Smile Anatomy: Emotional Self Regulation and Facial Expression Muscle Measurement and Training

Paul Ekman told professional actors and actresses to make emotional faces, one muscle group at a time. This way, the instructions didn't cue the actors to the kind of face formed. They weren't told to make a happy or frightened face, but rather, to move their facial muscles in specified patterns, ie.; pull the brows together, pull the mouth back horizontally, raise the upper eyelids, etcetera. Ekman found that different facial expressions produced different physiological response patterns. Just combining facial muscle activity patterns could produce predictable heart rate and hand temperature increases or decreases. Synthetic faces seemed to illumine the whole body with emotion-appropriate patterns of physiological activities.

In one study, military veterans with spinal cord injuries reported decreased experience of emotion after their injury. The more extensive the spinal cord damage and resultant greater loss of body sensation, the greater was their loss of their ability to feel emotion. Patients described their feelings as cold, as mental rather than feeling and emotional.

"But I can't make a fake smile," so many people respond when asked to turn on a fake or synthetic smile. I tell them to do it anyway! The goal of emotional self regulation is to teach individuals to learn to find their own buttons for activating the patterns of good feelings built into their nervous system. The other side of the coin is the need to identify how they inhibit good feelings. I explain to patients, that when we create a synthetic smile, we usually experience feelings that flicker between the real; "feeling-good" and; "I'm just faking this and I feel silly or stupid" feelings. The reason we can actually switch to feeling genuinely good just by creating a synthetic smile is response pattern activation. The activation of facial muscle patterns usually genuinely associated with good feelings actually facilitates the turning on of the real thing--a feeling-good, conditioned response.

New patients often resist instructions to smile. They resist, saying: "I can't smile," "I don't want to smile," "It feels silly," or "strange" or "It doesn't feel real so I don't want to do it."

I ask one to smile and he says he can't. I pause, allowing the silence to grow pregnant, then nod my head with a whimsical smile and ask, "C,mon. You can't smile?" I knit my brow, perplexed. "Do you have a neurological deficit?

No? Then you don't want to smile?"

My patients appear annoyed, as though they were about to say, "Leave me alone. I don't want to smile." But they do want to smile. My little pre-schooler acts the same way when he's miffed. I joke with him and he flickers between laughing, smirking and frowning. The patients are stuck in old patterns of inhibition that prevent them from opening up to good feelings when they want to.

It's so common for people to be uncomfortable expressing their feelings. John Perry describes how anorgasmic women are comfortable having orgasms masturbating with their legs closed, but become anxious when they spread their legs.

He teaches them to masturbate with their legs spread so they become comfortable with the position.

Here's how I work with smile resisting patients: I suggest, "You do want to smile, don't you? Let me show you how."

At that point, I demonstrate an exagerated smile. Or I'll tell a joke or threaten tickling (if it's a group.) So far, this effort has never failed. Every patient smiles and usually laughs spontaneously. Part of the reason my little trick works is because there are two nerve pathways which control the smile and other facial expressions. The upper nerve pathway is connected to the gray matter motor cortex of our brain. When we decide we want to smile and think "smile," then the motor cortex activates our smile via the upper nerve pathway. Stroke patients with damage to their motor cortex lose the ability to voluntarily turn on a smile, though some smile rehabilitation physical therapy can help.

But even after a stroke, patients with the lower smile pathway still intact will reflexively smile in response to something funny or ticklish, because the lower pathway is connected to the lower part of the brain, where emotions are mediated and where the stress and emotion mediating sympathetic nervous system is controlled. I get my patients to smile and laugh by bypassing their voluntarily or subconsciously disconnected upper smile pathway. I've tickled their lower smile pathway into activation by turning on synthetic smiles that activate the PE physiological response pattern, allowing them to feel the real thing.

The smile response pattern activation proves to my patient he can smile. When he sees my exagerated,smile, an image of a smile is formed in his brain. This smile image helps to animate or rouse his own smile-conditioned response pattern homunculus and to facilitate the lower pathway smile response pattern. The image functions like a template or behavioral "mold," shaping and helping the release of his feeling-good response, even though the patient had been stuck, inhibiting it a moment earlier.

Some patients are feeling so bad, they say they don't want to or can't smile. Then, smile biofeedback can be useful. Patients use zygomaticus EMG feedback to tell them what strategies help to boost their smile muscle strength and boost the EMG amplitude.

They learn to voluntarily create a genuine smile that helps them let go of their positive experience inhibiting behaviors. The concrete, muscle strength oriented feedback helps them to strengthen their smile reflex without initially expecting wonderful feelings. Over and over again, we've found in our research that people, when asked to smile as strong as they can, work and strain to make a smile. Sometimes, in their beginning efforts to intensify their smiles, they screw their faces into distorted smiles, very artificial in appearance (just as other physical therapy patients suffer from unwanted co-contraction of antagonist muscles). We crack some jokes, kid around. Making any feeling good sound, like laughter, humming, cheering, seems to strengthen the smile activity. When we coax them into laughing, the smile comes effortlessly with the help of the lower motor neuron pathway, and is 20% to 100% stronger than the strained effort. This approach actually teaches feeling relaxation-- the ability to stay relaxed and comfortable while feeling deep emotions.

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