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A Supplemental Guide to Relaxation and Mental Training

Katherine M. Leonard, Ph.D.

Ronna F. Jevne, Ph.D.

LEARNING TO RELAX

          This basic guide is offered as an introduction and supplement to relaxation training and stress reduction programs offered in medical settings.  We expect that you may have questions about this practice that are not covered here, and so we encourage you to ask your instructor or therapist about your particular concerns.

          Relaxation can allow you to create a quiet place or still point within yourself.  In response to a medical crisis or to chronic stress, you and members of your family may experience many intense and ongoing concerns.  You may often feel that you could be swept away if one more wave hits.  Having a still point can allow you to accept your feelings and reactions and then work with them to your best advantage.

          The practices presented here are designed to supplement weekly group or individual sessions.   Each week may emphasize different aspects and skills, but the routine includes all the basic steps so that newcomers will readily learn this technique.

What kind of relaxation do we teach?

          Relaxation techniques focus on physical muscle relaxation and mental relaxation.  We offer mental relaxation aimed at allowing the muscles to relax as well.  You will find this approach helpful if your mind tends to stay busy even though your body is relaxed.

          In describing relaxation, we may use such terms as (deep relaxation, self hypnosis) and (guided visualization) to describe what you will learn.  They are often used interchangeably because all of them involve developing the ability to relax yourself.   Relaxation is an important goal in itself because it helps you handle stress in your life more effectively.  When relaxation is focused upon controlling symptoms or achieving a personal goal, it may be referred to as self-hypnosis or guided visualization.

          With these skills you will gain more effective control of your responses to stressful situations.

          Be assured that you will remain in control of your relaxation experience.  Keep in mind that during a session, whenever there is a suggestion of a direction or an image that is uncomfortable or unsuitable, you can ignore it or change it to fit with your own experience and abilities.  For example, while many people are able to experience pictures in their minds during relaxation, you may be a person who imagines the feelings, sounds or smells of an experience.  This is fine:  any way you allow your imagination to help you to relax is right for you.  Should any emergency arise during your practise, such as a telephone call or a child in trouble, you will easily come out of your relaxation to handle that situation.  You will find that with practise, you can return to a relaxed state as soon as the situation requiring your attention passes.

          Relaxation is something we all experienced as young children.  Caught up in the stresses of growing up and taking on adult responsibilities, most of us forget how to let go of tension and take time out to relax.  Children and animals relax without thinking about it.  As adults, we consciously need to relearn how to relax.  Some of you may learn this very quickly while others may take longer.  We all have our own pace and way of learning.

What is deep relaxation like?

          Relaxation is a state that we all experience at times.  You may day dream or become so involved in a hobby that you don't notice time passing.  You may not notice activities around you.  While driving, your thoughts may drift and you are not aware of the passing scene until suddenly, you are at your destination.  Sometimes, deep relaxation is compared to sleep because you can experience dream-like images and "awake" feeling rested.  The difference is that unlike sleeping and dreaming, with deep relaxation and self-hypnosis, you are always aware and in control.  You may find thoughts and images drifting through your mind in a dream-like fashion, but you are not asleep, and you can direct your attention wherever you want.  You can select images or sensations and you can change them as you want.  Whether you are listening to a person or to a tape, you can remain aware of the voice during the whole time even though you may not be paying attention to the words.  In the same way, you can notice the other sounds around you and choose to ignore them or choose to use them as cues for deeper relaxation.  You can change the meaning of a sound.  For example, if you want to let the sound of an air conditioner remind you of something pleasant such as the distant sound of waves, it can become quite soothing.  If you find your thoughts drifting, gently bring your attention back to the relaxation process.

          Practice is important.  It is not necessary to practice rigidly every day, but 20 to 40 minutes four times a week can make a real difference both to your general well being and to the way in which you cope with stress.  If you want to develop a good habit, practise relaxation every day for three or four weeks and the habit will be yours.

          Many people learn relaxation techniques quickly.  For others learning something new is more complicated.  The less you concern yourself about doing this right away the sooner you will relax.  Enjoy each experience of relaxation for itself.

RELAXATION AT HOME

          Choose a time when you will have as few distractions as possible.  You may want to pick the same time and place in your home each day so that they become associated with relaxation.  A comfortable chair with a head rest works well for relaxation practise.  It is practical to learn to relax while sitting in a chair because chairs are everywhere:  in your doctor's waiting room, at the hairdresser's, at your desk, in a theatre, in the park.  Of course, learning to relax in any one position can lead to the discovery of many other ways to use the technique.  Relaxation becomes easier with practice.

          If possible, unplug the telephone for half an hour.  Your friends can reach you a little later.  Draw the curtains or face away from the direct light to avoid that distraction.   You may enjoy listening to quiet music or recordings of environmental sounds while relaxing.

Get Comfortable:

          Wear comfortable clothing that does not bind anywhere.  Loosen belts or other tight clothing.  Sit or lie with your legs uncrossed to avoid cutting off circulation.  You may rest your hands gently on your stomach, on the arms of the chair, or along the side of your body.  Use whichever position is most comfortable for you. You may want to raise your feet on a hassock or a small stool.  You may prefer lying down either with your knees up or your legs stretched out.  Any position that is comfortable and effortless is fine.

Breathing:

          Begin by paying attention to your breathing.  As breathing is something that happens automatically, there is no need to do anything about it.  You may notice that your breathing develops a regular rhythm which becomes deeper and slower as you relax.  Some people find that taking two or three deep breaths at the outset will help this rhythm to begin.  Place a hand on your stomach and notice it rising and falling as you relax.

          You can close your eyes whenever you like.  Often, by closing the eyes, people experience a shift of attention from outside to inside.  You are shutting out a large portion of the world around you.  Some people begin by staring at a spot on the wall until their eyes feel tired, and close automatically.  If you do not wish to close your eyes, just allow them to focus on a neutral spot.

          As your attention moves inward, you may notice that external sounds become less important and gradually fade out of your awareness.  Sounds that are irritating to your conscious mind can become soothing to your unconscious and can even become a cue to go more deeply into relaxation.  For example, the sounds of an air conditioner or cars in the street may begin to sound like a waterfall or distant ocean waves and evoke pleasant memories.

          Allow your attention to remain with your breathing for a while and enjoy the regular, effortless, flow of air into your lungs.  You may enjoy the image of a balloon being blown up and then gently released.  Counting breaths can give your mind something to do:  count each time you breathe out up to ten and then begin again or just count "one" each time you breathe out.  Imagining yourself in a rocking chair can enhance the natural rhythm of breathing.  Think of breathing as a way your body takes care of you.

Body Scan:

          Next, notice any places in your body that would like to become a little more comfortable.  You may be able to shift position slightly to increase your comfort.  You may also imagine your out-breath flowing down into that area and bringing comfort.  Some people like to imagine someone they really trust gently massaging specific muscles and helping them relax.  Others find that imagining lines or channels connecting each part of the body brings a sense of wholeness and releases tension.  Take time to explore and find the methods that work for you.  Remember that each relaxation experience is different.  Think of the release of muscle tension as the gift you give your body for all the work it does for you.  Know that whatever level of relaxation you reach this time will be beneficial and that you will experience even more relaxation with future practice.

Deepening:

          There are several ways to deepen relaxation which involve mental imagery.  For example, you can imagine yourself going down stairs, down an elevator, down an escalator, down a spiraling slide.  These all fit for people who imagine going down into relaxation. Others feel more like floating and like to imagine floating on soft fleecy clouds, a magic carpet, a boat, or in a hot air balloon.

          To deepen your level of relaxation, you may simply count from 1 to 20 or 20 to 1 and tell yourself with each number that you will become more deeply relaxed.  If you prefer letters write each letter of the alphabet on a black board you create in your mind.

          If you have difficulty calming your mind, imagine that you can project your thoughts on a screen like a cartoon.  Then slow the thoughts down until they stop and slowly fade away.  Repeat this as often as necessary.  Whatever approach you use will gradually bring you into a state where you can enjoy the refreshment of deep peace and comfort.  You may simply want to experience this state for a while, or you may want to give yourself positive suggestions related to some question or concern.

Cues:

          You may notice that a word such as "relax" or "calm", a phrase, another sound, an image or a sensation becomes closely connected with relaxation; this can become a cue to begin relaxing.  Sitting in the place where you usually relax might remind you to relax.  Perhaps a body sensation such as taking a deep breath, holding your hand in a certain position, or rolling your eyes back can signal your body to relax.  Visualizing a color or scene in nature is effective for some.  When you consciously use cues for the purpose of going into deep relaxation, you can become relaxed very rapidly.

Mental Activities:

          In the relaxed state you are more able to become aware of needs, feelings and abilities that you did not know you had.  Sometimes guided imagery will allow you to understand and provide solutions to problems you experience in daily life.  New ideas may arise.  You can use your imagination to practice coping with difficult situations and to solve problems creatively.  For example, you can have a conversation with some part of your body, a significant person, or yourself as you were in the past or as you may be in the future.  You can actively imagine yourself being or doing things in ways that you would like.  Athletes use this process to improve their performance by mentally rehearsing and visualizing success.  Go on a journey of discovery, travel to a place you know, to a mysterious cave, to an undersea garden, or to a special museum.  Let your imagination work for you, allow it to explore all possibilities.

          Do not make judgments about what comes to mind, just observe and accept.  Remember, however, that you are always in control of your fantasies.  If a disturbing thought or image comes to mind, you can choose to banish it.  Thoughts or images can be placed in a box on a shelf to be looked at later or can be removed completely from your fantasy.

          You may want to share your experiences with your instructor or practice group.  Others may have had similar experiences and can offer suggestions about how you might handle them.

Affirmations:

          Affirmations are positive suggestions related to changes you want to make.  They can apply to relaxation, to a headache, to relationships and in fact, to anything you want to experience more positively.  Your mind is very open in the relaxed state, and suggestions you make to yourself at this state may be more readily followed.

          When you create affirmations for yourself, you may find the following ideas helpful:  Phrase affirmations in the present tense and in the most simple and positive way you can.  Choose affirmations that feel totally right for you.  Affirmations are not meant to contradict your feelings or emotions; they are meant to provide support in your present condition.  Set aside your doubts and hesitations and create the belief that the affirmation can be true.

          Affirmations are about your experience and no one else's.  It is not helpful to say, "My spouse will love me more", when the only person you can control is yourself.  You can say instead, "I can experience more of my spouse's love".  Of course, as you behave more the way you want toward others, you have increased the likelihood that they will respond positively. In an open state, negative suggestions can be as powerful as positive suggestions.  Be aware of negative self suggestions and substitute positive suggestions for them.  You may actually want to list the affirmations you want to focus on prior to relaxing.

         

Affirmations that others have found helpful include:

                    I am willing to believe         . . .  I'm learning

                                                              . . . I will get stronger

                                                                    . . .  I will cope.

                    I am learning to accept      . . .  help from others

                                                               . . . my anger

                                                             . . .   all my feelings as part of myself.

                    I have faith.                       . . .    in myself

                                                                . . .   in my family

                                                                 . . .   in God.

                    I can give myself permission to . . .

                    I feel confidence flowing through my entire body.

                    It's okay to take my time.

                    I am whole and complete in myself.

                    I am doing my best.

                    Sometimes I need to feel this way.

                    It's okay to have a down day.

                    I am willing to forgive myself.

                    I can find a more healthy way to be down.

                    This too will pass.

                    I have coped with this before.

Returning to Full Alertness:

          Before re-awakening, you may want to tell yourself that these feelings of comfort and peace will stay with you and help you really enjoy the rest of your day.  Re-awakening may happen spontaneously if you become aware of any change in your environment. You may wish to tell yourself to wake up at a certain time.  Counting backward from five to one is a very simple way to return to full alertness.  On five become aware of things around you, on four become aware of your body, on three begin to move and stretch, on two take a deep breath, and on one open your eyes.  Suggest to yourself that you will feel wonderfully alert and refreshed.

SPECIAL APPLICATIONS OF RELAXATION

Pain Control:

          Pain and other symptoms are messages from our bodies that something is wrong.  When you have a long lasting or severe pain, talk to your doctor about it.  Using relaxation can help you to tolerate the pain until something can be done about it.  Relaxation can also enhance the effects of medication used in pain control and is a way you can participate in your health care. Regular relaxation will increase your general sense of well being and your ability to handle pain.

          When you are in a deeply relaxed state, muscle tension is decreased around the painful area and secondary pain is reduced.  If you held a sharp rock tightly in your hand, you would feel unnecessary pain from the rock until you let go.  In the same way, loosening the muscles around a painful area reduces the added pain.  Sometimes you can distract yourself from pain by focusing on a pleasant experience such as a nature spot, a favorite movie or happy event.   Children find it especially easy to become absorbed in the memory of a television program.  It is also possible to imagine the pain in another part of your body where you can tolerate it better, such as your little finger.

          You can become more involved with your pain by imagining you can hold it in your hands and look at it carefully.  Use all your senses:  give the pain a color, shape, texture, smell, sound, number.  Open it up and imagine what it's like inside.  Once you know it thoroughly, you can change your image of it.  Let it become lighter and let the wind blow it away.  Bury it, kick it away, let it fade out.  Send it off in a balloon.  Cool it down or warm it up.  Do whatever gives you relief.

          Children were the first to teach us to turn off the pain switches before receiving a needle.  They can understand that pain is experienced in the mind, so they imagine the pathways or wires connecting the site of the injection to the head.  Then, after visualizing one or more switches somewhere along the wire, they simply turn off the switches, and disconnect the pain.  Stroking the area that will be injected with a light circular motion for two or three minutes also helps that area go to sleep.  Let the child in you show you how to put your arm or other part to sleep.  You may be pleasantly surprised with how quickly you can learn to handle small pains.

Nausea:

          You can apply the same techniques used in pain control to nausea control.  Concentrating on a pleasant experience or place can help reduce the experience of nausea.  Some people imagine themselves standing in very cold water to focus their attention away from their stomachs.  Practicing deep breathing will relax the abdominal muscles and can reduce the vomiting response.  Our sense of time is changeable and a long uncomfortable procedure can be remembered as being very short while a joy can be stretched out.  When you experience a period of distress in your body, ask your body to remember it as a brief period.

Sleeplessness:

          Stress in our lives often interferes with our ability to sleep.  Having a regular routine for bed time preparation helps along with using a number of relaxation techniques.  If worries keep you awake, an effective technique is to imagine each worry being placed securely on a shelf for the night.  Actually allow yourself to fantasize a shelf and a container for each worry.  Then, become aware of each concern and consciously say:  "I'm putting you away on the shelf at least until morning.  There is nothing more that I can do with you tonight".  Another technique many patients find useful is to focus on body awareness.  Quietly say to yourself:  "I am aware of . . .  (list three things) that I can see.  I am aware of . . .  (list three things) that I can hear.  I am aware of . . .  (list three things) that I can feel.  Then repeat this pattern with two things in each category, and repeat it again with one in each category. If you are not already asleep, do this again from the beginning.

          If you use relaxation right before going to sleep, you can suggest to yourself that you will drift deeper into a sleeping state.  You can add that in the morning you will wake feeling very refreshed.  Sometimes upon wakening after an uncomfortable night and before you are fully awake, you might try going into a deep state of relaxation and giving yourself the suggestion that you will awaken the second time feeling well rested and ready for the day.

Fears:

          In a deeply relaxed state you can change the image of something you fear.  You can also change the meaning of this fear.  A woman who was afraid of black spiders imagined them as being green with pipe cleaner legs.  Then she multiplied them into a dancing chorus and finally slowed them down.  She took each aspect that frightened her and changed it into something humorous.  Similarly, a patient who was afraid of chemotherapy imagined it being delivered by a whole army of caring, committed soldiers who knew exactly what they were doing.  This greatly lessened his anxiety.

Goal Setting:

          Self hypnosis and relaxation can help you clarify concerns, values and beliefs.  Your experiences of pleasant scenes and special people can bring insights which may lead to change and new directions in your life.  You can allow the creative part of your mind to come up with wonderful ideas.  Let yourself dream; you may be surprised at the results this will bring.

          When you are deeply relaxed, visualize a goal as clearly as you wish.  The more concrete and real you make your goal the more likely you will be to achieve it.  Give your goal a time frame such as:  "by January I want to . . . " or "within weeks I will have . . . ", or "by tomorrow I'll know . . . "  Then, imagine the smallest first step toward your goal you might take.  Don't be concerned about all the possible steps; just focus on the first one.  The others will follow.  Practice visualizing goals often.  Over time they may change and new ones may become important.

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          You have at hand the tools to create a special quiet place within you.  With a still point, you can have a sense of strength and purpose.   As you become quieter, through relaxation, you expend less energy worrying about what you cannot control.  You can recognize the value of anger, the fact that confusion often comes before clarity and that discouragement often comes before the renewal of hope.  Learning to relax deeply is an easy way to create a still point in your life.

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READING ON RELAXATION AND GUIDED IMAGERY

Benson, Herbert (1975), The relaxation response.  New York: Avon.

Borysenko, Joan (1987), Minding the body, mending the mind.  Reading, Massachusetts:  Addison -Wesley.

Davis, E., Eshelman, E. & McKay, M. (2000).  The relaxation & stress reduction workbook.  Oakland:  New Harbinger Publications.

Gawain, Shakti (1978).  Creative visualization.  Toronto:  Bantam. 

Gendlin, Eugene. (1981).  Focusing.  Toronto: Bantam.

Kabat-Zinn, Jon (1990).  Full catastrophe living.  New York: Delacorte Press.

Miller, Emmett (1997).  Deep healing.  New York:  Hay House.

Naparstek, Belleruth (1994).  Staying well with guided imagery.  New York:  Time Warner Books.

Rossman, Martin (2000).  Guided imagery for self healing.  Novato, CA:  New World Library.

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ACKNOWLEDGEMENTS

This handbook was written byKatherine M. Leonard, Ph.D.,Psychologist, and Ronna F. Jevne, Ph.D., Research Associate, at the Cross Cancer Institute and was made possible through the Donna Cipin Memorial Fund.  It is dedicated to Donna Cipin, who was one of the first participants in the Cross Cancer Institute's Relaxation and Mental Training Program.  It is also dedicated to all the participants who have attended, supported, and helped to shape the program.

We would like to express appreciation to Susan Carnahan, under the auspices of the Cross Cancer Institute Volunteer Services Department, for her editorial assistance in preparing this handbook and to the Cross Cancer Institute Volunteers for their ongoing contributions to the Relaxation and Mental Training Program.

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