning of kinesthetic and proprioceptive senses. Garlick postulated that the AT mainly operates on these senses and the brain mechanisms related to those senses. He lists sensory nerve inputs from neck muscle spindles, Golgi tendon organs, skin and joint receptors, and differences in types of muscle fibers as physiological factors relevant to the transmission and reception of psychomotor information used in dyadic AT practice (Garlick, 1990).

More information on early AT research can be found here.

The Mind-body Problem

The false dichotomy of physical and nonphysical, mind and body, pervades medicine and causes many problems in conceptualization of disease, particularly with regards to so-called ‘mental illness’ (Mehta, 2011). The reality that the mind has no existence other than as an abstract cultural relational tool escapes the majority of people to this day. This is hard to accept for followers (and cultural descendants) of Abrahamic religions that long equated mind (personality/psyche/ego) with atomistic souls living in the ether or spiritual realm and merely interacting with the physical body. Mind-body dualism is so pervasive culturally that atheists are not immune; most people subconsciously separate mind and body to some degree because of cultural conditioning.

Reductionism by contrast, in the strict sense envisioned by its creators in the 1930s, is largely impractical in biology and was effectively abandoned by the early 1970s. Classical holism was a stillborn theory (from Vitalism) of the 1920s and the term has survived in several fields as a loose umbrella designation for various kinds of anti-reductionism (Gatherer, 2010). The AT is one such anti-reductionist holistic practice.

If things like back pain or mental illness turn out to be mostly ‘in the mind,’ i.e. mindfulness based stress reduction (MBSR) may alleviate back pain (Anheyer, 2017) and mindfulness based cognitive therapy may be an effective treatment for bipolar disorder (Xuan et al., 2020); what does that mean and what difference does it make? Subjectively it makes little difference if illness is mental or physical to the ill, however implications for treatment loom large. If these disorders are indeed mental (developmental vs neurological damage or malfunction etc.), then it would reason that the best treatments might also be mental: i.e. education, hypnosis, suggestion, placebo, etc.

Of course one’s ‘mind’ is ultimately physical, even as an abstract idea it must exist as some arrangement of neuronal pathways. Therefore, treatments such as talk therapy are not purely ‘non-physical’ as this would be ignoring the reality of what’s happening in the brain during such ‘non-physical’ treatments. There is some debate as to if talk therapy constitutes a medical treatment, but this sentiment itself likely stems from the problematic separating of physical and non-physical (‘mental’) outcomes and treatments as if they acted on seperate systems. Problems of interaction that arise from these categorizations seem to suggest a fundamental error in conception of the underlying systems.

Alexander Technique Method

AT teachers use skilled manual contact to observe and assess changes in activity, balance, and coordination. The teacher then highlights this behavior for the student while simultaneously giving verbal suggestions or directing the student’s use of volitional cognitive behavior (‘direction’ or conscious autosuggestion). With manual and verbal direction from the teacher, pupils learn to recognize and adopt better behavioral strategies. AT is particularly relevant in the interplay of cognition, behavior, and the initiation of movement (Stallibrass et al., 2002).

A core aspect of AT is a volitional cognitive behavior process called ‘directing,’ which involves applying specific intentions to postural tone, body schema, and spatial awareness. The practice of ‘directing’ attention to postural tone and body schema also involves monitoring departures from postural intentions and applying inhibitory control to motor planning to prevent automatic patterns of muscle activation, i.e. habits (Cacciatore et al., 2020).

‘Inhibiting,’ another core volitional cognitive behavior process in AT, may refer to the ‘undoing’ or prevention of unnecessary muscular activity, whether at rest, in anticipation, or in action. In an AT lesson, inhibition may also refer to prevention of motor planning while performing an action. The AT process of inhibiting may also refer to a more general intentional calming of the nervous system (Cacciatore et al., 2020). ‘Direction’ and ‘Inhibition’ as AT concepts may be two sides of the same coin rather than distinct ideas.

The functional organization and balance of the central body axis plays a primary role in AT because of the critical role of postural tone in this region. The neck may be especially crucial due to its proximal location at the top of spine and direct role in orienting the head (Loram et al., 2017). In one study, participants reported significantly reduced neck pain and fatigue of the superficial neck flexors during a cranio-cervical flexion test after AT lessons (Becker, 2018). In another study, patients with chronic nonspecific neck pain were given AT lessons or acupuncture and both added a small but clinically significant reduction in pain (MacPherson, 2015; Baime, 2016).

The spine’s instability and its central location require that axial tone mediate use of the limbs. Failure to dynamically adapt axial tone can manifest as jerky, uncomfortable, or poorly controlled movement (Gurfinkel et al., 2006). Correcting this can have wide-ranging benefits as postural tone interacts with executive processes, motor acts, emotional regulation, and pain (Cacciatore et al., 2011).

Taken together, ‘direction,’ ‘inhibition,’ and the prime importance of coordination and balance in the central body axis (torso/spine), form the basis of the theory of AT practice. The AT’s effects are theorized to come from positively affecting postural tone, which in turn has other cascading effects. Although the effectiveness of AT lessons has been shown at the behavioral level, their effects on altering brain circuitry are still unclear.

Similarities to MECPs and Psychotherapy

The AT has strong similarities with movement-based embodied cognitive practices (MECPs) such as Yoga (Schlinger, 2006), Qigong (Posadzki, 2009), and Tai Chi (Schmalzl, 2014); as well as more modern derivatives including variations on ‘mindfulness,’ (Siegel., 2007; Stern, 2021) like Mindfulness Based Stress Reduction (MBSR) (Anheyer, 2017). There are also correlations with various ‘somatic education/therapy’ methods (Kim, 2018).

The similarities include multiple parallels in effects treating back pain and PD disability between Yoga (Cramer et al., 2013; Ban et al., 2021) Tai chi (Li et al. 2012), and the Alexander Technique (Stallibrass, 2002; Little et al., 2008; Cohen et al., 2015). This further suggests that mechanisms of action are likely shared among MECPs and AT. One can start to make educated guesses about AT and the brain from imaging studies of these related fields.

There are also many parallels with psychotherapy (Ashar et al., 2022). Dyadic or dialectical contemplation, typically master and pupil, is at the core of many Eastern mindfulness modalities and MECPs and is similar in Western systems such as the AT and body-oriented psychotherapy (Posadzki, 2009; Kim, 2018; Stern, 2021). Interestingly, the AT influenced some forms of psychotherapy, including Gestalt therapy (Tengwall, 1981). Xuan et al. (2020) is a good example of the effectiveness of some Eastern mindfulness practices infused Western Therapy practices.

Within the field of contemplative science, the directing of attention to bodily sensations has so far mainly been studied in the context of seated meditation and mindfulness practices. Early cognitive research neglected the issues concerning the activation of action, preparedness, direction, and termination of action (Pervin, 1992). Advances in the neuroscience of motor control and promising initial results have led to increased interest in the role of cognition in motor behavior and the effect of body state on mental state. Fairly recently, cognitive neuroscience started to realize that mental functions cannot be fully understood without reference to the physical body and has shifted from a predominantly disembodied and computational view of the mind to embodied viewpoints (Schmalzl et al., 2014).

AT’s Relationship to Pain, Body Schema and Proprioception

A related component problem of pain is the emotional implications of chronic pain. Functional imaging studies have shown that stimuli associated with pain can activate the anterior cingulate cortex (ACC) even when no actual painful stimulus is applied. Singer et al. (2004) found that when women received a painful electrical shock to the back of their hand, their ACC, anterior insular cortex, thalamus, and somatosensory cortex became active. When they saw their partners receive a painful shock but did not receive one themselves, the same regions (except for the somatosensory cortex) became active (Carlson & Brickett, 2022). This illustrates that at least some parts of pain are indeed, ‘in our heads.’ The emotional component of pain can be provoked by empathy for someone, causing responses in the brain like the ones caused by actual pain.

A particularly relevant form of chronic pain in this context is phantom limb pain as one theory maintains that phantom limb pain can arise from a conflict between visual feedback and proprioceptive feedback from the phantom limb (Carlson & Brickett, 2022). People with low back pain (LBP) have, on average, reduced lumbar range of movement and proprioception; they also move more slowly compared to people without LBP (Laird et al., 2014). Chronic back and hand pain are associated with deficits in body schema (Gilpin et al., 2015).

Proprioceptive musculoskeletal education (AT) was shown to enhance respiratory muscular function in normal adults (Austin, 1992) suggesting a connection between AT, proprioception, and muscle activity of the torso/abdomen. Another AT study potentially related to altered body schema showed improvements in functional reach after AT lessons in healthy older women (Dennis, 1999). After overview of the research, Cacciatore et al. (2020) proposed a comprehensive neurophysiological model of the AT suggesting that a primary mechanism of AT’s effects is improving deficits in body schema.

The largest AT study to date was a randomized controlled trial with 579 participants led by Dr. Paul Little (Little et al., 2008). The so-called “ATEAM” trial evaluated the economic viability of therapeutic massage, exercise, and lessons in the AT for treating chronic and recurrent back pain, comparing the costs and outcomes at 12 months of courses of 6 and 24 lessons in the AT, 6 sessions of massage, and a general practitioner’s prescription for home-based exercise with a nurse follow-up for patients with chronic or recurrent non-specific back pain in primary care.

Exercise and lessons in the AT, but not massage, remained effective at one year; 24 lessons had the best results (measured in recorded days with vs without pain), but six lessons followed by exercise prescription was ‘85% as effective’ as 24 lessons. Therefore, the combination of six AT lessons followed by exercise was found to be the most cost-effective option (Hollinghurst, 2008). AT was viewed as effective by most participants (Yardley et al., 2010) and authors suggest that the AT is a powerful tool for self-efficacy as participants were able to apply skills learned from lessons to continue independent learning in the 6 lessons plus exercise group (Little et al., 2008). Subsequent smaller randomized controlled trials have shown the results are repeatable (Hafezi et al., 2021). Considering parallel research, these results also suggest that AT may affect body schema.

Postural Tone and Motor Planning

To plan an action, the motor system integrates sensory information from different sources into a coherent model (Medendorp & Heed, 2019; Gurfinkel et al., 2006). Tone and body schema work together to govern postural organization and provide a foundation for movement and balance (Ivanenko & Gurfinkel, 2018; Cacciatore et al., 2020). In AT, spatial and body-schema phenomena are thought to be deeply interwoven with tone (Cacciatore et al., 2011). Changes in tone lead to changes in the perception of the structural organization of the body, and an improved body percept facilitates further improvements in tone (Loram, 2017).

Using EMG to record muscle activity, one study found AT lessons decreased axial stiffness by 29% on average in subjects with low back pain while resisting rotation, leading the authors to suggest that dynamic modulation of postural tone can be enhanced through long-term training in the AT (Cacciatore et al., 2011). As the research on AT and tone indicates, changes in distribution and adaptivity of tone affect movement and balance. In a broad sense, tone is a foundational system that affects other aspects of motor behavior.

Changes in tone from AT-based instructions suggest that executive function can influence tone and body schema (Cohen et al., 2015; Cohen et al., 2020). This process may be related to what movement scientists call kinesthetic motor imagery, although such studies mostly examine the mental representation of overt movement rather than mental representations of desired postural states (Cacciatore et al., 2020).

Changes in body schema could also underlie changes in the adaptivity of tone. Postural tone (possibly in interaction with body schema) forms the central thesis of the current theoretical model of the AT proposed by Cacciatore et al. (2020). Because body schema is used as a central reference for posture, movement planning, and execution; its accuracy, precision, and integration with the motor system are likely to have widespread motor effects. Postural tone and body schema are similar in that both concern neurophysiological states rather than sequential processes involved in actions (Gurfinkel et al., 2006), and both are particularly suited to influence motor behavior in general. While there is no direct evidence that AT changes body schema, innumerous observations from practitioners and students support its relevance to AT practice (Cacciatore et al., 2020).

Parallels in Developmental Coordination Disorder

Developmental Coordination Disorder (DCD) has long been considered a motor disorder, but Martel and colleagues showed plasticity in body schema estimates used for motor control is altered in children and early adolescents with DCD, suggesting different pathology. The clinical assessment of the ability to point to or name several body-parts is generally preserved in children with DCD. This preserved motor learning, together with their noted reliance on vision to control hands and tools, point towards a body schema related deficit (Martel et al., 2022).

Children and early adolescents with DCD have trouble when comparing their predicted and received feedback, leading to difficulties in their body estimate (Pisella et al., 2019). Children with DCD experience difficulties in adjusting their body when their posture is challenged as this requires them to access their body representation for action. Physical therapists usually focus their approach on the body rather than motor disorders, working with children to improve their body awareness and find compensatory strategies (Martel et al., 2022). This sounds strikingly like the learning process in the AT and proposed mechanism of action by Cacciatore et al. (2020).

There have been no brain-imaging studies on AT treatment. However, clues into the brain mechanisms involved in AT lessons may be provided by related imagining research into Developmental Coordination Disorder (DCD). Symptoms of PD closely resemble symptoms of DCD and deficit in ‘body schema’ is hypothesized in both cases (Martel et al., 2022; Cacciatore et al., 2020).

‘Psychological’ Effects of AT

A variety of ‘non-physical’ outcomes of AT lessons including improved perceived general wellbeing and increased confidence were found by Kinsey et al. (2021). While physical effects of the AT are measurable, albeit subtle, non-physical outcomes are often reported and are difficult to quantify. Because AT practitioners and students philosophically conceive of the mind-body as an integrated whole, this interaction is not surprising (Tarr, 2011). Kinsey and colleagues make two informed theory statements on how non-physical outcomes can be generated by AT lessons: because the mind-body connection “improvements in physical wellbeing lead directly to psychological well-being,” and “an experience of mind-body integration leads people to apply AT skills to non-physical situations” (Kinsey et al., 2021).

Research that supports these theory statements can be found in the foundational work in AT & Parkinson’s (PD) done by Dr. Chloe Stallibrass and colleagues at the University of Westminster. A pilot study (Stallibrass, 1997) indicated that, in conjunction with drug therapy, AT could benefit people with PD. In a follow-up study (Stallibrass et al., 2002), ninety-three people with idiopathic Parkinson’s disease were assigned into three groups (AT, massage, and no additional care) and assessed using the ‘Self-assessment Parkinson’s Disease Disability Scale’ (SPDDS), ‘Attitudes to Self-scale’ and ‘Beck Depression Inventory’ (BDI). An additional study (Stallibrass, 2005) investigated retention of skills from the main study by voluntary follow up self-assessment questionnaire responses. The AT group improved compared with the no additional intervention group, pre-intervention to post-intervention on SPDDS tests and was comparatively less depressed post-intervention, supporting evidence that lessons in the AT are likely to lead to sustained benefit for people with Parkinson’s disease and that AT lessons may have non-physical outcomes (Stallibrass et al., 2002).

A study of people with chronic lower back pain found significant differences before and after AT lessons in their constructs of intention, perceived risk, direct attitude, and behavioral beliefs providing more evidence of non-physical outcomes from AT lessons (Kamalikhah et al., 2016). Perhaps not coincidentally, the AT was influential in the creation of some forms of psychotherapy (Tengwall, 1981). Some speculate that these outcomes might be explained by the documented therapeutic qualities of empathic touch (Tarr, 2011; Jones & Glover, 2014). 

‘Physical’ outcomes from Volitional Cognitive Behavior

There is also mounting evidence for psychophysical (physical and non-physical, Mindbody) outcomes among musicians applying the AT. A 2014 systematic review of trials found good evidence that AT lessons improve performance anxiety in musicians (Klein et al., 2014). A more recent a study found AT classes for music students may beneficially influence performance related pain, poor posture, excess muscle tension, stress, and performance anxiety (Davies, 2020). Another study of musicians reported that application of the AT to music performance showed improvements vs controls in heart rate variance, self-rated anxiety, and positive attitude to performance, as well as overall music and technical quality as judged by independent experts blind to subjects’ condition assignment (Valentine et al., 1995).

There have been multiple studies led by Dr. Rajal Cohen of the University of Idaho that quantitatively measured differences in axial tone, postural sway, postural uprightness, and step initiation; before and after verbal AT instruction among PD sufferers and healthy individuals (Cohen et al., 2015; Cohen et al., 2020). Improvements were recorded in the lateral center of pressure (CoP) displacement, smoothness of CoP path, axial rigidity (peak torque) and postural sway amplitude in both Parkinson’s patients and healthy individuals when given brief verbal instructions based on common AT directions compared to directions based on popular concepts of effortful posture correction (Cohen et al., 2015). These findings support other evidence that AT ‘thinking’ (direction, conscious autosuggestion, etc.) has distinct, measurable psychophysical outcomes.

Conclusion

Alexander recognized somatosensory defects, which he called ‘faulty sensory awareness’ and sometimes more provocatively ‘debauched kinesthesia’ as diseases of civilization as early as the 1890s. At the heart of most modern cognitive therapeutic modalities is the idea that maladaptive responses from our biology, that result in accumulation of chronic stress (allostatic load), can be cognitively inhibited to alter behavior and/or improve functioning.

Postural tone is a foundational system that affects all other aspects of motor behavior. The AT positively affects postural tone and therefore may indirectly positively affect all other aspects of motor behavior. Improvements in postural tone and body schema can, in turn, cause ‘non-physical’ outcomes because the interconnected nature of the mindbody denies the false dichotomy of physical and nonphysical. Taken together the conclusion supports Alexander’s foundational assertion that ‘use’ (psychomotor behavior) affects the functioning of the human organism.

We can now make educated theory statements that were previously impossible about the questions: What is causing psychophysical change in AT practice and how does it happen?

The answer is most likely a combination of systems related to interoception and proprioception that are recruited in the teaching/learning of the AT. With additional feedback from the instructor, the student’s interoception and proprioception is enhanced, causing modulation of body schema and postural tone. Accumulation of enough experiences of enhanced interoception and proprioception develops the skill of recalling those states volitionally without a teacher.

The possible connections among body schema, postural tone, and motor control suggest an intriguing area of potential research on changes in body schema through AT instruction. Similarities between MECPs (Yoga, Tai chi, Qi gong, etc.), Somatic Education/Therapy, and Psychotherapy should be examined in a comparative study. In addition, these inquiries all have interesting implications for the philosophical mind-body problem.

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Stallibrass, C., Frank, C., & Wentworth, K. (2005). Retention of skills learnt in Alexander technique lessons: 28 people with idiopathic Parkinson’s disease. Journal of Bodywork and Movement Therapies, 9(2), 150–157. https://doi.org/10.1016/j.jbmt.2004.06.004

Stern J. (2021). The Alexander Technique: Mindfulness in Movement Relieves Suffering Alternative and Complementary Therapies Volume: 27 Issue 1: February 11, 10-13. http://doi.org/10.1089/act.2020.29307.jcs

Stilwell, P., & Harman, K. (2021). Phenomenological Research Needs to be Renewed: Time to Integrate Enactivism as a Flexible Resource. International Journal of Qualitative Methods, 20. https://doi.org/10.1177/1609406921995299

Tarr, Jennifer (2011). Educating with the hands: working on the body/self in Alexander Technique Sociology of Health & Illness Vol. 33 No. 2 ISSN 0141–9889, pp. 252–265doi: 10.1111/j.1467-9566.2010.01283.x

Tengwall, Roger (1981). A note on the influence of F. M. Alexander on the development of gestalt therapy Journal of the History of the Behavioral Sciences volume 17 issue 1. https://doi.org/10.1002/1520-6696(198101)17:1<126::AID-JHBS2300170113>3.0.CO;2-X

Woodman, J. P. Moore, N. R. (2011). Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review – International Journal of Clinical Practice VL  – 66 IS  – 1 SN  – 1368-5031 UR https://doi.org/10.1111/j.1742-1241.2011.02817.x

Yardley L., Dennison L., Coker R., Webley F., Middleton K., Barnett J., Beattie A., Evans M., Smith P., Little P., (2010). Patients’ views of receiving lessons in the Alexander Technique and an exercise prescription for managing back pain in the ATEAM trial, Family Practice, Volume 27, Issue 2, Pages 198–204, https://doi.org/10.1093/fampra/cmp093

Valentine, E. R., Fitzgerald, D. F. P., Gorton, T. L., Hudson, J. A., & Symonds, E. R. C. (1995). The Effect of Lessons in the Alexander Technique on Music Performance in High and Low Stress Situations. Psychology of Music, 23(2), 129–141. https://doi.org/10.1177/0305735695232002

Xuan, R., Li, X., Qiao, Y., Guo, Q., Liu, X., Deng, W., Hu, Q., Wang, K., & Zhang, L. (2020). Mindfulness-based cognitive therapy for bipolar disorder: A systematic review and meta-analysis. Psychiatry Research, 290, 113116–113116. https://doi.org/10.1016/j.psychres.2020.113116

Websites:

https://www.nhs.uk/conditions/alexander-technique/

https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906

The Alexander Technique is in the interesting position of having been practiced for over 125 years in a wide variety of educational and medical settings while a proper biological theory of the mechanisms underlying AT has only recently been proposed. This was also the case for many of the early psychotropic drugs that were discovered serendipitously with no clear explanation for their purported mechanisms of action. The mechanisms of AT are still not fully understood.

American education philosopher and Columbia Teachers College president, John Dewey, wrote introductions to three of Alexander’s books. During the first half of the 20th century, Teachers College faculty members and graduates shaped the fields of educational and psychological assessment, social studies education, urban education and the study of gifted children. Dewey, in How We Think (1910), summarized his ‘analysis of a complete act of thought;’ which became a classic and was adapted by science-textbook authors as a concise description of the scientific method. Incidentally, his introduction to Alexander’s The Use of the Self (1939), was the first to claim that Alexander’s development of AT followed the scientific method. Dewey saw the AT as tied to the discovery of the location of various postural reflexes in the brainstem by Rudolf Magnus, a German researcher on the physiology of posture.

Magnus’ discovery was used as scientific proof of Alexander’s concept of ‘primary control,’ a crudely defined neologism referring to the head-neck-back relationship and its implications for coordination and general wellbeing. The term ‘central control’ was used in England to refer to Magnus’ discovery of the location of postural reflexes in the brainstem. Magnus found this region co-ordinated sensory input and that it was responsible for postural muscular tone. Magnus’ experiments were never done on humans, however, Magnus suggested the applicability of his findings to humans. Because of early poor translation or intentionally liberal application of Magnus, there are several issues in AT literature concerning Magnus and explanations of the AT, however, Magnus is still referenced by some contemporary AT teachers; i.e. Neurodynamics (2015) by Columbia Professor, Dr. Theodore Dimon.

Between 1923 and 1951 the British Medical Journal published 30 articles and letters testifying to the AT’s efficacy. A letter published May 29th, 1937 was signed by 19 doctors and surgeons who reported that patients had greatly benefited from AT and urged the medical community to investigate, however it took another 70 years for AT research to be published in the BMJ. In 1939, three doctors published letters in the BMJ claiming anatomist and researcher Dr. George E. Coghill’s work on the embryonic behavior of the American newt, amblystoma, provided scientific confirmation of Alexander’s discoveries.

The similarity was drawn between Coghill and Alexander’s idea of Primary Control by a number of AT proponents in the medical field who were looking for a biological basis for the AT. Coghill in response, acknowledged Alexander’s work established the same principles in vertebrate behavior and subsequently wrote an appreciation section in Alexander’s fourth and final book: The Universal Constant in Living (1941). However, A scathing critique of the AT in 1944, ‘Quackery Versus Physical Education’ published in the South African Fitness Journal, Manpower, insisted that Coghill’s research did not provide any evidence in support of Alexander. It also referred to Alexander’s ‘followers’ as a ‘head balancing cult’ and put their ‘belief’ down to ‘group hystero-neurosis typical of a new faith.’ As a result, Alexander sued the journal for defamation in 1945. 

The article contained a section, ‘The misquoted Sherrington’ which claimed Alexander had mischaracterized Sir Charles Sherrington’s research as being supportive to his work. Sherrington had coined the term “proprioceptive” in 1893. By 1900 he had concluded that the cerebellum was the head ganglion of the proprioceptive system and he also later discovered the stretch reflex. Sherrington also coined the terms neuron and synapse; he shared the 1932 Nobel Prize in medicine with Edgar Douglas Adrian. Interestingly Sherrington wrote a letter of support to Alexander that helped him win the libel case in 1948. Slowly, teachers of the Alexander Technique started to view Coghill’s research as not relevant to the Technique, but Coghill was widely quoted until at least the 1970s.

In a related vein of research, Nikolass Tinbergen wrote The Study of Instinct in 1951, in which he questioned the roles of internal and external stimuli in controlling behavioral expression and expounded on innate behavioral reactions in animals and the adaptiveness and evolutionary aspects of those behaviors. Tinbergen, writing about Coghill in 1951, concluded: ‘It seems that one cannot “crystallize out” from a diffuse total response, and that a kind of additive type of integration may play a part too, perhaps especially in the higher levels.’ Tinbergen dedicated a large portion of his acceptance speech for the 1973 Nobel Prize in Medicine to the AT as an example of ‘the usefulness of an ethological approach to medicine.’ Tinbergen noted AT teacher’s ‘exceptionally sophisticated observation’ that can ‘alleviate an astonishing variety of somatic and mental illnesses.’ The speech heavily references the work of Dr. Wilfred Barlow, a rheumatologist who married Alexander’s niece, and is reproduced in later editions of Barlow’s book The Alexander Technique.

Dr. Barlow was the first AT teacher to conduct research into the Technique. Barlow was the only AT teacher who developed the idea of making a formal diagnosis of pupils. Recognizing that Coghill, and in relation the AT principle of ‘primary control’ where head-neck relationship was thought to positively affect the ‘total pattern,’ was over-emphasised, Barlow subsequently came to think AT effects are caused by separately learned components, rather than simply by a generalized total pattern. Between 1946-1959 Barlow conducted a number of “before and after” AT lessons studies where pupils would undress and stand against a grid so that any asymmetries or deviations would be easy to identify and record via photography. 

Tufts University professor Frank Pierce Jones did many experimental studies involving the AT between 1951 and 1972. Jones endorsed the AT adopted view of Magnus, that ‘the postural reflexes, the response of the organism to gravity is a fundamental feedback which integrates other reflex systems.’ In his book Freedom to Change he refers to the stretch reflex, the righting and attitudinal reflexes as part of the explanation for the mechanisms of the AT. Jones predominantly measured changes in posture and movement (mainly sit-to-stand behavior) using multiple image photography with markers on various parts of the subject’s body illuminated by flashes. A summary of these studies was published in Psychological Review in 1965 and the book Body Awareness in Action (1976) which was published posthumously.

A physiologist and medical research scientist at the University of New South Wales, Dr. David Garlick, made a preliminary survey of possible physiological explanations involved in the AT and laid the groundwork for current theories. He stressed that the awareness of inter-relationship of muscle and mental states (body schema) as one of the most important effects of the AT. Garlick’s research included various types of postural analysis, the majority of which were published in The Lost Sixth Sense (1990). The “sixth sense” in this context refers to underdevelopment and/or malfunctioning of kinaesthesia and proprioceptive senses. Garlick postulates that the AT mainly operates on these senses and the brain mechanisms related to them; he lists sensory nerve inputs from neck muscle spindles, Golgi tendon organs, skin and joint receptors, and different types of muscle fibers as physiological factors relevant to the AT.

Although the effectiveness of AT has been shown at the behavioral level, their effects on altering brain circuitry are still unclear. In his 1985 book, The Man Who Mistook his Wife for a Hat, Oliver Sacks describes an extreme case of the loss of proprioception in the chapter, ‘On the Level.’  The patient discovers AT-like strategies of additional feedback (in this case affixing a spirit level to his glasses) coupled with the recruitment of cognitive mechanisms to help regulate what should be automatic, consciously adjusting his balance. In the chapter Sacks writes, “The awareness of relative position of trunk and limbs, derived from receptors in the joints and tendons – was only really defined (and named ‘proprioception’) in the 1890s; the complex mechanisms and controls by which our bodies are properly aligned and balanced in space – these have only been defined in our own century, and still hold many mysteries.”

References:

Mouritz.org Companion Articles: ‘Frank Pierce Jones’ ‘Wilfred Barlow’ ‘Wilfred Barlow’s research’ ‘Scientific explanations of the Alexander Technique’

https://mouritz.org/companion/article

In his recent best seller, The Myth of Normal, Dr. Gabor Mate describes the state collectively thought of as normal in society as a disordered one caused by maladaptation to the overwhelming stimulus of modernity. More than a century ago, Alexander wrote that modern humans behaved with faulty, overly effortful, reactive habits because of the rapidly changing environment and new, potent types of stimuli that humans are not evolved or adapted for. Alexander recognized somatosensory defects, which he called ‘faulty sensory awareness’ and sometimes more provocatively ‘debauched kinesthesia’ as diseases of civilization as early as the 1890s. At the heart of most modern cognitive therapeutic modalities is the idea that maladaptive responses from our biology, that result in accumulation of chronic stress (allostatic load), can be cognitively inhibited to alter behavior and/or improve functioning. At the turn of the 20th century the idea of diseases of civilization was well established and thought of as a probable cause of cancer and ‘degeneration.’

Degeneration theory was a major factor in medicine, especially psychiatry, from the second half to the 19th century through the beginning of the 20th century. At the time, the theory was a popular hypothesis for the genesis of mental disorders and neurological diseases, as, in contrast with the other fields of medicine, no biological pathology for mental diseases could be found. Alexander adapted aspects of degeneration theory into his own theories, i.e. when someone had poor ‘use of the self’ ‘psychophysical degeneration’ occurred and he claimed his technique would produce the opposite effects potentially curing related diseases. Degenerate theory was closely interlinked with various other ideological theories that formed the background philosophy of natural science during the nineteenth century, especially the theory of evolution which in turn gave birth to the theories of social Darwinism, eugenics, genetics and biological-vitalistic approaches.

Alexander was in many ways a “vitalist,” which was the popular view in biology at the time. Vitalism was tied with social reformers who believed that humans could inherit the effects of a healthy environment and, by passing environmentally-induced modifications to their offspring, achieve continuous progress. Vitalism arguably birthed the current popular scientific viewpoint on consciousness, emergentism, in which the properties of a system cannot be fully described in terms of the properties of its constituents (Schultz, 1998). Prominent vitalists included Louis Pasteur and Johannes Reinke, the latter’s work having influenced Carl Jung. Some AT proponents believe releasing chronic muscular tension and encouraging certain alignments of the head and neck increases vital energy flow and enables a higher plane of consciousness as well as a number of related health benefits.

Vitalism, sometimes called a form of bio-theology, is a rejected tradition in biology which proposed that life is sustained and explained by an unmeasurable, intelligent force or energy. The supposed effects of vitalism are the manifestations of life itself, which in turn are the basis for inferring the concept in the first place; this circular reasoning offers pseudo-explanation. Vitalism has many faces and has sprung up in many areas of scientific inquiry (Keating, 2002). In 1889, evolutionary biologist August Weismann’s germ-plasm theory signaled the beginning of the end of vitalism in biology and the birth of eugenics. Social Darwinism, a pseudoscientific precursor to eugenics that peaked in popularity during the 1870s, purported to apply biological concepts of natural selection and survival of the fittest to sociology, economics and politics (Leonard, 2009).

Scholars of social sciences in response created theories of human progress in which the social environment had a central role and biological heredity was diminished, creating a new theory of social progress based on a concept called ‘social heredity’ (Raymer, 2018). In Britain, the most prominent and influential social Darwinist was Herbert Spencer who coined the term ‘survival-of-the-fittest.’ Spencer was a widely read and influential philosopher in England and America during the Victorian era. Openly racist views were common, but race had further reaching implications as ethnic groups (i.e. Dutch, English or French) were considered different races (Lewis, 2016). Alexander’s ideas of the cognitive evolution of consciousness control of the self were likely influenced by these veins of thought. 

Alexander’s teaching in Australia originally consisted of acting and Delsarte techniques. Ironically, it was the great success of Delsarte that was its undoing. By the 1890s, it was taught everywhere, and not always in accordance with the emotional basis that Delsarte originally had in mind. No certification was needed to teach a course with the name Delsarte attached and the study eventually regressed into empty posing with little behind it. Perhaps this contributed to Alexander’s noted debts, subsequent move to London and ‘AT’ developments around this time. Alexander’s teaching in London departed from his prior teaching of acting and Delsarte and likely heavily borrowed from Dr. Scanes Spicer (Staring & Bouchard, 2002).

Dr. Scanes Spicer was a consulting ENT surgeon at St. Mary’s Hospital in London who was interested in all manner of the breathing practices that were practiced at that time. He noted that if patients did not have some kind of physical therapy their recovery took longer. Spicer had lessons from Alexander, approved of his method and sent him patients. Alexander helped Spicer with his patients’ therapy and Spicer helped Alexander build a teaching practice when he first arrived in London, especially among actors. This relationship lasted until 1908 when a split occurred (Staring & Bouchard, 2002). Spicer argued against the prevailing ideas from anthropologist and anatomist Sir Arthur Keith, that breathing is dominant over posture. Spicer turned Keith’s argument upside down, asserting that if you have good posture you will breath well as an effect, presenting his theory in 1909. Alexander was working with the idea that posture and breathing are simultaneously reciprocal. There is no doubt from the historical record that Spicer presented his findings to the public before Alexander did (Staring & Bouchard, 2002).

Alexander’s reaction to Spicer’s articles (two pamphlets in 1909 and 1910), was to claim that Spicer had stolen the idea from him. However, the core observations of Alexander were first articulated by Spicer more clearly and in medical terms. The true history of who influenced or taught Alexander is difficult to determine. However, the commonly propagated myth that he invented the AT by looking at the mirror is obviously false. Possible influences and collaborators include Leo Kofler, Oskar Guttmann, William Aikin, William Shakespeare, and Major Reginald Austin (Staring & Bouchard, 2002). Anthropologist and Alexander biographer Jeroen Staring on Alexander, “He was someone who had a double consciousness with authorities, that you use them as long as they are helpful to you and then put them aside when they don’t help you any more.”

After the Pall Mall Gazette medical editor wrote an article on deep breathing and tuberculosis, competing schools of breathing in London at the time wrote articles to the editor promoting themselves. Alexander sent a letter to the editor trying to establish himself by attacking Arthur Lovell and the Ars Vivendi school in a dispute that continued in the press through the summer of 1908. The medical editor of the Pall Mall Gazette, which at the time was the most popular newspaper in London, was Caleb Williams Saleeby. Saleeby was the head of the Eugenics Education Society and very influential, able to recruit members like Sir Charles Sherrington. He also invented the word “smog,” but now is forgotten, there is no biography of him (Staring & Bouchard, 2002).

Saleeby was a propagandist for eugenic ideas. A front of eugenics advocated by Saleeby was ‘nurtural eugenics,’ which refers more to public health and preventive medicine than eugenics. Saleeby was also an editor at Methuen, the publisher of Alexander’s book, Man’s Supreme Inheritance. Saleeby favorably described people like Alexander who, in spite of not having medical training, had a positive health impact on people who came to him for lessons. If Saleeby were not a eugenicist, we might be reading his texts on preventive medicine as Saleeby was promoting quitting smoking and being exposed to the sun for health (Staring & Bouchard, 2002). To be fair to Alexander and his proponents, it’s possible that Alexander’s writings on ‘race culture’ may have been an attempt to connect his ideas to Victorian pop-psychology for marketing purposes. Alexander’s ideas related to eugenics boil down to: if you help people change their habits, they can have better children.

In any case, Saleeby helped Alexander fund, and most likely write Man’s Supreme Inheritance. In Man’s Supreme Inheritance, Alexander asserted that modern man had evolved beyond ‘the savage’ whom Alexander described as being driven by instinctual reaction rather than conscious control. In light of Alexander’s philosophy of mind-body unity he saw, ‘conscious control of the self’ (or ‘good use of the self’ etc.) as a moral issue and someone with ‘bad use’ was behaving immorally (unconsciously). Because Alexander’s thoughts on evolution of conscious control (essentially a racist ego development theory), he and Saleeby saw the AT as applied eugenics. In America, the decline of eugenics in the 1930s and 1940s was only one part of the increasing hostility to progressive era eugenics, scientific racism, race-inspired imperialism and the use of biology more generally in the social sciences (Leonard, 2009). Alexander’s teaching studio had a corresponding decline during those years and financial difficulties instigated the first teacher training course in 1931. Alexander’s later writings mostly avoided controversial views on ‘race culture.’

In 1944, a scathing critique of the AT, ‘Quackery Versus Physical Education’ was published in the South African Fitness Journal, Manpower. It insisted that research cited as supportive did not provide any evidence in support of Alexander. It also referred to Alexander’s ‘followers’ as a ‘head balancing cult’ and put their ‘belief’ down to ‘group hystero-neurosis typical of a new faith.’ The article contained a section, ‘The misquoted Sherrington’ which claimed Alexander had mischaracterized Sir Charles Sherrington’s research as being supportive to his work. Alexander sued the journal for defamation in 1945. Interestingly, Sherrington wrote a letter of support to Alexander that helped him win the libel case in 1948. The victory came at a significant cost for Alexander as the award did not cover his costs and the stress likely contributed to a stroke around this time.

Most AT teachers and students are unaware of this dimension and history of AT and perhaps should consider the historical implications when using concepts like evolution in any explanation of the AT. Alexander trained about 80 teachers before his death in 1955, these teachers mostly quietly overlooked Alexander’s eugenics ideas. The fact that his books were out of print for decades kept these shocking facts from being widely known, feeding the hagiographical myth of Alexander that’s typically propagated. Beyond being factually incorrect, Alexander’s racist and dehumanizing language is shocking today but sadly was not unusual for writings from that era and largely went un-protested during Alexander’s lifetime.

Today, AT societies are openly anti-racist, i.e. The Society of Teachers of the Alexander Technique (STAT)’s website has a prominently displayed ‘Diversity and Anti-discrimination Statement’ that reads: “STAT supports diversity and opposes racism’ and every other form of prejudice or discrimination. It deplores all expressions thereof, in any form, contemporary or historical. STAT and its members stand apart from any and all prejudicial or discriminatory passages in the writings of F. M. Alexander. They neither expound nor define the body of practice and theory that has come to be known as the Alexander Technique; they play no part in the manner in which the Technique is taught in STAT- approved teacher training schools or in the practice of the Technique by its Teaching Members; Alexander’s writings are not treated as core texts, but as historical texts read critically for reference. Equality and freedom from discrimination are fundamental to STAT’s advancement of the Technique.” There is also the Judith Leibowitz Scholarship Fund provides scholarships ‘to empower BIPOC who want to train to become AT teachers and expand the AT teaching community.’

However, a long standing question as to whether or not to change the name of the AT seems as relevant as ever. As long as the work is labeled the ‘Alexander’ technique the community will have to deal with the baggage of the man. Alexander insisted he not be mimicked, never used the label AT, and his writings are far from textbooks on how to learn the AT. FM’s writings in many ways needlessly mystify the AT into postural metaphysics. Perhaps it’s time to stop telling the myth of Alexander, if not for reasons previously written, it makes AT appear cultish and turns off prospective students.

References:

Schultz S. G. (1998). A century of (epithelial) transport physiology: from vitalism to molecular cloning. The American journal of physiology, 274(1), C13–C23. https://doi.org/10.1152/ajpcell.1998.274.1.C13

Leonard. (2009). Origins of the myth of social Darwinism: The ambiguous legacy of Richard Hofstadter’s Social Darwinism in American Thought. Journal of Economic Behavior & Organization, 71(1), 37–51. https://doi.org/10.1016/j.jebo.2007.11.004

Raymer, E. (2018). Human progress by human effort: neo-Darwinism, social heredity, and the professionalization of the American social sciences, 1889-1925. History and Philosophy of the Life Sciences, 40(4), 1–23. https://doi.org/10.1007/s40656-018-0225-y

Lewis H. (2016). CHAPTER 2: SOCIAL DARWINISM: A Brief Outline of Social Darwinism and Its influence on 19th Century Britain and Elsewhere. The Journal of Psychohistory, 44(2), 154–.

Staring J., Bouchard E. 2002 The Early History of F.M. Alexander: Jeroen Staring Talk at the American Center for the Alexander Technique 2/13/2002

Keating J. C., Jr. (2002). The Meanings of Innate. The Journal of the Canadian Chiropractic Association, 46(1), 4–10.

https://www.judithleibowitzscholarship.org/

https://alexandertechnique.co.uk/about-stat/about-stat

Parkinson’s disease (PD) is a progressive neurological disease that includes a range of symptoms related to control of posture (Doherty et al., 2011). The biological basis for PD is death of dopamine secreting neurons caused by degeneration of the substantia nigra and nigrostriatal system. The brain contains two major systems of dopaminergic (DA) neurons: the nigrostriatal system (damaged in PD), and the mesolimbic/mesocortical system, which consists of dopaminergic neurons in the ventral tegmental area that innervate the nucleus accumbens and the prefrontal cortex. Parkinson’s disease (PD) damages only the nigrostriatal system because elevated intracellular calcium ions and dopamine combine to kill cells in the nigrostriatal system; the mesolimbic/mesocortical lacks elevated levels of calcium ions (Carlson & Bricket, 2022).

Most cases of Parkinson’s disease (PD) do not have genetic causes but there are PD correlated gene mutations known to cause higher levels of defective proteins to accumulate and damage dopaminergic neurons. Primary symptoms of PD are muscular rigidity, slowness, tremor, and postural instability. PD can be caused by environmental toxins (i.e. insecticides), faulty metabolism, or unrecognized infectious disorders. Functional-imaging studies have shown that akinesia (difficult initiating movement) was associated with decreased activation of the supplementary motor area and that tremors are associated with abnormalities of a neural system involving the pons, midbrain, cerebellum, and thalamus (Carlson & Bricket, 2022).

The standard treatment for PD is L-DOPA, the precursor of dopamine. Increased levels of L-DOPA causes a patient’s remaining dopaminergic neurons to produce more dopamine but eventually the number of nigrostriatal dopaminergic neurons declines and symptoms become worse. Deprenyl, an MAO inhibitor, slows the progression of PD, especially if therapy begins soon after onset. MAO inhibitors appear to work on symptoms but do not slow the degeneration of neurons (Carlson & Bricket, 2022). Medication often alleviates some Parkinsonian motor symptoms, but it does not cure them and may make aspects of postural control worse (Contin et al., 1996). Surgical options including fetal tissue transplant, but not all patients benefit and some transplant recipients later develop severe dyskinesias. Other surgical options include brain lesioning the globus pallidus (GPi) and/or the subthalamic nucleus (STN), or implanting electrodes for deep brain stimulation (DBS) of the STN (Carlson & Bricket, 2022). 

Woodman & Moore (2011) suggest the effectiveness the Alexander Technique (AT) in PD related disability. Movement based embodied cognitive practices (MECPs) similar to AT (Posadzki, 2009), such as Yoga, Qigong and Tai Chi have shown promise in alleviating symptoms associated with PD disability (Cohen et al. 2015). The AT is a method of neuromuscular re-education known to affect postural tone and movement coordination (Cacciatore et al., 2011). According to the National Health Service (UK), “lessons in the AT may help one carry out everyday tasks more easily and improve feelings about Parkinson’s disability.” A pilot study (Stallibrass, 1997) indicated that, in conjunction with drug therapy, AT could benefit people with Parkinson’s disease. 

A subsequent larger scale study (Stallibrass et al., 2002) included ninety-three people with idiopathic PD assigned into three groups (AT, massage, and no additional care) assessed using the Self-assessment Parkinson’s Disease Disability scale (SPDDS), Attitudes to Self-scale and Beck depression inventory (BDI). The AT group improved compared with the no additional intervention group, pre-intervention to post-intervention on SPDDS tests and was comparatively less depressed post-intervention, supporting evidence that lessons in the AT are likely to lead to sustained benefit for people with Parkinson’s disease (Stallibrass et al., 2002). Reductions in depression seem to stem from greater agency based on questionnaire responses (Stallibrass, 2005). 

 More recently, Cohen et. al (2015) showed that distinct effects on posture and mobility were apparent by measuring axial tone, postural sway, postural uprightness, and step initiation after Parkinson’s patients were given brief postural instructions based on AT directions. These inquiries all have interesting implications for the philosophical mind-body problem and have inspired continuing research.

More on the topic.

References

Carlson, N., Birkett, M. (2022), Foundations of Behavioral Neuroscience (10th ed.), Pearson.

Cacciatore T., Gurfinkel, V. S., Horak, F. B., Cordo, P. J., & Ames, K. E. (2011). Increased dynamic regulation of postural tone through Alexander Technique training. Human Movement Science, 30(1), 74–89. https://doi.org/10.1016/j.humov.2010.10.002

Contin M, Riva R, Baruzzi A, Albani F, Macri’ S, Martinelli P. Postural stability in Parkinson’s disease: the effects of disease severity and acute levodopa dosing. Parkinsonism Relat Disord. 1996;2:29-33.

Cohen RG, Gurfinkel VS, Kwak, E, Warden AC, Horak FB. Lighten up: specific postural instructions affect axial rigidity and step initiation in patients with Parkinson’s disease. Neurorehabilitation and Neural Repair. 2015;29:878–888. doi:10.1177/1545968315570323

Doherty K., van de Warrenburg, B. P., Peralta, M. C., Silveira-Moriyama, L., Azulay, J.-P., Gershanik, O. S., & Bloem, B. R. (2011). Postural deformities in Parkinson’s disease. Lancet Neurology, 10(6), 538–549. https://doi.org/10.1016/S1474-4422(11)70067-9

Posadzki P. (2009). Qi Gong exercises through the lens of the Alexander Technique: A conceptual congruence. European Journal of Integrative Medicine, 1(2), 87–92. https://doi.org/10.1016/j.eujim.2009.04.001

Stallibrass C. An evaluation of the Alexander Technique for the management of disability in Parkinson’s disease- a preliminary study. Clinical Rehabilitation. 1997;11(1):8-12. doi:10.1177/026921559701100103

Stallibrass, C., Sissons, P., & Chalmers, C. (2002). Randomized controlled trial of the alexander technique for idiopathic parkinson’s disease. Clinical Rehabilitation, 16(7), 695-708. https://doi.org/10.1191/0269215502cr544oa

Stallibrass, Frank, C., & Wentworth, K. (2005). Retention of skills learnt in Alexander technique lessons: 28 people with idiopathic Parkinson’s disease. Journal of Bodywork and Movement Therapies, 9(2), 150–157. https://doi.org/10.1016/j.jbmt.2004.06.004

Woodman, J. P. Moore, N. R. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review 2011 – International Journal of Clinical Practice VL  – 66 IS  – 1 SN  – 1368-5031 UR https://doi.org/10.1111/j.1742-1241.2011.02817.x

National Health Service of the UK – AT page https://www.nhs.uk/conditions/alexander-technique/

The Alexander Technique As I See It by Patrick Macdonald is a charming, clear, and at times laugh out loud funny take on learning, teaching, and practicing the Alexander Technique.

Clearly not one to spend much time pontificating, Mr. Macdonald opens the book with three simple questions that are not only the most commonly asked in the AT but also three of the most difficult questions to give a concise answer to:

What is the Alexander Technique?  What does it do? What is its value?

Keeping with his no nonsense approach, the majority of the book is contained in the first section, “Notebook Jottings.” In these jottings he gives his opinions and insights on most themes even remotely related to the Alexander Technique. These entries include musings on trying, feeling, exercises, directing, breathing, doctors, learning, seeing, relaxation and collapse, egotism, thinking, time, nervousness, the Bible, hoping, imitation, specialists, responsibility, judgements, luck, statistics, laziness, shaving, and even siesta. Some of my favorite jottings from the first section include:

On Trying: When at first you don’t succeed, never try again, at least, not in the same way. Trying almost always involves extra and excessive tension.

On Right and Wrong: If your right is wrong, then it follows that any attempt on your part to be right will produce the wrong result. Rather it is better to be prepared to be wrong. This leaves the way open for the real right to take place. Do not forget that right and wrong change; What’s right today should be wrong tomorrow … Remember, you are slowly eliminating the wrong. Finality, for most of us, and that includes me, is not in sight.

On Managing to Exist: The ability of some people to be terribly dis-coordinated and yet to remain alive is one of the marvels of Nature.

On the Modern Arts: A good number of people, nowadays, confuse gross mal-coordination with originality.

On Change: You cannot change and yet remain the same, though this is what most people want.

On Thinking and Doing: In the first place you must learn to think and not to do. After that you must learn to let the doing come about as a result of the thinking … It is alright to do, as long as you do the right thing.

On Ends and Means: I think it was Aldous Huxley who wrote, after lessons with Alexander, that it was of the utmost importance to see that the means used to any end did, in fact, bring about that end and no other. It will be seen that the controversy about whether ends justify means or not has no basis in reality. What is real is that means condition ends directly, and that ends condition means indirectly. All the rest is verbiage.

On Yoga: I may have been unlucky in having pupils who came to me after incorrectly studying Yoga. They were rigid both in neck and brain, and it would appear that learning to stand on one’s head had not done any good to the one or to the other…

On Up: You need to know where up is, and what up is. One has to learn the Art of falling upwards.

Learned Ignorance: John Dewey, when asked by Alexander what a conference of philosophers had been about, replied, “Learned ignorance, my dear Alexander, learned ignorance.”

Once you get through the very entertaining and informative jottings, the very short (only about 40 pages) formal book appears. The first chapter details Alexander’s Discovery very concisely. There are extensive quotes from Alexander’s book, “The Use of the Self” detailing the ingenious process that Alexander worked out to change his habits of use. One interesting note is that he substitutes Alexander’s terminology “Primary Control” with “Master Reflex.” Stating that when the head/neck/back relationship is well established the subsequent organization of the whole body does itself reflexively.

In the second chapter Mr. Macdonald begins by reminding us of the changing meaning of words, specifically in regards to the technique once one has had additional experiences with the technique (ex. Neck free, head forward and up, etc.). He uses an interesting example of a child, John Smith age 10 and then John Smith age 12. While he is the same John Smith, he is also different.

He then goes on to explain the primary directions (and what directions is) mostly focusing on what not to do, as well as describing many of the common tendencies of pupils and what is seemingly behind those tendencies such as belief systems. Another great analogy that Mr. Macdonald uses is that the AT is as simple as A B C; it should be borne in mind, however, that A B C is only simple to the non-native english speaker after he has learned what A B C is about.

The third chapter is about why people study the AT and after some useful general and specific information about Use and the forces in play within the body the chapter makes way for several inspiring case studies of Mr. Macdonald’s students. The students were suffering from problems including: Asthma, Bronchitis, Paralysis (from stroke), Depression, Slipped Disc, Migraines, Rheumatism and Arthritis, Heart Trouble, and Childbirth Complications.

In chapter four (on teaching the technique) Mr. Macdonald further explains direction and gives a very clear and unique description that is helpful in understanding the nature of direction. He distinguishes direction, muscular movement, and position explaining that direction should be taking place consciously within muscular movement and position and that the internal direction does not always go in the same direction as the muscular movement. He uses the analogy of a magnet being drawn to a piece of metal, even if you move the magnet away from the metal it is still being oriented in that direction. In sitting even though you are moving down in space with muscular movement, the internal direction should be a lengthening spine with the head going forward and up.

He further explains that the internal direction or flow is always going on whether conscious or unconscious and that the primary job of the Alexander Teacher is to persuade one’s student to exchange contracting impulses with expansive ones. Before reading this I had thought direction was something I did while being a mindful Alexandrian, however this is not the case, even as I sit still internal direction/flow is happening; you can make a choice to be aware and influence it or let your habits take the lead.

Also included in the chapter are notes about style and originality in teacher the technique, which he mostly warns against. He reminds the reader of the importance of the teacher’s use and gives tips on getting expansive responses from the student and gives a good deal of different explanations and practical applications of inhibition and direction. He frames giving the directions in a sequential way, noting that each direction depends on the last one being maintained and reinforced.

Let the neck be free

Let the neck be free for the head to go forward and up

Let the neck be free for the head to go forward and up for the back to lengthen and widen (etc.)

The final chapter is a compilation of letters and excerpts expressing appreciation of the technique by professors, doctors, scientists, authors, and various former students. Mostly written to various medical associations and newspapers to encourage greater awareness of the technique, they reflect the general lack acceptance by the medical and academic communities at the time. The chapter concludes with a timeline of Alexander’s life in relation to the development of the technique- something that is not completely agreed upon within the AT community.

Overall the book is a must read for any serious AT student or teacher. Patrick Macdonald was a unique figure that was highly educated (Cambridge), had a medical background, and also had a physical background as an amateur boxer. He is reportedly (in the accounts from other teachers that were on the training course with F.M.) the one who discovered what Alexander was getting at in the first training course, before this Alexander had little faith that anyone could learn to teach his technique. The book contains gems from sixty years of teaching, it’s a real shame that it is out of print. If you find a copy, buy it immediately!