Alexander technique

The Alexander Technique (AT), named after Frederick Matthias Alexander, is an educational process that develops the ability to realign posture and to avoid unnecessary muscular and mental tension. Alexander believed the individual's self-awareness could be inaccurate, resulting in unnecessary muscular tension such as when standing or sitting with body weight unevenly distributed, holding one's head incorrectly, walking or running inefficiently, and responding to stressful stimuli in an exaggerated way. Alexander said that those who habitually "misused" their muscles could not trust their feelings (sensory appreciation) when carrying out activities or responding to situations emotionally.^[1]

Alexander developed the technique's principles in the 1890s^[2] in an attempt to alleviate breathing problems and hoarseness during public speaking. He credited his method with allowing him to pursue his passion for acting in Shakespearean theater.^[3]

Some proponents of the Alexander Technique state that it has treatment potential for a variety of health conditions. However, as of 2013, supporting medical evidence was of low to moderate quality and overall, the effectiveness of the Alexander Technique is uncertain because of insufficient evidence.^[4] There is evidence suggesting the Alexander Technique is helpful for long-term back pain, long-term neck pain, and may help people cope with Parkinson's disease, but little evidence that it helps any other medical conditions.^[5]

History

Frederick Matthias Alexander (1869–1955) was a Shakespearean orator who developed voice loss during his performances. After doctors found no physical cause, Alexander reasoned that he was inadvertently damaging himself while speaking to cause the problem. He observed himself in multiple mirrors and saw that he was contracting his posture prior to phonation in preparation for verbal responses. He hypothesized that a habitual pattern of pulling his head backwards and downwards needlessly disrupted the normal working of the total postural, breathing, and vocal mechanisms.

With experimentation, Alexander developed the ability to stop the unnecessary and habitual contracting in his neck, displacement of his head, and shortening of his stature, and found that his problem with recurrent voice loss was resolved. While on a recital tour in New Zealand (1895) he began to realise the wider significance of head carriage for overall physical functioning. Further, Alexander observed that many individuals commonly tightened their musculature in the same pattern as he had done, in anticipation of many other activities besides speech.

Alexander believed his work could be applied to improve individual health and well being. He further refined his method of self-observation and re-training to teach his discoveries to others. As part of his teaching method, he also developed a unique way of imparting the improved kinesthetic and proprioceptive experience to his students. This approach to using the hands also allowed him to re-arrange the working of a person's entire supportive musculature as it functions in relation to gravity from moment to moment. He explained his reasoning in four books published in 1918, 1923, 1931 (1932 in the UK) and 1942.

He also trained teachers to teach his work and to use their hands in this unique way from 1930 until his death in 1955. Teacher training was continued during World War II between 1941 and 1943, when Alexander accompanied children and teachers of the Little School to Stow, Massachusetts to join his brother, A. R. Alexander, who also taught his brother's technique. The American teacher training course included Frank Pierce Jones,^[6] who went on to conduct research work to explore aspects of the Alexander Technique at the Tufts Institute for Psychological Research, and he published many of his studies in professional journals.

Since the 1960s, numerous training schools for teachers of the Alexander Technique have started up in the United States—some based upon the standards of training laid down by the Society of Teachers of the Alexander Technique established in England after Alexander's death in 1955 and others established by those who had not undergone the required length of training. In 1987, The North American Society of Teachers of the Alexander Technique was established to maintain high teaching standards. It is now called The American Society of Teachers of the Alexander Technique and is affiliated with the original Alexander society in London.

Influence

The American philosopher and educator John Dewey became impressed with the Alexander Technique after his headaches, neck pains, blurred vision, and stress symptoms largely improved during the time he used Alexander's advice to change his posture.^[7] In 1923, Dewey wrote the introduction to Alexander's Constructive Conscious Control of the Individual.^[8]

Aldous Huxley had transformative lessons with Alexander, and continued doing so with other teachers after moving to the US. He rated Alexander's work highly enough to base the character of the doctor who saves the protagonist in 'Eyeless in Gaza' (an experimental form of autobiographical work) on F.M. Alexander, putting many of his phrases into the character's mouth.^[9] Huxley's work 'The Art of Seeing' also discusses his views on the technique.

Sir Stafford Cripps, George Bernard Shaw, Henry Irving and other stage grandees, Lord Lytton and other eminent people of the era also wrote positive appreciations of his work after taking lessons with Alexander.

Since Alexander's work in the field came at the start of the 20th century, his ideas influenced many originators in the field of mind-body improvement. Fritz Perls, who originated Gestalt therapy, credited Alexander as an inspiration for his psychological work.^[10] The Feldenkrais Method and the Mitzvah Technique were both influenced by the Alexander Technique.

Process

Alexander's approach emphasizes certain strategies applied to the use of the self, which could be now called 'mindful' action, though in his four books he did not use that term. The technique is applied dynamically to everyday movements, as well as to actions selected by teacher or student.

Actions such as sitting, squatting, lunging or walking are often selected by the teacher. Other actions may be selected by the student, tailored to their interests or work activities such as hobbies, computer use, lifting, driving or performance in acting, sports, speech or music. Alexander teachers often use themselves as examples. They demonstrate, explain, and analyze a student's moment to moment responses as well as using mirrors, video feedback or classmate observations. Guided modelling with a highly skilled hand contact is the primary tool for detecting and guiding the student into a more coordinated state in movement and at rest. Suggestions for improvements are often student-specific.^[11]

Exercise as a teaching tool is deliberately omitted because of a common mistaken assumption that there exists a "correct" position. There are only two specific procedures that are practiced by the student; the first is lying semi-supine; resting in this way uses "mechanical advantage" as a means of redirecting long-term and short-term accumulated muscular tension into a more integrated and balanced state. This position is sometimes referred to as "constructive rest", or "the balanced resting state". It's also a specific time to practice Alexander's principle of conscious "directing" without "doing". The second exercise is the "Whispered Ah", which is used to co-ordinate free breathing and vocal production.

Freedom, efficiency and patience are the prescribed values. Proscribed are unnecessary effort, self-limiting habits as well as mistaken perceptual assumptions. Students are led to change their largely automatic routines that are interpreted by the teacher to currently or cumulatively be physically limiting, inefficient, or not in keeping with best use of themselves as a whole. The Alexander teacher provides verbal coaching while monitoring, guiding and preventing unnecessary habits at their source with a specialized hands-on assistance.^[12]

This specialized hands-on skill also allows Alexander teachers to bring about a balanced working of the student's supportive musculature as it relates to gravity's downward pull from moment to moment. Often, students require a great deal of hands-on work in order to experience a fully poised relation to gravity in both movement and at rest as they react to all life's stimuli. The hands-on skill requires Alexander teachers to maintain in themselves from moment to moment the improved psycho-physical co-ordination they are communicating to the student.^[12]

Alexander developed terminology to describe his methods, outlined in his four books that explain the experience of learning and substituting new improvements.

Constructive Conscious Control

Alexander insisted on the need for strategic reasoning because kinesthetic and proprioceptive sensory awarenesses are relative senses, not truthful indicators of a person's factual relationships within him/herself or within the environment. A person's habitual neuro-muscular relation to gravity is often sensed internally as normal, however inefficient. Alexander's term, "debauched sensory appreciation" describes how the repetition of an action or response encourages the formation of habits as a person adapts to various circumstances or builds skills. Once trained and forgotten, completed habits may be activated without feedback sensations that these habits are in effect, even when only thinking about the situations that elicit them.^[13] Short-sighted habits that have become harmfully exaggerated over time, such as restricted breathing or other habitually assumed adaptations to past circumstances, will stop after learning to perceive and prevent them.

End-gaining

Another example is the term "end-gaining". This term means to focus on a goal so as to lose sight of the "means-whereby"^[14] the goal could be most appropriately achieved. According to Alexander teachers, "end-gaining" increases the likelihood of selecting older or multiple conflicting coping strategies. End-gaining is usually carried out because an imperative priority of impatience or frustration justifies it. Excessive speed in thinking and acting often facilitates end-gaining.

Inhibition

In the Alexander Technique lexicon, the principle of "inhibition" is considered by teachers to be the most important to gaining improved "use." F.M. Alexander's selection of this word predates the meaning of the word originated by Sigmund Freud. Inhibition, or 'intentional inhibition', is the act of refraining from responding in one's habitual manner - in particular, imposed tension in neck muscles (see Primary Control). Inhibition describes a moment of conscious awareness of a choice to interrupt, stop or entirely prevent an unnecessary habitual "misuse". As unnecessary habits are prevented or interrupted, a freer capacity and range of motion resumes and a more spontaneous choice of action or behavior can be discovered, which is experienced by the student as a state of "non-doing" or "allowing."

Primary control

This governs the normal or abnormal working of our postural mechanisms in relation to gravity from moment to moment, and there can be either a correct or incorrect employment of our "primary control" in every waking moment in reaction to the stimulus of living. The correct employment of the primary control involves a particular quality of head, neck, torso, and limb relationship as we respond to gravity and all life's stimuli. Our responses are influenced for good or ill by the qualities of head and eye direction at the inception of a reaction. A subtle projection of intention for the neck to be free, the head to flow forward and up, the back to lengthen and widen serves to counteract the common backward and downward pull of the head on the neck and shortening in stature that can often be detected at the beginning of every reaction to a stimulus from within or without—as seen particularly in the startle pattern. Students gradually learn to include a constant attention to their lengthening in stature as a basis for initiating and continuing an action, responding to stimuli, or remaining constructively at rest.

Directions

To continue to select and reinforce the often less dominant "good use", it is recommended to repeatedly suggest, by thinking to oneself, a particular series of "Orders" or "Directions." "Giving Directions" is the expression used for thinking and projecting the positive aspect of how one's self may be used in the most unified psycho-physical way as conveyed by the teacher's hands during a lesson. "Directing" is suggestively thought, rather than willfully accomplished, because the neuro-muscular responses to "Directing" often occur underneath one's ability to perceive how they are actually carried out neurophysiologically and neurocognitively. As freedom of expression or movement is the objective, the most appropriate responses cannot be anticipated, but are observed and chosen in the moment.

Psycho-physical unity

Global concepts such as "Psycho-physical Unity" and "Use" describe how thinking strategies and attention work together during preparation for an action or for withholding one. They connote the general sequence of how intention joins together with execution to directly affect the perception of events and the outcome of intended results.^[15]

Uses

The Alexander Technique is used and taught by classically trained vocal coaches and musicians. Its advocates state that it allows for a balanced use of all aspects of the vocal tract by consciously increasing air-flow, allowing improved vocal skill and tone. Because the method has been used to improve breathing and stamina in general, advocates also claim that athletes, people with asthma, tuberculosis, and panic attacks have found improvements. The method is said by actors to reduce stage fright and to increase spontaneity.^[16]

The Alexander Technique is a frequent component in acting training.^[15] According to Alexander Technique instructor Michael J. Gelb, people tend to study the Alexander Technique in an attempt either to rid themselves of pain, to increase their performance abilities, or for reasons of personal development and transformation.^[17]

Method

The Alexander Technique is most commonly taught privately in a series of 10 to 40 private lessons which may last from 30 minutes to an hour. Students are often performers, such as actors, dancers, musicians, athletes and public speakers, or people who work on computers, or who are in frequent pain for other reasons. Instructors observe their students, then show them how to hold themselves and move with better poise and less strain.^[18] Sessions include chair work and table work, often in front of a mirror, during which the instructor and the student will stand, sit and lie down, moving efficiently while maintaining a comfortable relationship between the head, neck and spine.^[19]

To qualify as a teacher of Alexander Technique, instructors are required to complete 1,600 hours, spanning three years, of supervised teacher training. The result must be satisfactory to qualified peers to gain membership in professional societies.^[11][20]

Health effects

Some advocates for the Alexander technique have claimed it can help people with many kinds of health conditions.^[5]

One example is a claim that it can benefit people with asthma. A document on the website, "The Complete Guide to the Alexander Technique", self-described as "the most comprehensive source for information about the Alexander Technique worldwide"^[21] states: "Could it be that asthmatics are particularly prone to constricting their nasal and throat passages when trying to take deep breaths? And could it be that this is caused by poor breathing habits, habits that may well have been learned in early childhood? If so, reeducation of the sort the Alexander Technique provides could make a huge difference in their lives."^[22] Two Cochrane reviews of the relevant literature, one in 2000^[23] and a follow up in 2012, stated that "no trials were found that met the selection criteria" and concluded that "robust, well-designed randomised controlled trials are required in order to test claims by practitioners that AT can have a positive effect on the symptoms of chronic asthma and thereby help people with asthma to reduce medication."^[24]

A review by Aetna last updated in 2016 stated: "Aetna considers the following alternative medicine interventions experimental and investigational, because there is inadequate evidence in the peer-reviewed published medical literature of their effectiveness." and included Alexander technique in that list.^[25]

A review published in 2015 and conducted for the Australia Department of Health in order to determine what services the Australian government should pay for, reviewed clinical trials published to date and found that: "Overall, the evidence was limited by the small number of participants in the intervention arms, wide confidence intervals or a lack of replication of results." It concluded that: "The Alexander technique may improve short-term pain and disability in people with low back pain, but the longer-term effects remain uncertain. For all other clinical conditions, the effectiveness of Alexander technique was deemed to be uncertain, due to insufficient evidence." It also noted that: "Evidence for the safety of Alexander technique was lacking, with most trials not reporting on this outcome. ^[4]

A review of evidence for Alexander Technique for various health conditions provided by UK NHS Choices last updated in July 2015 found that:

There's evidence suggesting the Alexander technique can help people with:

• long-term back pain – lessons in the technique may lead to reduced back pain-associated disability and reduce how often you feel pain for up to a year or more
• long-term neck pain – lessons in the technique may lead to reduced neck pain and associated disability for up to a year or more
• Parkinson's disease – lessons in the technique may help you carry out everyday tasks more easily and improve how you feel about your condition^[5]

NHS Choices also states that "some research has also suggested the Alexander technique may improve general long-term pain, stammering and balance skills in elderly people to help them avoid falls. But the evidence in these areas is limited and more studies are needed. There's currently little evidence to suggest the Alexander technique can help improve other health conditions, including asthma, headaches, osteoarthritis, difficulty sleeping (insomnia) and stress."^[5]

A review published in BMC Complementary and Alternative Medicine in 2014 focused on "the evidence for the effectiveness of AT sessions on musicians' performance, anxiety, respiratory function and posture" concluded that: "Evidence from RCTs and CTs suggests that AT sessions may improve performance anxiety in musicians. Effects on music performance, respiratory function and posture yet remain inconclusive."^[26]

A review published in the International Journal of Clinical Practice in 2012 found: "Strong evidence exists for the effectiveness of Alexander Technique lessons for chronic back pain and moderate evidence in Parkinson’s-associated disability. Preliminary evidence suggests that Alexander Technique lessons may lead to improvements in balance skills in the elderly, in general chronic pain, posture, respiratory function and stuttering, but there is insufficient evidence to support recommendations in these areas."^[27]

See also

• Psychomotor learning

References

Further reading

• Alexander, FM Man's Supreme Inheritance, Methuen (London, 1910), revised and enlarged (New York, 1918), later editions 1941, 1946, 1957, Mouritz (UK, 1996), reprinted 2002. ISBN 0-9525574-0-1
• Alexander, FM Constructive Conscious Control of the Individual, Centerline Press (USA,1923), revised 1946, Mouritz (UK, 2004) ISBN 0-9543522-6-2
• Alexander, FM The Use of the Self, E. P. Dutton (New York, 1932), republished by Orion Publishing, 2001, ISBN 9780752843919
• Alexander, FM The Universal Constant in Living, Dutton (New York, 1941), Chaterson (London, 1942), later editions 1943, 1946, Centerline Press (USA, 1941, 1986), Mouritz (UK, 2000) ISBN 0-913111-18-X, ISBN 978-0-913111-18-5, ISBN 0-9525574-4-4
• Brennan, Richard (May 1997). The Alexander Technique Manual. London: Connections UK. ISBN 1-85906-163-X. 
• Jones, Frank Pierce (May 1997). Freedom to Change; The Development and Science of the Alexander Technique. London: Mouritz. ISBN 0-9525574-7-9. 
• Jones, Frank Pierce (1999). ed. Theodore Dimon, Richard Brown, ed. Collected Writings on the Alexander Technique. Massachusetts: Alexander Technique Archives. ASIN B0006RIXCO.