Chasing Masculinity: Why It Hurts Sometimes

In my work, I have regularly come across young men trying to counter feelings of personal failure with attempts at (and these quotes are their words, not mine) “becoming alpha,” “building swag,” and “gaining clout.” You may have guessed (correctly) that I work with young adults. By this, they often mean that they are trying to embody that elusive image of masculinity. You can probably conjure up an idea of what that image looks like: it involves suppressing emotion, solving problems without help, being successful, and acting aggressively if needed (Jansz, 2000). Despite that initial hope many young men have that those qualities will help them, we know from the research that trying to conform to traditional male gender roles is actually related to more psychological distress (Hayes & Mahalik, 2000; Houle, Mashara, & Chagnon, 2008; Liu, Rochlen, & Mohr, 2005; Moller-Leimkuhler, 2003). Men who try to force themselves to stick to traditional gender roles are more likely to be reluctant to seek help and to struggle with expressing emotion, which can lead to difficulty admitting when they are in distress (Moller-Leimkuhler, 2003). In other words, they may not know how to talk about what’s going on for them, so they bottle up their emotions and suffer silently. Because of this reluctance to seek help and lean on the people in their lives, trying to conform to a traditional male gender role can increase the risk of suicidal behaviour (Houle, Mashara, & Chagnon, 2008). When we consider the research, we see that young men often experience a gender-specific pressure to conform to traditional masculinity, and that pressure can cause stress, worry, confusion, and misery.

The important takeaway is not that masculinity is harmful, but rather it can be harmful to mental health if someone is struggling silently for fear of appearing less masculine to others

The important takeaway is not that masculinity is harmful, but rather it can be harmful to mental health if someone is struggling silently for fear of appearing less masculine to others. Perhaps surprisingly to many people, research shows that men with high self-compassion are actually better able to adhere to masculine norms without internalizing shame or self-criticism for engaging in behaviours they view as less masculine (Health et al, 2017). In other words, when a man is self-compassionate, he is less concerned with whether self-compassion is considered masculine or not. He is more accepting of help when he needs it and acknowledges that mistakes and feelings of failure are a part of life, and understands that admitting either of these things does not legitimately threaten his masculinity. These qualities help him lead a healthy and balanced life. Luckily, self-compassion is a skill that can be developed through time, effort, and practice.

When a man is self-compassionate, he is less concerned with whether self-compassion is considered masculine or not. He is more accepting of help when he needs it and acknowledges that mistakes and feelings of failure are a part of life, and understands that admitting either of these things does not legitimately threaten his masculinity.

Building up self-compassion is one way of strengthening ourselves against the onslaught of external pressures that threaten our mental health. Self-compassion refers to viewing both positive and negative experiences as opportunities for growth and learning. It involves relating to yourself in a kinder way, understanding that failure and setbacks are a part of life, and recognizing your feelings and where they’re coming from. Self-compassion is a buildable skill that has been shown to improve mental health (Neff, Kirkpatrick, & Rude, 2007; Neff & McGehee, 2010) and help with motivation for our goals (Sirois, Kitner, & Hirsch, 2015). Part of the reason self-compassion is helpful to mental health is because it helps us become more self-accepting and view our weaknesses with less harsh criticism (Neff, Kirkpatrick, & Rude, 2007). When we are self-compassionate, we acknowledge our weaknesses but instead of trying to hide them away, we actively seek to learn from them or improve them because that's what will be helpful to us.

On that note, here’s a question I often hear about self-compassion: “I don’t want to accept myself. If I accept my mistakes, doesn’t that mean that I’m just being complacent and letting myself off easy? How do I improve myself if I just accept myself how I am?” First, it’s important to realize that this is a misconception. Self-compassion isn’t about letting yourself off easy, sometimes it’s actually about doing the more difficult thing because you know it’s better for you. Self-compassion is about acknowledging where you went wrong and committing to improvement for the future. Some people misguidedly assume that self-criticism will be the motivation they need to do better, but let’s look at an example. Imagine you’ve been planning on feeling healthier but get tempted by the donut in the lunchroom. If you beat yourself up for that decision and think to yourself “I’m useless. I don’t stick to any of my plans. I just ruined everything.” it’s likely that you’ve started down a self-critical spiral. Those self-critical thoughts lead to a depressed mood, and there goes your motivation to eat healthy for the rest of the day. Now imagine instead you try to take a self-compassionate approach. You think to yourself, “I regret that choice, but it happens. It’s not a big deal. I won’t lose all my progress if I just keep things balanced and make healthier choices the rest of the day.” That self-compassionate attitude may be enough to stop your motivation from crashing. Ideally, that attitude can carry on the next day, when you know the self-compassionate thing to do is to resist the unhealthy snacks because, as good as it would taste in the moment, you know it would upset you based on the health goals you’ve set for yourself. The self-compassionate thing isn’t the easy thing, it’s the what’s best for you thing.

"I’ve basically been taught not to share my feelings, so it makes sense that a lot of the time I feel like I can’t reach out to other people. It’s okay that I feel uncomfortable with the idea of talking to a friend about what I’m dealing with, in fact a lot of people feel the same way I do. At the same time, I know talking to people helps, and I know I deserve that help."

Let’s circle back to self-compassion and that gender-specific pressure to conform to traditional masculinity. So, what does self-compassion sound like for someone who is struggling with these issues? It could sound like “I’ve basically been taught not to share my feelings, so it makes sense that a lot of the time I feel like I can’t reach out to other people. It’s okay that I feel uncomfortable with the idea of talking to a friend about what I’m dealing with, in fact a lot of people feel the same way I do. At the same time, I know talking to people helps, and I know I deserve that help.” Self-compassion could look like texting that friend, calling that help line, or booking that counselling session. There’s hundreds of examples of what self-compassion could sound like or look like. And hey, if you think that could never and will never be you, let me tell you that reading an article on ways of showing yourself self-compassion is you being self-compassionate. References Hayes, J. A., & Mahalik, J. R. (2000). Gender role conflict and psychological distress in male counseling center clients. Psychology of Men & Masculinity, 1, 116-125. doi:10.1037/1524-9220.1.2.116 Heath, P. J., Brenner, R. E., Vogel, D. L., Lannin, D. G., & Strass, H. A. (2017). Masculinity and barriers to seeking counseling: the buffering role of self-compassion. Journal of Counseling Psychology, 64, 94-103. doi: 10.1037/cou0000185

Houle, J., Mashara, B. L., & Chagnon, F. (2008). An empirical test of a mediation model of the impact of the traditional male gender role on suicide behavior in men. Journal of Affective Disorders, 107, 37-43. doi: 10.1016/j.jad.2007.07.016

Liu, W. M., Rochlen, A., & Mohr, J. J. (2005). Real and ideal gender-role conflict: Exploring psychological distress among men. Psychology of Men & Masculinity, 6, 137-148. doi:10.1037/1524-9220.6.2.137 Möller-Leimkühler, A. M. (2003). The gender gap in suicide and premature death: Why are men so vulnerable? European Archives of Psychiatry & Clinical Neuroscience, 253, 1-8. doi:10.1007/s00406-003-0397-6 Neff, K. D., Kirkpatrick, K. L., & Rude, S. S. (2007). Self-compassion and adaptive psychological functioning. Journal of Research in Personality, 4, 139-154. doi: 10.1016/j.jrp.2006.03.004

Neff, K. D., & McGehee, P. (2010). Self-compassion and psychological resilience among adolescents and young adults. Self & Identity, 9, 225-240. doi: 10.1080/15298860902979307 Sirois, F., Kitner, R., & Hirsch, J. (2015). Self-compassion, affect, and health-promoting behaviors. Health Psychology, 34, 661-669. doi: 10.1037/hea0000158

Take a SHALLOW breath: can we improve asthma through breathwork?

Could we be breathing better? All of us are familiar with the idea of taking a deep breath. We’re told to do it when stressed, anxious, angry, or overwhelmed. I have even written a previous blog post about the science behind deep breathing and the mechanisms by which it helps calm the body (spoiler: it’s the extended exhale that matters, not the inhale). Much more rarely, however, have we been told to take a shallow breath. A number of research studies out there seem to be highlighting the benefits of shallow nasal breathing, so let’s delve into the research for a more comprehensive understanding.

Why is Nasal Breathing Better?

The Short:

Our bodies are built to breathe through our noses, and the production of nitric oxide is stimulated when we inhale and exhale through our nose.

The Simple: Unlike the mouth, breathing through the nose filters, humidifies, and warms air. When we breathe through our nose, we are helping clear our air pathways of dust, allergens, and bacteria. That’s why breathing through our nose instead of our mouth is the first defense against infections like covid19. If that wasn’t enough to make you think twice about your breathing, mouth breathing is also associated with more throat infections and cases of gingivitis¹.

The Science: Nitric oxide plays a key role in the beneficial effects that come from nasal breathing. It is produced in our paranasal sinuses and its production is stimulated by nasal breathing. When we breathe through our nose, our nose produces nitric oxide. The people that breathe through their mouth have been shown to have less nitric oxide in their airways². Here’s why nitric oxide is important: it stimulates mucus secretion which increases removal of dust and viral particles from our airways, it produces antimicrobial effects against bacteria and viruses, and it can actually help inactivate viruses by modifying their ability to reproduce³. Nitric oxide also helps to deliver more oxygen to tissues in our body, so when we are breathing through our noses, we are actually helping send oxygen to faraway tissues in our body.

Why are “Mouth Breathers” so common right now?

The prolonged use of face masks during the covid-19 pandemic may actually be responsible for converting some of us from nose breathers to mouth breathers. Studies have noted wearing facemasks can actually alter our normal breathing pattern⁴ ⁵. That said, there’s not enough research out there on this topic. It remains uncertain how many of us are actually mouth breathers, though pre-pandemic studies have reported numbers like 26% to 56% ⁶ ⁷ and there is a chance that it's higher following long term mask usage. Most of the studies that look at mouth breathing focus on children populations and state potential causes of mouth breathing to be adenoid issues, thumb sucking, chronic allergies, deviated nasal septums, excessive pacifier use, and nasal polyps ⁸. There just isn’t enough research out there on adult populations to draw any sort of conclusion as to why mouth breathing continues into adulthood, but regardless, we know it happens.

Does Nasal Breathing Improve Asthma?

An association between asthma and mouth breathing has been shown in the research with children, adolescents, and adults⁹, but there’s not enough evidence out there to clearly understand the link between them. That said, there has been research about improving asthma by switching from mouth breathing to nasal breathing, so we can see that the way we breathe has an important role in asthma.

One study found that shallow nasal breathing led people to use their inhalers less, and that using their inhaler less did not make their asthma worse¹⁰.

shallow nasal breathing led people to use their inhalers less, and using their inhaler less did not make their asthma worse¹⁰.

So in other words, nasal breathing helped people use their inhalers less and their asthma did not get worse from not using their inhaler regularly. The tricky part: Even though they were using their inhaler less, it wasn’t because their airways improved or their lung inflammation went down. There wasn’t a physiological improvement due to the breathing exercises. The researchers suggest that maybe participants were using their inhalers less because they didn’t need to inhale their full dose of corticosteroids anyway to manage their asthma, and that a lower dose is all that would be required to help their asthmatic needs. Either way, nasal breathing seems to have made people feel that their asthma is more manageable.

A study in 2008 took a different approach: it researched whether forced mouth breathing would decrease lung function in people with mild asthma. Lung function actually did decrease over time on days where participants were mouth breathing, and coughing and wheezing were more likely to happen, too¹¹.

Buteyko Breathing Method (AKA slow and shallow breathing)

The Buteyko method is a form of nasal breathing that is based on the premise that slow and shallow nose breathing improves asthma by inducing hypoventilation and raising blood carbon dioxide levels¹². Buteyko breathing makes use of control pause exercises and breath holding exercises to improve breathing. The idea behind it is that asthma is related to hyperventilation that causes chest tightening (bronchospasm) and mucus build up (accumulation of secretion). The goal of Buteyko breathing then is to improve these two things by normalizing blood carbon dioxide levels through smaller inhalation and exhalations (called reduced-volume breathing).

Here’s an example of a control pause exercise that’s used in Buteyko breathing to evaluate breathing health. The below exercise is adapted from a study at Mansura University¹³.

​1. Sit upright with good posture.

2. Take a small breath in (2 s) and a small breath out (3 s). Hold nose after the “out” breath, with empty lungs but not too empty.

​3. Count how many seconds you comfortably last before the need to breathe in again.

4. Release the nose and breathe in through it. This breath should be no greater than the breath prior to taking measurement. Pausing too long could cause you to take too big of a breath after the measurement.

Here’s an example of a breath holding exercise that’s used in Buteyko breathing, adapted from the same study.

1. Place a finger under your nose, just above your top lip, close enough to your nostril that you can feel airflow.

2. Breathe air slightly into tip of the nostril. Imagine the finger is a feather that you don’t want to move when you exhale.

3. The more warm air you can feel, the bigger you are breathing. Concentrate on calming your breath to reduce the amount of warm air on your finger.

4. Maintain this shallow nasal breathing for 4 minutes.

Here’s how you’d put them together, adapted from the same study.

1. Reduce breathing for 4 min. Wait 2 min and take Control pause. Reduce breathing for 4 min. Wait 2 min and take Control pause.

The Mansura University study found that these Buteyko breathing exercises (practiced daily for four weeks) improved asthmatic symptoms, peak expiratory flow rate, and improved performance on a pulmonary function test. Another study found that a group of participants who had been trained in Buteyko breathing saw an 85% reduction in rescue inhaler use and a 50% reduction in regular inhaled steroid use even at 6 month follow up¹⁴.

---

Here's the "Too Long; Didn't Read" of it:

• Nasal breathing filters, humidifies, and warms air. It clears our air pathways of dust, allergens, and bacteria and sends oxygen to tissue in our body. Mouth breathing does NOT have these positive effects.
  

• We can become better nasal breathers through practice.
  

• Nasal breathing improves asthma and sleep quality.
  

• The Buteyko Breathing method has been shown to significantly improve scores on lung function tests, decrease asthmatic symptoms, and improve physical performance.
  

• More studies in this area are needed, but for now the outcomes look promising.

---

References

Abreu, R. R., Rocha, R. L., Lamounier, J. A., & Guerra, Â. F. M. (2008). Prevalence of mouth breathing among children. Jornal de Pediatria, 84, 467-470.

Akturk, E. S., Aydin, I., & Seker, E. D. (2022). The effects of mask usage during the COVID-19 pandemic on temporomandibular joint. Clinical Oral Investigations: preprint.

Araújo, B. C. L., de Magalhães Simões, S., de Gois-Santos, V. T., & Martins-Filho, P. R. S. (2020). Association between mouth breathing and asthma: a systematic review and meta-analysis. Current Allergy and Asthma Reports, 20(7), 1-10.

Bruton, A., & Thomas, M. (2011). The role of breathing training in asthma management. Current opinion in allergy and clinical immunology, 11(1), 53-57.

Fricker, J., Kharbanda, O. P., & Dando, J. (2013). Orthodontic diagnosis and treatment in the mixed dentition. In Handbook of Pediatric Dentistry (pp. 409-445).

Hallani, M., Wheatley, J. R., & Amis, T. C. (2008). Enforced mouth breathing decreases lung function in mild asthmatics. Respirology, 13(4), 553-558.

Martel J, Ko YF, Young JD, Ojcius DM. Could nasal nitric oxide help to mitigate the severity of COVID-19? Microbes Infect. 2020 May-Jun;22(4-5):168-171. doi: 10.1016/j.micinf.2020.05.002.

Martins, D. L. L., Lima, L. F. S. C., de Farias Sales, V. S., Demeda, V. F., da Silva, A. L. O., de Oliveira, Â. R. S., & Lima, S. B. F. (2014). The mouth breathing syndrome: prevalence, causes, consequences and treatments. A literature review. Journal of Surgical and Clinical Research, 5(1), 47-55.

McHugh, P., Aitcheson, F., Duncan, B., & Houghton, F. (2003). Buteyko Breathing Technique for asthma: an effective intervention. Journal of the New Zealand Medical Association.

Mohamed, E. M. H., ELmetwaly, A. A. M., & Ibrahim, A. M. (2018). Buteyko breathing technique: a golden cure for asthma. American Journal of Nursing, 6(6), 616-624.

Opat, A. J., Cohen, M. M., Bailey, M. J., & Abramson, M. J. (2000). A clinical trial of the Buteyko breathing technique in asthma as taught by a video. Journal of Asthma, 37(7), 557-564.

Slader, C. A., Reddel, H. K., Spencer, L. M., Belousova, E. G., Armour, C. L., Bosnic-Anticevich, S. Z., ... & Jenkins, C. R. (2006). Double blind randomised controlled trial of two different breathing techniques in the management of asthma. Thorax, 61(8), 651-656.

Törnberg, D. C. F., Marteus, H., Schedin, U., Alving, K., Lundberg, J. O. N., & Weitzberg, E. (2002). Nasal and oral contribution to inhaled and exhaled nitric oxide: a study in tracheotomized patients. European Respiratory Journal, 19(5), 859-864.

Triana, B. E. G., Ali, A. H., & León, I. G. (2016). Mouth breathing and its relationship to some oral and medical conditions: physiopathological mechanisms involved. Revista Habanera de Ciencias Médicas, 15(2), 200-212.

Verma, S. Mouth Mask: A Blessing Or A Curse For Oral Health. Journal of Prosthodontics Dentistry.

Positive Affirmations: Powerful and Underused

My body and my mind are strong and powerful. Noise and distractions fade into silence. I am perfectly capable of getting this done. I breathe with control, slowly and gently. –These are just a few examples of “self-talk” that are positive affirmations: statements we think (or say) to ourselves designed to help us build an optimistic mindset¹. Consider those affirmations and notice they could be used by an athlete before a game, a student before a presentation, a person exercising, and even a mother in labor. In fact, there’s research showing affirmations like these are helpful in every single one of those scenarios.

The Goal of Affirmations? To steady the mind and body by talking to ourselves positively and intentionally. The Science of Affirmations? It works! (We’ll get into this). The Problem with Affirmations? Most of us are guilty of thinking that these kinds of statements are “cheesy, “corny,” or “unhelpful” and so we don’t harness their power as often as we could- and I’ll be so bold as to add, as often as we should.

---

How Positive Affirmation Helps the Body and the Brain:

Positive self-affirmation has been linked to better academic performance², sports performance, health³, and emotional well-being⁴. Basically, self-affirmation helps get us into the right state of mind to take on challenges. As just one example, it can help athletes keep themselves calm, cool, and collected in the face of game day stress⁵. As an example for students, positive affirmation has been shown to help them feel less anxious and more capable before presentations⁶.

Biofeedback: Our thoughts can easily cause bodily changes. Just think of how when stuck in traffic worrying about arriving late, your pulse and heartrate quicken. Lots of studies have echoed that the power of the mind can create a change in our body. One such study used something called emwave HRV biofeedback (that monitors heartrate) to show that positive affirmation practice for 5 minutes a day over 4 weeks reduced anxiety before class presentations⁷.

The takeaway? A small daily exercise like listening to a guided affirmation video can literally change the way you handle life.

fMRI Technology: Neuroscience studies have discovered that brain activity in certain decision making areas of the brain actually increases during self-affirmation practice. Using fMRI technology to scan the brain, one study found that positive self-affirmation increased activity in the ventromedial prefrontal cortex region in the brain. Activity in that particular brain region made it more likely that people would engage in more positive behavior for their wellbeing following the self-affirmation practice⁸. What’s interesting is that it seems positive self-affirmation helps people approach stressful situations as challenging instead of threatening.

What’s interesting is that it seems positive self-affirmation helps people approach stressful situations as challenging instead of threatening.

A key difference is that challenges are to be overcome while threats are to be avoided. Those who practice self-affirmation feel more confident that they can handle stress, which in turn helps them do so⁹. We can see how this would be the case, because it makes a ton of sense that telling yourself every day you are capable and in control would make you feel more capable and in control. The athlete feels in the zone; the student knows they have it in them to give the presentation; the person exercising knows their body and mind is capable of persevering.

How Do I Practice Positive Affirmations?

In my practice, many young adults have told me that they find it devastatingly uncomfortable to say and repeat nice things to themselves. I often hear things like “I don’t want to get a big ego,” “It feels weird to talk to myself” and, most especially, “I don’t actually believe those things about myself.” In other words, self-affirmation feels threatening to them, and they don’t want to try it. So, the very thing that can help them cope better with threats also seems threatening! This is a normal reaction and, often, expected. Self-affirmation helps create an optimistic mindset, so if someone has a more pessimistic outlook, then it makes sense that optimism would feel threatening and uncomfortable. The easiest way to challenge yourself here would be to start slow, consider the science and evidence showing it’s helpful, and try to be open-minded about the process, saving your judgments and evaluations for after you’ve gained some firsthand experience.

---

Practical Exercises

Find Youtube Videos. Consider what challenge you’re facing: does it have to do with your health? Friends? Family? School? Work? Youtube is full of relaxing guided self-affirmation videos for all of the above. Find one you like and listen to it in a quiet comfortable space. You can do so while working on something else or while closing your eyes and relaxing. Even a 5 minute video here and there will help.

Search Spotify. Music and podcast apps also have many of these guided affirmation tracks available. If you prefer to listen rather than brainstorm your own affirmations, apps like Spotify are a great resource.

Write Them Down. Think of the challenge you’re facing and try to brainstorm a handful of positive self-affirmations. As you brainstorm, write them down. There’s lots of research out there about the connections between physically writing something down and processing it better in our mind. It helps us go from “passive” to “active”.

Create a Poster. If you’d rather read your affirmations, create a poster or print one off and hang it somewhere you can often see it, like a wall in your bedroom. Try to be intentional about reading it each day.

Recite Your Favorite Affirmations. When you do find a few affirmations that feel especially relevant to you (whether you heard them via video or brainstormed them yourself), practice repeating them to yourself a few times each day. The more you practice, the more fluid and normal it feels.

Build It Into Your Routine. Ideally, positive self-affirmation practice would become part of your regular routine. For example, listening to a guided video for 5 minutes every night before bed. Or as another example, writing down three positive affirmations every morning. Or, saying two positive affirmations aloud every morning in the mirror. However you decide to incorporate it into your schedule, making it part of a routine will help you stay consistent.

---

Affirmations for Focus and Learning:

Noise and distractions fade into silence

I am perfectly capable of learning

My mind was designed to learn and grow

I focus solely on the task at hand

Affirmations for Performance:

I breathe with control, slowly and gently

I am doing my best with what I know

My mind is still, my body is calm

I am flexible and open to change

I answer to the best of my abilities and move on

I pause, breathe, and take each challenge one at a time

Affirmations for Social Connections:

I am worthy of love and friendship

I build healthy and solid relationships with people

I make friends naturally with ease

I attract positive people into my life

I am welcoming new people into my life every day

---

References

Bakner, E., & Martin, N. (2016). Coherence monitoring with emwave biofeedback to decrease college student presentation anxiety. In International Journal of Exercise Science: Conference Proceedings (Vol. 8, No. 4, p. 26).

Baltzell, A., & Akhtar, V. L. (2014). Mindfulness meditation training for sport (MMTS) intervention: Impact of MMTS with division I female athletes. The Journal of Happiness & Well-Being, 2(2), 160-173.https://mindfulness4u.org/wp-content/themes/wbgxt77mjxrd20qcb0vp5129109/files/frontend/articles/pdf/v02i02/6.pdf

Blascovich, J., & Mendes, W. B. (2000). Challenge and threat appraisals: The role of affective cues. In J. Forgas (Ed.), Feeling and thinking: The role of affect in social cognition (pp. 59–82). Paris: Cambridge University Press.

Cohen, G. L., Garcia, J., Apfel, N., & Master, A. (2006). Reducing the racial achievement gap: a social psychological intervention. Science, 313, 1307– 1310.

Falk, E. B., O’Donnell, M. B., Cascio, C. N., Tinney, F., Kang, Y., Lieberman, M. D., ... & Strecher, V. J. (2015). Self-affirmation alters the brain’s response to health messages and subsequent behavior change. Proceedings of the National Academy of Sciences, 112(7), 1977-1982.

Harris, P. R, & Epton, T. (2009). The impact of self affirmation on health cognition, health behaviour and other health-related responses: a narrative review. Social and Personality Psychology Compass, 3, 962–978.

Lee, M. M., Turetsky, K. M., & Spicer, J. (2017). Cognitive, social, physiological, and neural mechanisms underlying self‐affirmation: An integrative review. Yale Review of Undergraduate Research in Psychology.

Rana, M. (2018) Positive affirmations and its benefits on psychological well-being. EDU WORLD, 5.

https://www.researchgate.net/profile/Ashok-Acharya-2/publication/348805443_EDU_WORLD_VOL_IXNO2/links/60111b89299bf1b33e2904f8/EDU-WORLD-VOL-IX-NO2.pdf#page=20