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Quicksand in the Concert Hall

Publication date: 30 January 2013

Yesterday on Radio 4's the Today programme there was an item about coughing during classical concerts. Apparently these days it's much more common and bothers many performers and concert goers alike. Research shows that people cough twice as often during concerts compared to ordinary life. On reflection I didn't find that too surprising. What I did find surprising was how mystified everyone seemed to be about why it should be so.

Some rather silly explanations surfaced, such as unconscious attention seeking. I think the real explanation is rather more obvious. I come across similar things every day in my therapy practice, particularly in the context of working with biofeedback.

People go into the concert hall thinking to themselves, "try not to cough". If I say to you, "don't think about a pink elephant", what's the first thing that comes into your mind? Negatives such as "don't" are nearer the surface - relevant to the logical mind but less so to the unconscious mind.

I think a fundamental feature of the mind is that whatever thought or idea or image comes into your mind, a part of you asks - not necessarily consciously - "what would that feel like?" - and then part of you simulates the answer. This is quite helpful mostly - for example you're in a restaurant and you ask yourself, "should I order the frogs' legs?". But sometimes it's not so useful. If you have a fear of flying, and a month before your holiday you start thinking about getting on the aeroplane etc., then you don't have to wait to feel bad - you can have some of the fear there and then.

This simulation is something to do with the body. Emotions play themselves out in our body's physiology (in part). In anticipatory anxiety your heart speeds up, you have butterflies in your belly, etc.

Put these ideas together and you can start to see why people cough in classical concerts. In brief, the sequence is: 1. don't think about coughing, 2. (unconsciously) what would it feel like to cough? 3. focus goes to little signs, looking out for a tickley throat, 4. this sort of imaginative attention amplifies whatever signs are there, making a cough more likely, 5. struggle against it and you're caught in a kind of mental quicksand that makes the cough irresistible.

Biofeedback is really useful in therapy because it really shows up the nature of mind in this way - especially the mind-body connection. The therapist or coach draws attention to the bodily responses to even fleeting thoughts and images, creating awareness (mindfulness), which is the first step on the way to change. Learn to reverse or transform these bodily responses, and you take the heat out of worrisome thoughts.

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