stress management techniques Strategies to Help You Relax and Tune In to Total Health Table of Contents

1 Before You Begin Using Skills

3 Using the Relaxation Skills Scripts

4 Autogenic Training

5 Autogenic Training Script

8 Body Scan

10 Body Scan Script

12 Diaphragmatic Breathing

14 Diaphragmatic Breathing Script

16 Inner Direction

16 Inner Direction Script

18 Present Moment Awareness

20 Present Moment Awareness Script

22 Progressive Relaxation

24 Progressive Relaxation Script

26 Quieting Response

26 Quieting Response Script

27 Relaxation Response

28 Relaxation Response Script

30 Shavasana

31 Shavasana Script Before You Begin Using Relaxation Skills

Relaxation skills can help you better deal driving or doing other things that need If you have any of these feelings while with and help you meet your healthy your full attention. You should always practicing these skills, just STOP. Open your living goals. The relaxation skills used in practice these skills in a safe setting. eyes and think about something neutral or this challenge are meant for adults 18 pleasant. If your thoughts or feelings upset years of age and older. 3. These skills should not replace your you after practicing the skills, talk with a doctor’s advice. Do not change your health care provider or other professional Make sure to read these guidelines before medicine or medical care routine trained to help with mental health. Some of you start practicing the relaxation skills. without first talking to your doctor or these may include: Most of the time, relaxation skills are safe. other health care providers. But there can be some risk. Please keep • Family doctors in mind: 4. Stop practicing the skills and talk with your doctor if you notice either of • Psychiatrists 1. Talk to your doctor before you start the following: • Psychologists using these skills to manage stress. This is very important if you have: • Pain you already have gets worse • Social workers • You notice a new type of pain • Mental health counselors • or any other chronic lung Follow your doctor’s advice about • Religious leaders/counselors condition or breathing problem managing your pain and whether it is okay • Heart disease (the muscle or blood for you to use these skills. vessels of the heart don’t work 5. You may have thoughts or feelings well); conditions include coronary while you practice the skills or after artery disease, heart failure, you stop. Often these thoughts and abnormal heart rhythms, and heart feelings can be helpful. But sometimes valve problems they can be hard to handle. Practicing • Abuse or trauma in your past these skills might cause you to feel: • Any other mental or physical health • Anxious problem that you think may be • Worried affected by practicing these skills • Nervous • Been diagnosed with, are taking • Emotionally upset any medication for, or are receiving other treatment for , , or other mental, emotional, or behavioral problems 2. Always give your full attention to practicing the skills. Set a time when you do not have anything else to do. Do not practice the skills while you are

2 Techniques Using the Relaxation Skills Scripts

Use the relaxation skills training scripts Below are some tips for recording the in whatever way feels comfortable for relaxation skills scripts. you. When you are ready to practice a skill, you can: 1. Speak in a relaxed voice. 2. Pause for 2-3 seconds at each • Read through it with pauses: ellipsis (“…”). Read through the script yourself. 3. Pause for 4-5 seconds between Pause to experience the imagery after each . each paragraph. Pauses longer than 5 seconds are shown in bold • Have someone read it to you: text in the scripts. Have someone read the script to you, pausing for 2-3 seconds at Use background music if you’d like. each ellipsis (“…”) and for 4-5 Volume should be loud enough that the seconds between each paragraph. music can be clearly heard, but not so Pauses longer than 5 seconds are loud that it competes with or drowns shown in bold text in the scripts. out the voice on the recording. • Record the script: You or a friend or family member can record the script. Then you can practice the lesson whenever it’s convenient for you.

Autogenic Training

Autogenic Training is one of the most As you practice this relaxation skill, you When you’re ready to begin practicing thoroughly researched and widely used will experience sensations of heaviness this lesson, you can sit in any relaxation skills. The term autogenic, and warmth. Heaviness is a sign that comfortable chair. Sit a bit forward or self-generating, refers to how your muscles are relaxing, and warmth from the back of the chair so that you your mind can influence your body indicates that blood is flowing into your feel balanced. Put your feet on the floor to balance the physical systems that limbs. Both sensations are positive with your legs slightly spread apart at control circulation, breathing, and heart signs of relaxation. Occasionally, these a comfortable distance. Sit up straight rate. Autogenic Training is a relaxation sensations might involve tingling or with your shoulders dropped so you skill that focuses on breathing and mild twitching. This is normal and don’t feel stiff, and let your arms hang on feelings of heaviness and a sense will eventually stop as you continue comfortably at your sides. Overall, you of warmth in the limbs. With regular to practice this relaxation skill. If should feel comfortably balanced on practice of this skill, you can learn you feel discomfort at any time, stop your chair, so make any subtle shifts in to induce a state of deep physical immediately. You should not feel any your posture to help you experience an and mental relaxation that promotes discomfort or pain while practicing inner balance. the body’s natural balancing and this skill. If for any reason you feel like normalizing functions. People report stopping the process at any time, you deep muscular and psychological can simply return your attention to the relaxation and relief from tension when outside world. using this skill successfully.

4 Stress Management Techniques Autogenic Training Script

Seated comfortably, gently roll your in your mind as you repeat to yourself Your body feels peaceful and tranquil. head in a half circle in front of you. 3 times, “My breathing is rhythmic and You are relaxed. Concentrate now on Slowly roll your head from side to side smooth…my breathing is rhythmic and your right arm and hand and say to a few times to release tension in your smooth…my breathing is rhythmic yourself 3 times, “My right arm and neck and jaw. Then bring your head up and smooth.” Take 3 or 4 deep hand feel heavy and warm…my right to face forward. Take in a moderately breaths…drawing air down into your arm and hand feel heavy and warm… deep breath, drawing the air deep into abdomen…then breathe regularly. my right arm and hand feel heavy and your abdomen. You should feel your warm.” Imagine the sun shining on stomach area expand as you inhale. The length of your in breath and your arm and hand. Feel the warmth Then, slowly release the breath. out breath should be equal and spreading through your arm and hand comfortable. As you relax, your as they grow heavier and heavier. Concentrate on your breathing, which breathing will become slower, smoother, should be smooth and rhythmic, with and more rhythmic. Allow any tension to gently flow like your in breath equal to your out breath. water…from your right arm to your Imagine that your breaths are like With each breath, feel relaxation left arm. waves lapping at the shore. Allow your washing over you like waves. Imagine eyes to close gently, whenever you feel the waves washing over your feet and Concentrate now on your left arm and ready. Keep this image of the waves legs. Feel the waves cover your arms, hand and say to yourself, “My left arm your neck, and your head. Your arms, and hand feel heavy and warm…my left legs, and feet feel heavy and warm. arm and hand feel heavy and warm… Feel the waves of relaxation sweep over my left arm and hand feel heavy and you. Feel your limbs growing heavier… warm.” Again, imagine the sun shining warmer. Your breathing is calm… on your arm and hand. Feel the warmth rhythmic…smooth. spreading through your left arm and hand as they grow heavier and heavier.

Autogenic Training Script continued...

At this point you are seated with your not clenched…your legs are relaxed. period of time. Imagine that the top arms hanging at your sides, letting You should feel relaxed all over, your of your head is tied to a balloon by a gravity do the work. Slowly and gently mind free from thought. string. Imagine the balloon is floating bring your right arm and hand up and away, and gradually lifting your head let them flop onto your lap. Now bring Now, let the tension flow like water to upwards. Feel your back muscles your left arm and hand up and let them your back and neck muscles. Feel the flop onto your lap. heaviness and warmth in your back and relaxing and lengthening. Feel the bones neck muscles. Say to yourself 3 times, or vertebrae in your back stacking up, Concentrate now on your arms and “My back and neck are heavy and one on top of another, stretching out hands. They feel heavy and warm. warm…my back and neck are heavy and lining up. Feel your neck muscles Say to yourself 3 times, “My arms and and warm…my back and neck are relaxing and getting longer. Now feel hands are heavy and warm…my arms heavy and warm.” Imagine bathing in the vertebrae in your neck stacking up, and hands are heavy and warm…my the sun and feel the warmth spread all one on top of another, stretching out arms and hands are heavy and warm.” over your upper body, radiating through and lining up. Feel your back and neck Feel the warmth flow through your arms your arms and hands…to your back muscles stacking up and relaxing while and hands, down into your fingers to and neck. Your entire upper body now your back, neck, and head are being your fingertips. You feel relaxed all over feels heavy and warm. gently lifted upward and lengthened by as your arms and hands get heavier this balloon floating overhead. and warmer. Your body is relaxed and calm…your breathing is deep and rhythmic…your While your arms are heavy and warm, heart is beating gently and evenly. scan your body from head to toe to find any muscle tension in other parts of Muscles need to be contracted before your body. Make sure your shoulders they can relax completely. In order are dropped and relaxed…your jaw is to properly relax your back and neck muscles, first create a light tension in your back and neck muscles for a brief

6 Stress Management Techniques

Now imagine that the balloon pops neck stacking up…stretching out and this state at any time, and that taking and allow your head to roll forward lining up. Feel your back and neck this mental “snapshot” will help you and your shoulders to drop limply like muscles stacking up and relaxing while remember this state, just like returning to a rag doll. This step is one of the most your back, neck, and head are being a familiar place that you know. important to do properly. Just allow your gently lifted upward and lengthened by How you finish this relaxation skill is as head to gently roll forward as far as is this balloon floating overhead. important as how you began it. First, comfortable for you, without forcing your Now imagine that the balloon pops and take a deep breath. Bring your arms and chin down toward your chest. Your entire allow your head to roll forward and your hands up toward your chest, similar to upper body is now limp, like a rag doll. shoulders to drop limply like a rag doll. a bicep curl…curling your arms and Your back muscles feel heavy and warm. Your entire upper body is now limp. Your hands to your chest as you inhale… Your back and neck muscles are longer, back muscles feel heavy and warm. and then, as you exhale, stretch your relaxed, and free of tension and pain. Your back and neck muscles are longer, arms and hands up over your head like

Now, let’s do this again. Imagine the relaxed, and free of tension and pain. someone just waking from a nap… balloon again. Imagine the balloon is When you’re ready, slowly lift your head now, bring them down to your sides. As floating away and gradually lifting your up, facing forward and comfortably you exhale, open your eyes and stretch head upwards. Feel your back muscles balanced on your shoulders. your arms and legs…and, if you like, let your body move around a little in relaxing and lengthening. Feel the bones You’ve now completed Autogenic your chair. Feel how good it is to move or vertebrae in your back stacking Training. You should be mentally alert, about after sitting still during this time up…stretching out and lining up. Feel yet physically relaxed. Take a few of relaxation and renewal. your neck muscles relaxing and getting moments to experience and remember longer. Now feel the vertebrae in your this feeling. Take a few more deep breaths. If you are going to resume physical activity, Take a mental picture of yourself in this first do some stretching to stimulate state. Remember how your body feels… the muscles that have been relaxed. If

and let this feeling become as vivid as you find yourself yawning, don’t assume

possible. Know that you can return to that you are now tired. Take this as a

sign that the exercise has worked, and

you are relaxed and free from tension.

Body Scan

Body Scan is a physical and mental take a few moments for the muscles in The most difficult part of the Body Scan relaxation skill. It is based on yoga and your legs to become fully coordinated is relaxing without falling asleep. In order has been practiced in India for over again after being deeply relaxed. to help you stay awake while lying down, 2,000 years. The word yoga means just prop your arm up at the elbow so union, and the practice of yoga creates In order to practice this skill, lie on that your forearm is at a 90-degree angle a union of mind and body that can lead your back on a comfortable surface, to your body. With your hand relaxed, to improved physical and psychological such as a firm bed or carpeted floor. your knuckles should point toward the health and well-being. This particular You might place a blanket or sweater relaxation skill has been evaluated by over yourself, as sometimes people research and effectively used in clinics become chilly while practicing this skill. for a wide variety of conditions. It is To support your body in a balanced and one of the simplest, safest, and most comfortable position, you can place a effective techniques for promoting pillow under your knees and another physical relaxation and mental clarity. small pillow or rolled up towel under your neck. If you are performing this Before you begin practicing this skill lying down, your position should be relaxation skill, there are a few comfortable, but not so comfortable that important points to keep in mind. First, you fall asleep. If you’re not comfortable if at any time you feel discomfort— lying down, you can practice this skill mental or physical—stop immediately. in any other position that’s comfortable You should not feel any discomfort or for you. pain while practicing this skill. Second, as you move or stand up at the end of this relaxation skill, do it slowly. It might

8 Stress Management Techniques ceiling. If you start to fall asleep while While practicing this relaxation skill, it you practice this skill, your muscles will is normal and natural for your mind to relax and your arm will drop—waking wander. If you notice this happening, you up in the process. If this happens, simply bring your awareness back to the just bring your attention back to the present and to the body part that you are exercise and continue. As you gain more on, without judging yourself for experience with this skill, you probably having temporarily been distracted. won’t need to prop up your arm in order to stay awake. Body Scan Script

Begin with some gentle diaphragmatic Now, bring your attention to the toes of breathing. Your diaphragm is the large, your left foot. Without moving or wiggling flat muscle below your lungs that helps your toes, simply notice whatever you breathe. As you breathe, let the sensations arise in that area of your air come in and out at its own pace— body. Just be with whatever sensations without trying to take a deep or shallow you notice. Imagine that you are breath. If you wish, you can close your breathing into and out of the toes of your eyes to help you focus when practicing left foot, continuing to focus on whatever this skill. sensations may be arising there. If there are no distinct sensations or feelings Place both hands gently on your present, then just attend to the absence abdomen, with the tips of your middle of sensations or feelings. During this fingers just barely touching. Allow exercise, it is normal and natural for yourself to feel the air gently entering your mind to wander and no longer through your nose. Don’t try to draw the be attending to the present moment air in, just let it come in at its own pace. sensations in your body. If you notice this Notice how your stomach inflates as the happening, simply bring your awareness air comes in, like a balloon filling with air, back to the present and to the body causing your 2 middle fingers to move part you’re focusing on without judging slightly apart. yourself for having been temporarily Now, as you allow your breath to flow out distracted. at its own pace, your middle fingers will come back together. Take the next few moments to allow your breath to come at its own pace, noticing your stomach gently rising and your middle fingers parting on the in breath…and your stomach falling and your fingers coming back together on the out breath. The goal is to simply let the breath be, not forcing it, simply allowing the gentle rising and falling of your stomach with each in breath and out breath.

10 Stress Management Techniques Following several rounds of breathing you pay attention to whatever sensations into and out of the left toes, move your are present in each body part, you might attention to the parts of your left foot… become aware of feelings or thoughts the top of your foot…the bottom of your that are also present, such as judgment, foot…your ankle…and repeating the contentment, or anxiety. Just notice any same process, imagine allowing your thoughts and feelings in the same way breath to move into and out of each you notice physical sensations, without area, just noting without judgment or judgment or evaluation, just observing evaluation whatever sensations are with interest and attention. present there. Continue in this way through your entire body…your right Pause several minutes foot, left calf, left upper leg, right calf, After you’ve moved your attention right upper leg, buttocks, groin, and through your entire body, return your so on up to your face and finally attention to your breath and the gentle to the top of your head. rise and fall of your abdomen, and take a Throughout this process, stay aware of few more deep breaths. If you are going your breath, using it as an anchoring to resume physical activity, first do some point for your mind, especially if you find stretching to stimulate the muscles that that your attention has wandered. As have been relaxed. If you find yourself yawning, don’t assume that you are now tired. Take this as a sign that the exercise has worked, and that you are relaxed and free from tension. If you have practiced this skill in a seated position, take a deep breath in. Bring your arms and hands up toward your chest, similar to a biceps curl… curling your arms and hands to your chest as you inhale…and then, as you exhale, stretch your arms and hands up over your head like someone just waking up from a nap…now bring them down to your sides. As you exhale, open your eyes and stretch your arms and legs… Feel how good it is to move about after sitting still during this time of relaxation and renewal. The diaphragm is a broad muscle Diaphragmatic below your lungs that attaches to your ribs and helps you to breathe. Breathing Diaphragmatic Breathing is based on yoga and traditions that have been practiced in India and Japan for over 2,000 years. The word yoga means union, and the practice of yoga breathing creates a union of mind and body that can lead to improved physical and psychological health and well-being. Breathing is one of only a few activities of the body which are both voluntary (you and involuntary (you breathe without

12 Stress Management Techniques having to think about it). By consciously effects of relaxation, and this balanced focusing your attention on your breathing, posture will help keep you mentally alert you can create a rhythmic and relaxing but physically relaxed. Put your feet on breath cycle. the floor with your legs slightly spread apart at a comfortable distance. Overall, This particular relaxation skill has been you should feel comfortably balanced on evaluated by research and used in your chair, so make any subtle shifts in clinics to reduce stress and help with a your posture to help you experience an wide variety of conditions. Diaphragmatic inner balance. breathing is one of the simplest, safest, and most effective techniques for creating physical relaxation and mental clarity. By focusing your attention on the natural cycle of your breath and maintaining a rhythmic breathing pattern, you can voluntarily relax and help improve your overall health and well-being. One of the earliest indications of stress is breathing in a shallow, tight, or rapid manner. As soon as you notice this, you can begin practicing this slow diaphragmatic breathing. When you’re ready to begin practicing this lesson, you can sit in any comfortable chair. Sit a bit forward from the back of the chair so that you feel balanced. Drowsiness is one of the first Diaphragmatic Breathing Script

There are many ways to breathe. When minutes to allow your breath to come in you’re tense, you tend to breathe in at its own pace, noticing your stomach quick, shallow breaths. When you’re gently rising and your middle fingers relaxed, however, your breathing tends to parting on the in breath…and your be deeper and slower. stomach falling and your fingers coming back together on the out breath. The goal For a moment, take a big breath in is to simply let the breath be, not forcing through your nose. Then, exhale through it, simply allowing the gentle rising and your mouth forcefully. falling of your stomach with each in and As you breathe, let the air flow in and out out breath. at its own pace without trying to take a deep or shallow breath. If you wish, you can close your eyes to help you focus when practicing this skill. Place both hands gently on your abdomen, with the tips of your middle fingers just barely touching. Allow yourself to feel the air gently entering through your nose. Don’t try to draw it in, just let it come in at its own pace. Notice how your stomach inflates as the air comes in, like a balloon filling with air, causing your middle fingers to move slightly apart. Now, as you allow your breath to flow out at its own pace, your middle fingers will come back together. Take the next few

14 Stress Management Techniques Just as you are aware of the tips of your Take a few moments to remember how Diaphragmatic Breathing Script middle fingers moving apart and coming you feel right now so that you can more back together in a rhythmic cycle, you easily return to this state as you continue may also notice that your breathing is to practice this skill. Let this memory slow and regular…your diaphragm is become colorful and vivid…knowing relaxed…or that you feel the air passing that you can return to this state any time in and out of your nostrils, like waves on you wish. the ocean. All of these sensations serve as reminders that you are in a state of How you finish this relaxation skill is as mental alertness and physical relaxation. important as how you began it. First, Just relax and enjoy this for a little while. take a deep breath. Bring your arms and hands up toward your chest, similar to Pause 2 minutes a bicep curl…curling your arms and hands to your chest as you inhale… and then, as you exhale, stretch your arms and hands up over your head like someone just waking from a nap…now, bring them down to your sides. As you exhale, open your eyes and stretch your arms and legs…and if you like, let your body move around a little in your chair. Feel how good it is to move about after sitting still during this time of relaxation and renewal. Take a few more deep breaths. If you are going to resume physical activity, first do some stretching to stimulate the muscles that have been relaxed. If you find yourself yawning, don’t assume that you are now tired. Take this as a sign that the exercise has worked, and you are relaxed and free from tension. Inner Direction

Inner Direction is an effective relaxation acquired a bit of a “side show” skill that is based on the principles of reputation due to its use in nightclub . In the late1800s, a physician performances, it is actually a powerful named Dr. Anton Mesmer discovered and effective relaxation skill. that when people became deeply relaxed, they were more receptive to Practice this exercise several times about behaving in a particular manner. during the day. Each time you practice This technique was originally called this exercise you will find it easier and “mesmerism” but was later called easier to relax. “hypnosis.” Although hypnosis has

Inner Direction Script

Sit in a comfortable chair or lie on a couch or a bed with your hands resting in your lap or by your side...take 3 slow deep breaths…each time you inhale, focus on filling your lungs with clean, fresh air…and each time you exhale, feel all of the tension leave your lungs. You feel good, you feel fine…you feel perfectly relaxed. Each and every breath that you take lets you relax deeper and deeper…each and every sound that you hear allows you to relax deeper and deeper…nothing will disturb you…just breathe deeply and relax deeply…let your body relax…let all of your muscles relax as you gain control over the

16 Stress Management Techniques Inner Direction Script continued... powerful subconscious part of your practice this exercise, you will find Day by day, in every way, you are mind…all of your cares and troubles are yourself relaxing to a greater and greater getting better and better. You feel good just drifting away…you can bring them degree…your body feels totally relaxed you feel fine…you feel totally and back any time you want…but it feels and your mind is keenly alert, aware completely relaxed…in a moment good to let them drift away right now. and very powerful…you can achieve you are going to count from one to 5…by the time you reach 5, you will Each and every breath you take allows anything you want when you call upon be alert and awake and feel better you to relax deeper and deeper…each your own mind power…you will find than you have ever felt before… and every sound that you hear allows you yourself sleeping better when it’s time each and every time you practice this to relax deeper and deeper…you feel to and you will find that you have exercise, you will find yourself relaxing good…you feel fine…you feel perfectly more energy when you are awake…your life is getting better and better. to a greater and greater degree…all and completely relaxed…your mind is right…1…2…3…4…5…you are alert and aware and your body is relaxing wide awake…alert and feeling better in perfectly…each and every time you every way. Present Moment Awareness

18 Stress Management Techniques Present Moment Awareness is an By recognizing these triggers or This lesson begins with a simple effective, easy-to-learn relaxation aggravating factors as early as possible, awareness of your breathing. Then skill that is based on a 2,500-year-old you can change behaviors or habits to you will move your attention to what is tradition of mindfulness meditation. benefit your health and well-being. happening in the present moment, such Historically, this type of meditation has as any physical sensations you may been most commonly associated with The goal of this skill is awareness, being be feeling. Finally, you can bring your Eastern healing practices and principles. more in touch with what is happening attention to thoughts as they come into Since the practice of mindfulness in your body and mind. When thoughts your awareness. is simply a particular way of paying or feelings come up in your mind, or attention on a moment by moment you experience pain or other physical This exercise can be practiced in any basis, this skill can also be used to sensations, you don’t ignore or suppress position. However, it is most effectively great benefit without any religious or them; you just observe and take note of done while seated, either in a chair with philosophical associations. Just as them as they occur moment by moment. your feet flat on the floor or in whatever modern day medicine has its foundations Non-judgmental observation helps you seated position is the most comfortable in the religious systems of ages past, to focus on what is in your mind in the for you. Whatever position you choose, relaxation skills such as mindfulness present moment. You learn to see the the goal is to sit with an upright, and Present Moment Awareness moment as it is and accept it. When you dignified, and noble posture with your have an ancient history but are now increase your awareness and have an spine held straight, and without being recognized as scientifically proven stress accepting attitude about what you are rigid or tense while you maintain this management skills. This skill can make experiencing, you may find that you can balanced posture. you more aware of the internal and feel more comfortable and in control. external events that can trigger a stress By accepting what each moment offers, response in your body and mind. you can experience life more fully and respond more effectively to situations as they arise. Present Moment Awareness Script

Close your eyes, and begin with a gentle your attention ride the waves of each Continue to be with your breath. If you awareness of your breathing. Your breath breath, staying with the breath through suddenly discover that your attention has will serve as an anchoring point, bringing its entire cycle…beginning, middle, drifted off, just notice that this occurred you back again and again to the present end…and even paying attention to any without being critical of yourself. Or if moment, reminding you to be awake spaces that might be present between you notice any self-criticism, simply note right here, awake and conscious of what the in and out breaths. that without being critical of the fact is arising in your experience right now, that you’re being critical. Come back to simply letting go of thoughts of the past Let your mind be relaxed, but focused. your breath. If your attention wanders and future. Ride the waves of each breath, feeling a thousand times, come back to your your breath as it flows in and out. It breath a thousand times. Now, just let go of trying to breathe in may help to focus on your breath in a any particular way. Simply allow your particular place, most commonly your breath to flow naturally, paying gentle nostrils as the air moves in and out, or but steady attention to each breath as it your stomach as it gently expands and flows in, and then naturally flows out… contracts with each in and out breath. not guiding or directing the breath… simply noticing and observing it. Just let

20 Stress Management Techniques The key to this skill is knowing where Now, let your attention move from Finally, bring your attention to the your attention is in any given moment. awareness of your breath to simply process of thinking itself. Just notice as Therefore, noticing that your mind has paying attention to any physical thoughts come up and pass away, come wandered from your breath is just as sensations that you may be experiencing. up and pass away. Rest in this simple important as staying focused on Just breathe into any area of tension or awareness, just observing the arising of your breath. discomfort as though it was a balloon thought itself without getting caught up that you could fill with warm air. As in the content of the thoughts. If you find Gradually, through practice, you can you exhale, imagine that the area of this difficult, come back every now and develop the ability to notice sooner and discomfort is leaving your body… then to awareness of your breathing as sooner that your attention has drifted dispersing with each breath out into a way of re-connecting yourself to the from your breath. You can also develop smaller and smaller pieces until it present moment. more steadiness in your mind, which vanishes. If you don’t notice any frequently brings a deep sense of inner discomfort, simply notice the absence How you finish this relaxation skill is as peace and stillness. This peace and of discomfort. As with the breathing important as how you began it. First, stillness is always present just below the exercise, simply become aware if your take a deep breath. Bring your arms and surface of your thoughts. attention wanders at any point and hands up toward your chest, similar to return your focus to any discomfort, or a bicep curl…curling your arms and the absence of discomfort. hands to your chest as you inhale… and then, as you exhale, stretch your arms and hands up over your head like someone just waking from a nap…now, bring them down to your sides. As you exhale open your eyes and stretch your arms and legs…and, if you like, let your body move around a little in your chair. Feel how good it is to move about after sitting still during this time of relaxation and rejuvenation. Take a few more deep breaths. If you are going to resume physical activity, first do some stretching to stimulate the muscles that have been relaxed. If you find yourself yawning, don’t assume that you are now tired. Take this as a sign that the exercise has worked, and you are relaxed and free from tension. Progressive Relaxation

Progressive Relaxation was developed Creating the appropriate amount of When you’re ready to begin practicing through the research of a physician tension when you contract or tighten this lesson, you can sit in any named Edmund Jacobson in the early your muscles is very important when comfortable chair. Sit a bit forward 1930s. Dr. Jacobson was a prominent practicing Progressive Relaxation. To best from the back of the chair so that you researcher in muscle physiology at illustrate the right amount of tension, feel balanced. Put your feet on the floor Harvard and Cornell universities. He take a tennis ball or a ball of a similar with your legs slightly spread apart at a discovered that people could activate size in your hand. Gently squeeze the ball comfortable distance. Sit up straight with specific muscles just by imagining enough to produce slight indentations your shoulders dropped so you don’t feel doing an activity. He placed electrodes or dimples. Hold it comfortably for 3 stiff, and position your arms comfortably. on the body to measure muscle activity seconds, and then gently relax your Overall, you should feel comfortably while people imagined performing muscles. The level of tension created balanced on your chair, so make any various activities. He found that when when squeezing the ball is exactly the subtle shifts in your posture to help you people imagined they were walking, tension level needed for the Progressive experience an inner balance. the electrodes measured activity in the Relaxation exercises to be effective. correct muscles for walking. In a similar Remember, if you feel pain, you may be way, when he had people imagine they doing the exercise incorrectly or tensing were eating, their jaw muscles became your muscles too much, and you should more active. From this research he stop immediately. You should not feel concluded that many medical problems any discomfort or pain while practicing were the result of people unconsciously this skill. If for any reason you feel like activating muscle tension. stopping the process at any time, you can simply return your attention to the In response to this, Dr. Jacobson outside world. developed a series of relaxation skills that focus on tensing and then relaxing specific muscles in order to achieve a state of physical and mental relaxation. It is interesting to note that Progressive Relaxation Therapy achieved widespread recognition during WWII when it was used by combat pilots to remain relaxed but alert while sitting in the confined cockpits of their fighter planes. Today, Progressive Relaxation remains one of the most thoroughly documented and widely used relaxation skills for muscular pain, heart problems, rehabilitation after an accident or stroke, dental problems such as grinding your teeth, and other conditions.

22 Stress Management Techniques

Progressive Relaxation Script

Seated comfortably, gently roll your head in a half circle in front of you. Slowly roll your head from side to side a few times to release tension in your neck and jaw. Then bring your head up to face forward. Take in a moderately deep breath, drawing the air deep into your abdomen. You should feel your stomach area expand as you inhale. Then, slowly release the breath.

24 Stress Management Techniques Concentrate on your breathing, which First, gently tense the muscles of your Next, focus on the muscles in your should be smooth and rhythmic, with right hand and arm as though you are chest, back, and belly. Breathe in your in breath equal to your out breath. squeezing a ball. Make a fist and bend deeply and hold your breath. Keeping Imagine that your breaths are like waves your arm. Your muscles should feel tight. a slight arch in your low back, tighten lapping at the shore. Allow your eyes to your chest and tense your abdominal close gently, whenever you feel ready. Hold this tension for about 3 seconds, muscles by drawing in your belly. Hold Keep this image of the waves in your counting 1-1000…2-1000…3-1000. this position for about 3 seconds, mind as you repeat to yourself 3 times: Now release the tension and relax the counting 1-1000…2-1000…3-1000. “My breathing is rhythmic and smooth… muscles of your right hand and arm for Now release and relax the muscles my breathing is rhythmic and smooth… about 30 seconds. of your chest, back, and abdominal my breathing is rhythmic and smooth.” Pause 30 seconds muscles for 30 seconds. Take 3 or 4 deep breaths…drawing air down into your abdomen…then breathe Now focus on the muscles of your left Pause 30 seconds regularly. hand and arm. Gently tense the muscles Now, bring your attention to your legs. of your left hand and arm as though you First, without lifting your toes, raise The length of your in breath and out are squeezing a ball, just as you did breath should be equal and comfortable. your right heel and push down with the with your right hand and arm. Make a ball of your foot, pressing your toes into As you relax, your breathing will become fist and bend your arm. Your muscles slower, smoother and more rhythmic. the floor. Feel the tension in your thigh should feel tight. Hold this tension for and calf and hold this position for 3 Now it is time to start tensing and about 3 seconds, counting 1-1000…2- seconds, counting 1-1000…2-1000… relaxing the 6 major muscle groups of 1000…3-1000. Now release the tension 3-1000. Now release the tension and your body one at a time. and relax the muscles of your left hand relax the muscles of your right leg for and arm for about 30 seconds. about 30 seconds. Pause 30 seconds Pause 30 seconds Next, bring your attention to the Now, without lifting your toes, raise muscles of your face. Close your eyes your left heel and push down with the tightly…lift your eyebrows…clench ball of your foot, pressing your toes into your teeth…and pull back the corners the floor. Feel the tension in your thigh of your mouth as if you were making a and calf and hold this position for 3 big smile. Hold this tension for about 3 seconds, counting 1-1000…2-1000… seconds, counting 1-1000…2-1000… 3-1000. Now release the tension and 3-1000. Now release the tension and relax the muscles of your left leg for relax the muscles of your face for about about 30 seconds. 30 seconds. Pause 30 seconds Pause 30 seconds Take a few moments more to enjoy this Now tighten the muscles in your state of rest and relaxation. shoulders and neck. Pull your shoulders up and press your head back without Pause 10 seconds bending your neck. Hold this tension for about 3 seconds, counting 1-1000…2- When you are ready, breathe in deeply 1000…3-1000. Now release the tension and begin moving your fingers and toes. and relax the muscles of your shoulders Take another deep breath and begin to and neck for about 30 seconds. stretch…and as you exhale, open your eyes. Pause 30 seconds Quieting Response

The Quieting Response is a mini- in the body part that’s being measured, This skill needs to be practiced often so relaxation skill that is designed to such as increasing or decreasing muscle that you can use it whenever needed. counteract sudden or unexpected stress tension. Since Dr. Stroebel’s clinical Fortunately, the Quieting Response can reactions. It relieves muscle tightening, work was with children, he developed be done with your eyes open or closed, jaw clenching, and breath holding. the simplest possible relaxation skill any time, and in any place. The goal is that could be used by children to for the Quieting Response to become During the 1960s and 1970s, Dr. Charles practice relaxation without the use of an easy-to-use, effective skill that Stroebel, a psychiatrist at the Institute instruments. Dr. Stroebel’s works for you. Focus your awareness for Living in New Haven, Connecticut, work resulted in the Quieting Response, on whatever is distressing or annoying. was one of the pioneering researchers in a relaxation skill that is used effectively The awareness of feelings of distress the clinical applications of biofeedback. with both children and adults to manage or annoyance is the “trigger” or cue for Biofeedback is a technique that uses a variety of conditions. As you practice you to begin using the 4 steps of the various instruments to measure activity this deceptively simple but effective Quieting Response. in the body and “feed back” that technique, it can provide a quick and information to the person practicing the easy reminder to you and your entire technique. Once an individual receives body that it is time to become physically this biofeedback, he or she can learn relaxed and mentally alert. how to increase or decrease the activity

Quieting Response Script

Step 1: Become aware of what is There is actually research indicating that distressing or annoying you—a when you smile, you can change your ringing phone, a sarcastic comment, a body response and body chemistry to worrisome thought, whatever you notice become more relaxed. So the expression that distresses or annoys you. This “Put on a happy face” is an excellent becomes your cue to start practicing the recommendation that can truly help. Quieting Response. Step 4: Inhale slowly to the count of 3, Step 2: Repeat the following phrase to imagining your breath coming in through yourself: “Alert mind, calm body.” the bottom of your feet and upward through the rest of your body. Then Step 3: “Smile” inwardly with your exhale slowly. Feel your breath moving eyes and your mouth. This stops facial back down your body, down your legs, muscles from making a fearful or angry and out through your feet. Let your jaw, expression. The inward smile is more tongue, and shoulder muscles become a “feeling” than something obvious to limp and totally relaxed. anyone who may be watching you. Now you can resume your usual activities, aware of being more relaxed. 26 Stress Management Techniques Relaxation Response

In the early 1970s, Dr Herbert Although initially this skill included women to reducing . In Benson of Harvard Medical School several steps, as it has evolved these this relaxation skills program we will began researching the physical and steps have been simplified to 2 key use a slightly modified version of the psychological benefits of meditation and components. The first key component Relaxation Response. With practice deep relaxation techniques. In reviewing is a mental focus, such as repeating a and patience, you can learn to use this various techniques, he recognized personally meaningful word or phrase relaxation skill to help you improve specific steps that were characteristic or simply repeating the word “one.” The your health and well-being. Practice of virtually all methods of relaxation. second key component is maintaining this skill once or twice daily, but not With this realization, he formulated the a non-judging, receptive awareness within 2 hours after any meal, since the Relaxation Response, a series of simple that gently lets go of any distracting digestive process seems to interfere steps that result in a state of physical thoughts as they come up while with creating the Relaxation Response. relaxation and mental alertness. practicing the skill. Now, when you’re ready to begin The Relaxation Response has been practicing this lesson, you can sit in effectively applied in clinical research any comfortable chair. Sit a bit forward ranging from improving fertility in from the back of the chair so that you feel balanced. Put your feet on the floor with your legs slightly spread apart at a comfortable distance. Sit up straight with your shoulders dropped so you don’t feel stiff, and let your arms hang comfortably at your sides. Overall, you should feel comfortably balanced on your chair, so make any subtle shifts in your posture to help you experience an inner balance. Relaxation Response Script

Seated comfortably, gently roll your head With each breath, feel relaxation washing Feel how good it is to move about after in a half circle in front of you. Slowly over you like waves. Imagine the waves sitting still during this time of relaxation roll your head from side to side a few washing over your feet and legs. Feel and renewal. times to release tension in your neck the waves cover your arms, your neck, and jaw. Then bring your head up to and your head. Your arms, legs, and feet Take a few more deep breaths. If you are face forward. Take in a moderately deep feel heavy and warm. Feel the waves going to resume physical activity, first do breath, drawing the air deep into your of relaxation sweep over you. Feel your some stretching to stimulate the muscles abdomen. You should feel your stomach limbs growing heavier…warmer. Your that have been relaxed. If you find area expand as you inhale. Then, slowly breathing is calm…rhythmic…smooth. yourself yawning, don’t assume that you release the breath. are now tired. Take this as a sign that the Take your time and focus on releasing the exercise has worked, and you are Concentrate on your breathing, which tension in each muscle as you allow the relaxed and free from tension. should be smooth and rhythmic, with relaxation to spread up through your body your in breath equal to your out breath. to the muscles of your face. Imagine that your breaths are like waves lapping at the shore. Allow your Become aware of your breath as you eyes to close gently, whenever you feel breathe through your nose. Each time ready. Keep this image of the waves in you breathe out, say the word “one,” your mind as you repeat to yourself 3 silently to yourself. If you’d like, you times, “My breathing is rhythmic and can select a different word or phrase to smooth…my breathing is rhythmic and repeat, such as “peace,” “shalom,” or smooth…my breathing is rhythmic and “om.” Allow the relaxation to occur at its smooth.” Take 3 or 4 deep breaths… own pace. If you notice any distracting drawing air down into your abdomen… thoughts, simply let them go and return then breathe regularly. to repeating your chosen word with each out breath. Continue breathing easily and The length of your in breath and out naturally as the background music (if breath should be equal and comfortable. used) continues for another 10 minutes. As you relax, your breathing will become slower, smoother, and more rhythmic. Pause 10 minutes If you haven’t already, gently close your How you finish this relaxation skill is as eyes as you prepare to deeply relax all important as how you began it. First, of your muscles. Place your hands and take a deep breath. Bring your arms and forearms comfortably in your lap. You hands up toward your chest, similar to may want to make a gesture of closure a bicep curl…curling your arms and by gently clasping your hands together hands to your chest as you inhale… with your fingers intertwined or by and then, as you exhale, stretch your cupping one hand on top of the other arms and hands up over your head like with the palms of your hands facing someone just waking from a nap…now, upward. This gesture of closure is a bring them down to your sides. As you universal symbol of the harmony of mind exhale open your eyes and stretch your and body. arms and legs…and, if you like, let your body move around a little in your chair.

28 Stress Management Techniques

Shavasana

The word Shavasana is made up of small pillow or rolled up towel under the 2 Sanskrit words. “Shav” means back of your neck. Your position should attention back to the exercise and “deeply quiet body” and “asana” be comfortable, but not so comfortable continue. As you gain more experience means “pose” or “posture.” Therefore, that you fall asleep. You might place a with this skill, you will probably not Shavasana roughly translates as blanket or a sweater over yourself, as need to prop up your arm in order to “deeply quiet posture.” Although people sometimes become chilly while stay awake. Shavasana is an ancient yoga practicing this skill. If you’d like, you technique, it was first applied in the can cover your eyes with a soft cloth. While practicing this relaxation skill, it early 1970s by the renowned London If you suffer from eyestrain, you might is normal and natural for your mind to cardiologist, Dr. Chandra Patel, to help first dampen this cloth with some cool wander. If you notice this happening, lower blood pressure. Her pioneering water. If you’re not comfortable lying simply bring your awareness back to research was published in the British down, you can practice this skill in the present without judging yourself for Medical Journal and opened up a any other position that’s comfortable having been temporarily distracted. new approach to the treatment of high for you. blood pressure. Although Shavasana is still frequently used with heart disease The most challenging part of practicing and high blood pressure, research has Shavasana is relaxing without falling also shown it to be effective with other asleep. In order to help you stay awake conditions such as muscle pain, back while lying down, just prop your arm pain, and insomnia. up at the elbow so that your forearm is at a 90-degree angle to your body. In order to practice this skill, lie on your With your hand relaxed, your knuckles back on a comfortable surface, such should point toward the ceiling. If you as a firm bed or a carpeted floor. To start to fall asleep while you practice support your body in a balanced and this skill, your muscles will relax and comfortable position, you can place a your arm will drop—waking you up in pillow under your knees and another the process. If this happens, just bring your

30 Stress Management Techniques Shavasana Script

Begin by lying down in a quiet place. Now close your eyes and begin to notice Now let your breath go, allowing your Position your arms comfortably beside your breath. Breathe slowly and deeply, breathing to resume its own natural your body, with your palms turned allowing a sense of calm relaxation to rhythm. Gradually let go of the tension upward. Keep your heels about a foot fill your body. Concentrate on loosening in your body and mind, and stay gently apart, and let your toes roll outward. all of the tension in your body and mind. present with the sensations of your Take 5 to 10 long, slow breaths in…and breath. Just let your thinking mind out. go as you remain very attentive… enjoying a state of deep relaxation and Pause for 5 – 10 breaths heightened awareness. If your mind wanders, simply notice this and then bring your awareness back to the present moment…just lying and resting in this simple, relaxed, open awareness… letting go of everything, holding onto nothing, just letting life and breath move through your body and mind. After you’ve practiced this skill for 5 to 10 minutes, take a deep breath in…and as you exhale, open your eyes. M600-3343A 04/13 © 2013 American Specialty Health Incorporated (ASH). All rights reserved. The Healthyroads logo is a trademark of ASH.