Flow State: What Is It and How Can It Help My Lyme Disease?

By Celine Tien


Experiencing Flow State

The first time Kotler experienced flow state, his Lyme disease was at its lowest point. He felt he was a burden to his family and friends, he was lucid for half an hour a day, and he could barely get out of bed.

One day, his close friend came over to his house and forced him to surfing with them. That day, Kotler needed his friends to carry him out to the water just to catch a two feet high wave. He had the immense privilege of surfing before, but it had been years since he could drive to a beach or get on a board. 

Within thirty seconds of catching the first wave, Kotler recalled, “I popped up into an entirely new dimension. I’m standing on my board and I’ve got near panoramic vision. Time has slowed down and most importantly, I felt great. I feel better than I’ve felt in three years. My muscles don’t hurt. I’m clear headed.” Kotler would later come to understand that experience as flow state. While most people do not have the chance to surf, Kotler would also come to understand that the mental and physical state he was in while surfing could be generated in more accessible ways. 

Kotler began to take part in activities, even from home, where he could consistently generate flow state. Over the course of about six months, Kotler said he went from 10% functionality up to about 80%.  

Today, Kotler is a bestselling author, a Pulitzer Prize nominated journalist, and one of the world’s leading experts on peak performance. And Kotler credits his health today to one life-changing mental and physiological experience: flow state.

What is Flow State? 

Flow state, or flow, is when you are simultaneously relaxed and focused. It is a mental and physical state many describe as “in the zone.” In flow,  you are completely engaged with the activity at hand and the activity is rewarding in of itself. It feels timeless. 

Flow state was first named by psychologist Mihaly Csikszentmihalyi in 1975, although the concept of flow state has existed under various names throughout history. Csikszentmihalyi first began his research into flow state when he worked to characterize a mental and physical state he had observed in artists who would become so immersed in their work, they often disregarded their need for food, water and sleep.

In these artists, Csikszentmihalyi began to hypothesize that for the most part, people are able to decide what they want to focus their attention on. However, when an individual is in flow state, they are completely engrossed with the task at hand such that they can lose awareness of external thing such as people, time, distractions, and perhaps even things like pain and anxiety. 

We have now come to study the cognitive science of flow state under the rubric of ‘effortless attention’ since Csikszentmihalyi’s pioneering research in the 1980s. 

How Can Flow State Be Helpful?  

Simply put, flow just feels good. Studies show flow can put your mind and body into a drug-less state of ecstasy. It has the ability to feel so good because it can:

  • Quiet your mind
  • Relax you
  • Generate dopamine
  • Focus you

To understand how powerful flow is, we need to first understand your Autonomic Nervous System (ANS). Your ANS is made up of two primary branches: your sympathetic system (fight, flight, or freeze mode) and your parasympathetic system (rest, digest, and recover mode).

Both ANS branches are absolutely necessary. Your sympathetic system helps to alert you to threats and engage your body so you can respond to those threats (ex. quickened heart rate, increased sweating, etc.) On the other hand, your parasympathetic system turns on to allow your body and mind to relax, recover, and even digest food after meals.

The majority of people with chronic autoimmune conditions have trouble regulating the two branches of the ANS. Oftentimes, the chronic condition patients we work with live at a near constant “fight-or-flight” mode because their body engages their sympathetic system to combat the pain they experience or anticipate experiencing, and then cannot re-engage their parasympathetic system to rest and recover. 

You’ll notice that flow creates a perfect balance between “relaxation” and “focus” which means when your body is in flow state, it can generate just enough arousal from the sympathetic system to focus, while simultaneously engaging your parasympathetic system such that you’re feeling relaxed and restored. This balance between the two branches of the ANS can allow an individual to enter a mental and physical state where they can better manage anxiety, increase overall functionality, and increase sleep quality. 

As Kotler says, “For a person [like me] with a chronic autoimmune condition like Lyme, your nervous system is going crazy. Flow resets the nervous system back to zero. It calms it back down.”

How Do you Engage Flow? 

There is a common misconception that flow state can only occur spontaneously. In fact, there are two tried and true methods for generating flow state for an individual.

The first method is to engage in an activity you are passionate about. For many people, engaging in an activity they love can move their mind and body into flow. An example would be Kotler’s activity of choice: surfing. Other examples might be writing, coloring, baking, playing basketball, playing tennis, video gaming, and more. 

Individuals have reported that even knitting once a day can help generate flow, making them utterly focused yet relaxed while completely absorbed with the act of knitting itself.

However, it is notable that this approach is a less certain method for entering flow on command. While engaging in an activity you’re passionate about can be rewarding, the circumstance around the activity and extraneous factors can prevent an individual from experiencing flow state. 

The second method for achieving flow state is more consistent: Heart Rate Variability (HRV) biofeedback. Biofeedback is the ability to see what your body is doing in real-time and then learning how to change it.

Heart Rate Variability (HRV) biofeedback specifically focuses on teaching an individual to increase your HRV. HRV is the measure of the variance in time between heartbeats. HRV can be very complicated but the most important thing to know is that HRV biofeedback can directly affect an individual’s nervous system. 

In fact, an increased HRV can force an individual’s body to activate their parasympathetic system, their “rest, digest, and recovery” mode, to then lead them towards flow state. This can be powerful because HRV biofeedback becomes a tool to train your body to move into flow state on command. 

In traditional HRV biofeedback, you put on a heart rate sensor and you are able to see your real-time heart rate graph on a computer in front of you. A specialist is then able to walk you through various relaxation exercises and how you how your heart rate graph starts to change in front of you. 

With consistent practice, you learn how to change your graphs on your own and subsequently auto-regulate your nervous system. 

Biofeedback is traditionally hard to access because it requires facilities that support biofeedback equipment and a specialist to conduct the biofeedback training with you. However, new technology now enables you to do biofeedback at home. 

Furthermore, there is now research that shows biofeedback can be made more effective while done in Virtual Reality. Doing biofeedback in VR can be powerful because it intuitively teaches you the biofeedback in an immersed and focused environment. 

For example, you can now wear a VR headset at home, and be transported to a VR environment where it feels like you are sitting on the beach with the night sky and Aurora Borealis above you. At the same time, you’re wearing a Bluetooth heart rate sensor that clips onto your ear. In the VR beach environment, you will see your real-time heart rate graph. Then through a calibrated breathing guide and voice-over, an individual will be guided towards increasing their HRV, activating their parasympathetic system, and into a flow state. As your HRV changes, the world around will change: the Aurora Borealis will become more colorful and bright, and constellations will form in the sky. 

My team and I research and develop a mobile app that does just this: teach individuals with chronic conditions such as chronic pain, autoimmune diseases like Lyme, and generalized anxiety disorder, how to experience flow state through Virtual Reality and biofeedback at home. 

While Virtual Reality powered biofeedback training can be advantageous for some individuals, visual symptoms such as blur, diplopia, photophobia, and visual fatigue can be a crucial factor in deciding whether to pair HRV biofeedback with Virtual Reality because VR requires close proximity between the eyes and light emitted from the VR experience. While we observed most chronic condition patients in our case studies opt for the VR experience, we observed Lyme patients who opted to do HRV biofeedback just on the phone at an increased distance from the eyes. 

Today, Flowly: relaxation training is accessible on the Apple App Store, and all membership types include a Virtual Reality headset and Biofeedback Sensor shipped to an individual’s home, with the added option of doing all HRV biofeedback sessions not in VR (just on the phone). 

Flowly has gone through case studies conducted at the Good Samaritan Hospital in Los Angeles, Phase I controlled clinical trials at the University of Pittsburgh Medical Center and researched at the University of Southern California. Flowly is backed by the National Institutes of Health and the National Institute of Drug Abuse. 

There are various ways to tap into flow state outside of Flowly including the first method, experimenting and identifying an activity in which you can most consistently experience flow state. Most importantly, give yourself the time to explore various ways to tap into flow state. Understanding how to manage your nervous system is all about meeting your body where it’s at.

Celine Tien is the founder of Flowly: relaxation training, an NIH-backed mobile platform that combines Virtual Reality and biofeedback training to help individuals transition from pain state to flow state. Tien is also Principal Investigator on NIDA-backed clinical trials at the University of Pittsburgh Medical Center and USC.