Creativity: Relaxing The Left Brain: Inverted Drawing Exercise

This exercise is worth 20 points. To turn in your work you will need to scan it in and created a PDF file (please send a copy of the original work as well so I can see what you were trying to copy). You are not being graded on your artwork rather on your ability to describe your experience in two to three paragraphs. Talk about how you were feeling prior to the exercise, during it and when it was done. Comment on what you think of this exercise in creativity and relaxation, how it felt to actually do the drawing, how you felt during and after the inverted drawing exercise. Note how you were feeling, what your brain was doing and engaged in before, during and after the exercise.

According to Kalat for almost all right handed people and more than 60% of left handers, the left hemisphere of the brain controls speech while the right hemisphere is responsible for spatial relationships such as what an object would look like if it was rotated. The left brain is verbal, logical, rational and analytical while the right brain deals with images, patterns, dreams, analogies and new ideas. Because of this difference in processing, the right brain is more conducive to the relaxation response (Davis, Eshelman, McKay, 2000).

Using the imaginative and creative part of the brain can be relaxing. This exercise is adapted from The Relaxation & Stress Reduction Workbook (pg 58).I used this exercise in a Stress and Coping course. This exercise draws on the theory and work by Betty Edwards an art teacher and researcher (see the vase-face exercise on the moodle site). She forces her students to shift from thinking about a drawing exercise to intuiting the drawing exercise by asking them to draw the image upside down.

The inverted drawing exercise is designed to cognitively shift you from labeling, logical, rational mode to a nonverbal, visual, intuitive mode the left brain can’t process. After the inverted drawing exercise, according to Edwards, “students reported less time urgency, less attachment to meaning, and a heightened sense of alertness, while feeling relaxed, calm, confident and exhilarated.”

Text Box: Find a quiet place to draw where you will not be disturbed. Play music if you like. Choose a drawing that interests you from an art book. Turn the drawing upside down and begin to copy what you see. Do not turn the drawing right side up until you have completed your artwork. Finish the drawing in one time period allow at least 35-40 minutes. Set a timer if this helps.   To begin: Look at the inverted drawing for a minute and take in the lines, angles and shapes. You can see how it fits together, when you draw start at the top and copy each line, moving from line to line, putting it together like a puzzle. Do not name parts as you draw. Take your time, line to line, don’t make the exercise hard. Allow your movements to be easy and slow.   After you’ve finished drawing, take a moment to recognize how you feel and your state of mind. Do you feel calm and relaxed? Did you lose track of time, were you able to turn off the left brain chatter? Did you allow yourself to not label the parts, or judge and criticize your work? Now turn the drawing right side up and see how you did. Surprisingly most people do a fairly decent job of copying the inverted image. (adapted from Drawing on the Right Side of the Brain as it appeared in The Relaxation & Stress Reduction Workbook (pg 58).

Kalat, J.W. (2008). Introduction to Psychology 9e.

Davis, M., Eshelman, E. R., & McKay, M. (2000). The Relaxation & Stress Reduction Workbook.

“This comprehensive workbook deserves to be in the library of every active therapist, but it shouldn’t be left on the shelf! Once again, the authors have empowered the reader with straight- forward instructions on every major approach to stress management known. From worry to chronic headaches to information overload, here is your one-stop guide to recovery.”

— R. Reid Wilson, Ph.D., author of Don’t Panic: Taking Control of Anxiety Attacks

“This text remains, after twenty years, the clearest, best-organized, and most readable book on stress management. It has achieved the status of the ‘classic’ self-help reference in the field.”

— Edmund J. Bourne, Ph.D., author of The Anxiety and Phobia Workbook, Coping with Anxiety, and Beyond Anxiety and Phobia

“An exemplary book on stress. It is lucidly written, rationally ordered, and comprehensive, and each section is densely packed with instructions and exercises which make the workbook easy to practice.”

— Somatics Magazine: Journal of the Mind/Body Arts and Sciences

 

 

 

The Relaxation & Stress

Reduction W O R K B O O K

Martha Davis, Ph.D. Elizabeth Robbins Eshelman, MSW

Matthew McKay, Ph.D.

New Harbinger Publications, Inc.

S I X T H E D I T I O N

 

 

Publisher’s Note This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.

The material in chapter 13 that is based upon the work of Michelle G. Craske and David H. Barlow’s Master Your Anxiety and Worry, 2nd ed. (2006) pages 99–109 is used by permission of Oxford University Press.

Distributed in Canada by Raincoast Books

Copyright © 2008 by Martha Davis, Elizabeth Robbins Eshelman, and Matthew McKay New Harbinger Publications, Inc. 5674 Shattuck Avenue Oakland, CA 94609 www.newharbinger.com

All Rights Reserved

Acquired by Tesilya Hanauer; Cover design by Amy Shoup; Edited by Kayla Sussell

Library of Congress Cataloging-in-Publication Data Davis, Martha, 1947- The relaxation and stress reduction workbook / Martha Davis, Elizabeth Robbins Eshelman, and Matthew McKay. — 6th ed. p. cm. Includes bibliographical references and index. ISBN-13: 978-1-57224-549-5 (pbk. : alk. paper) ISBN-10: 1-57224-549-2 (pbk. : alk. paper) 1. Stress management. 2. Relaxation. I. Eshelman, Elizabeth Robbins. II. McKay, Matthew. III. Title. RA785.D374 2008 616.9’8–dc22 2008003637

PDF ISBN: 978-1-57224-680-5

 

 

 

We would like to dedicate this book to our families.

Thank you, Bill and Amanda, Don, Judy, Rebekah and Jordan.

 

 

 

Contents

Preface to the Sixth Edition ix

Acknowledgments xi

How to Get the Most Out of This Workbook xiii

1 How You React to Stress 1 * Sources of Stress * Fight-or-Flight Response * Chronic Stress and Disease * Schedule of Recent Experience * Prevention * Symptoms Checklist * Tactics for Coping with Stress * Tactics for Coping with Stress Inventory * Knowing Your Goal * Symptom-Relief Effectiveness * Symptom-Relief Effectiveness Chart * Further Reading

2 Body Awareness 19 * Background * Body Inventory * Stress-Awareness Diary * Record of General Tension * Further Reading

3 Breathing 27 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Preparing to Do Breathing Exercises * Breathing Basics * Special Considerations * Breathing for Tension Release and Increased Awareness * Breathing for Symptom Control or Release * Final Thoughts * Further Reading * Recordings

4 Progressive Relaxation 41 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Special Considerations * Further Reading * Recording

5 Meditation 47 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Exercises * Special Considerations * Further Reading * Recordings

 

 

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6 Visualization 65 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Basic Tension and Relaxation Exercises * Special Considerations * Further Reading * Recordings

7 Applied Relaxation Training 75 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Special Considerations * Further Reading * Recording

8 Self-Hypnosis 83 * Background * Symptom-Relief Effectiveness * Contraindications * Time to Master * Instructions * Special Considerations * Further Reading

9 Autogenics 99 * Background * Symptom-Relief Effectiveness * Contraindications * Time to Master * Instructions * Special Considerations * Further Reading * Recording

10 Brief Combination Techniques 109 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Further Reading * Recordings

11 Focusing 117 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Suggestions for Focusing on Special Problems * Special Considerations * A Real-Life Example of the Power of Focusing * Final Thoughts * Further Reading * Websites

12 Refuting Irrational Ideas 135 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Refuting Irrational Ideas * Special Considerations * Further Reading

13 Facing Worry and Anxiety 157 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Instructions for Imagery Exposure * Special Considerations * Turn Worry into Problem Solving * Problem-Solving Worksheet * Final Thoughts * Further Reading

14 Coping Skills Training for Fears 187 * Background * The Five Steps of Coping Skills Training for Fears * Symptom-Relief Effectiveness * Time to Master * Instructions * Special Considerations * Further Reading

 

 

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15 Anger Inoculation 205 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Special Considerations * Further Reading

16 Goal Setting and Time Management 223 * Background * Limits of Multitasking * Symptom-Relief Effectiveness * Time to Master * Instructions * Clarifying Your Values * Setting Goals * Developing an Action Plan * Evaluating How You Spend Your Time * Combating Procrastination * Organizing Your Time * Further Reading * Recordings

17 Assertiveness Training 249 * Background * Symptom-Relief Effectiveness * Time to Master * Instructions * Further Reading

18 Work-Stress Management 279 * Background * What Causes Work Burnout? * Symptom-Relief Effectiveness * Time to Master * Five Steps Toward Managing Your Work Stress * Final Thoughts * Further Reading * Website

19 Nutrition and Stress 297 * Background * Symptom-Relief Effectiveness * Time to Master * Twelve Steps to Positive Eating * Self-Assessment * Taking Charge of Your Nutritional Well-Being * Set Your Personal Positive Eating Goals Now * Final Thoughts * Further Reading * Other Resource * Websites

20 Exercise 329 * Background * How Does Exercise Reduce Stress? * What Is the Evidence? * Types of Exercise * Symptom-Relief Effectiveness * Time to Master * Developing Your Own Exercise Program * Choosing the Best Type of Exercise for Yourself * Establishing Goals * Sample Exercise Program * Special Considerations * Further Reading * Television Programs, Videos, and DVDs * Websites * Community Resources * Training Resources for Long-Distance Activities

21 When It Doesn’t Come Easy—Getting Unstuck 355 * Taking Responsibility for Your Decisions * Confront Your Excuses * Confronting Roadblocks to Stress Management and Relaxation * When Symptoms Persist * Persistence Pays

Index 361

 

 

 

Preface to the Sixth Edition

Today, we are inundated with all kinds of information, including a lot of information about stress and stress management. What is unique about this book is that it immediately zeros in on what is relevant to you; that is, the specific stressors in your life and how you react to them. Once you’ve identified the sources of your stress, your most disturbing symptoms, and how you typi- cally cope with them, you are directed to the techniques that will help you in your particular situation. In short, you don’t have to waste your time reading material that isn’t relevant to your specific needs; instead you can focus on simple step-by-step instructions that will teach you how to feel better now.

This workbook is based on more than twenty-five years of clinical experience working with clients who came to us with symptoms of tension and stress like insomnia, worry, high blood pressure, headaches, indigestion, depression, and road rage. When they seek help, many of these people report they are experiencing some kind of a transition, such as a loss, a promotion, or a move. This isn’t surprising, since stress can be defined as any change to which you must adapt. Most clients describe feeling worn down by everyday hassles such as dealing with inconsiderate or rude people, commuting long distances, caretaking children and elderly relatives, and man- aging tons of paperwork. One client referred to this “wearing down” process as a “death by a thousand cuts.” Indeed, unmanaged stress can have an accumulative effect that may lead to major psychological and physical illnesses. Clients also tell us about some of their less successful stress- management strategies: working harder and faster; numbing their pain and soothing themselves with drugs, alcohol, and food; worrying about their problems; procrastinating; and taking their frustrations out on others.

To date, more than 700,000 people have purchased this book to learn how to relax their bodies, calm their minds, turn around their self-defeating behavior, and take control of their hectic lives. About every five years we update this workbook, adding new strategies that the latest research and our clinical experience have shown to be effective. We eliminate techniques we’ve learned are not especially helpful, and we simplify and shorten some techniques to save you time. This allows us to keep this workbook as an up-to-date, relevant resource for professionals, a solid source of information for individuals who want to learn to manage their stress on their own, and a popular textbook in classes and workshops on stress management and relaxation.

 

 

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Recent research supports the commonsense notion that it is better to face your troubles than to run away from them. Although escaping painful feelings like anxiety, depression, and anger may make you feel better in the short run, in the long run, avoidance prevents you from having positive corrective experiences associated with facing these painful feelings. For example, drop- ping a speech class because you are worried about blowing a talk in front of a group of strangers may alleviate your anxiety immediately, but you don’t get the experience of surviving giving the talk and the confidence that comes from learning that you can do it, albeit imperfectly. Instead, you continue to live in fear of public speaking, and the next time you are faced with giving a talk in front of a group, you are still terrified.

With this in mind, we’ve added some techniques to strengthen your ability to tolerate dis- tressing feelings as well as build up your self-confidence so you can accomplish your goals more effectively. We’ve replaced the chapter called Thought Stopping with the new chapter Focusing. This chapter will teach you to explore the feelings in your body and understand what they mean. Rather than trying to suppress your feelings, you are invited to move toward accepting them and learning from them, using a simple but profound technique called “Focusing.” Typically, this lessens or eliminates the power of distressing feelings in your life.

We’ve revised the Worry Control chapter (now called Facing Worry and Anxiety) with an emphasis on facing your fear of uncertainty, using Michelle G. Craske’s and David H. Barlow’s new model of exposure. The Coping Skills Training chapter has been divided into two chapters: Coping Skills Training for Fears and a new chapter called Anger Inoculation.

Whether you want to make just a few changes in your lifestyle or you need a major life over- haul, this workbook shows you how to get started and stick with a program that is tailored just for you. Based on the feedback we’ve received from our clients and readers who’ve used these techniques, your efforts will be amply rewarded.

 

 

Acknowledgments

The authors wish to acknowledge the following contributors to the sixth edition of this book. Their expertise, experience, and collaboration have made this a more valuable edition.

Caryl Fairfull, RD, is a registered dietitian and has held leadership positions in the American Dietetic Association. She is a graduate of the University of California at Santa Barbara and com- pleted her dietetic internship at the Bronx VA Hospital in the Bronx, New York. Ms. Fairfull managed the Department of Nutrition Services for Kaiser Permanente’s Santa Clara Medical Center in northern California. She has developed nutrition care guidelines and provided indi- vidual and group nutrition counseling. She currently works at Sierra Nevada Memorial Hospital in Grass Valley, California, providing clinical nutrition services. Ms. Fairfull wrote chapter 19, Nutrition and Stress.

Cheryl Pierson-Carey, PT, MS, is a rehabilitation specialist at Kaiser Permanente in Fremont, California, and an associate clinical professor in the UCSF/SFSU Graduate Program in Physical Therapy. She holds degrees from Indiana University, Purdue University, and Samuel Merritt College. She is a member of the American Physical Therapy Association. Ms. Pierson-Carey wrote chapter 20, Exercise.

The authors would like to thank Albert Ellis, PhD for volunteering to review and give feedback on the Refuting Irrational Ideas chapter. Dr. Ellis developed Rational Emotive Behavior Therapy upon which this chapter is based.

We would also like to express our appreciation to Patricia Eaton LMFT for suggesting the case study in the Focusing chapter. Ms. Eaton is a therapist in the Psychiatry Department at Kaiser- Permanente Medical Center in Santa Clara.

 

 

 

How to Get the Most Out of This Workbook

This workbook teaches you clinically proven stress-management and relaxation techniques. Each technique is presented with concise background information followed by step-by-step exercises. As you practice these techniques, you will gain new insight into your personal stress response and learn how to reestablish balance and a sense of well-being in your life.

Use this workbook as a guide. Read chapters 1 and 2 first. They are the foundation upon which all of the other chapters are built. Then you will know enough about stress and your per- sonal reactions to stress to decide which chapters will be most helpful for you to read next.

Chapters 3 through 10 teach techniques for relaxation. Chapters 11 through 15 will help you with your stressful thoughts and feelings. Chapter 16 assists you in managing your time more effectively so that you can free up time to relax and do more of what is most important to you. From chapter 17 you can learn to communicate more assertively and chapter 18 gives you many options to deal with environmental and interpersonal stress at work. Chapters 19 and 20 teach the basics of nutrition and exercise. Chapter 21 gives you some suggestions on how to increase motivation, deal with problems that come up along the way, and stick to your plan.

Stress and tension are present in your life every day. Stress management and relaxation can be effective only if you make them a daily part of your lifestyle. As you are learning the skills in this book that are pertinent to you, practice them repeatedly to ensure that you will be able to carry them out anytime you need to, without having to refer to written materials. Regular conscious practice can lead to habits of regular relaxation and stress reduction at an unconscious level.

Here are some suggestions that will help you relax on a regular basis:

• Make an agreement with yourself to set aside a specific time each day dedicated to relaxation. If finding the time to do the exercises in this book is an issue, read chapter 16 on time management.

• The length of time required each day to practice the relaxation techniques in this workbook varies. Start small. Doing a relaxation exercise for five minutes on a regular basis is better than doing it only once for an hour. Aim for twenty to thirty minutes

 

 

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of relaxation time once or twice a day. Note that some people prefer to take more frequent, shorter relaxation breaks.

• You decide when is the best time to relax based on your schedule by answering these two questions: When do you need to relax most? When can you realistically break away from external demands to take some time for yourself? Here are some examples of what clients in our stress-management and relaxation classes have found most helpful and doable:

• Beginning the day with a relaxation exercise makes people more focused and proactive in dealing with the stressful demands of their day.

• Taking a relaxation break during the day can reverse growing tension that would otherwise culminate in painful symptoms such as a headache or indigestion.

• Relaxing before leaving work or upon arriving at home allows a person to let go of and decompress from the tensions of his or her busy day and to become calm and revitalized enough to enjoy personal time at home.

• Using a relaxation exercise to go to sleep quickly and then sleep soundly can result in waking up refreshed.

• Choose a quiet place where you will not be interrupted to learn the techniques. Once mastered, many of the relaxation techniques presented in this workbook can be done in stressful situations.

• Since this is a new activity for you, it is a good idea to let people around you know what you are doing. Ask them to help out by leaving you alone without distracting you. Family members, fellow office workers, and friends are usually very supportive of these exercises once they understand what you are doing and why.

• It’s best not to practice a relaxation exercise right after eating a big meal or when very tired, unless your purpose is to fall asleep.

• You will enjoy your experience more if you choose a comfortable position in a location that has a comfortable temperature, wear loose clothing, and remove your contacts or glasses.

See your health care provider before beginning the work in this book if any of the following circumstances are relevant to you:

• If you are over thirty or if your reaction to stress involves physical symptoms, such as frequent headaches, stomach problems, or high blood pressure, your doctor

 

 

xv

should perform a physical examination to rule out possible physical problems that may need medical attention.

• If, after starting your stress-management program, you experience any prolonged negative physical effects.

• If you have been taking medication that you may no longer need once your stress- related symptoms go away with regular practice of these exercises.

Your health care provider can be a supportive partner in your efforts to live a healthier life.

 

 

 

1

How You React to Stress

Stress is an everyday fact of life. You can’t avoid it. Stress results from any change you must adapt to, ranging from the negative extreme of actual physical danger to the exhilaration of falling in love or achieving some long-desired success. In between, day-to-day living confronts even the most well-managed life with a continuous stream of potentially stressful experiences. Not all stress is bad. In fact, stress is not only desirable it is also essential to life. Whether the stress you experi- ence is the result of major life changes or the cumulative effect of minor everyday hassles, it is how you respond to these events that determines the impact that stress will have on your life.

SOURCES OF STRESS

You experience stress from four basic sources:

1. Your environment bombards you with demands to adjust. You must endure weather, pollens, noise, traffic, and air pollution.

2. You also must cope with social stressors such as demands for your time and attention, job interviews, deadlines and competing priorities, work presentations, interpersonal con- flicts, financial problems, and the loss of loved ones.

3. A third source of stress is physiological. The rapid growth of adolescence; the changes menopause causes in women; lack of exercise, poor nutrition, and inadequate sleep; illness, injuries, and aging all tax the body. Your physiological reaction to environmental and social threats and changes also can result in stressful symptoms such as muscle tension, headaches, stomach upset, anxiety, and depression.

4. The fourth source of stress is your thoughts. Your brain interprets complex changes in your environment and body and determines when to turn on the “stress response.” How you interpret and label your present experience and what you predict for your future can serve either to relax or to stress you. For example, interpreting a sour look from your boss to mean that you are doing an inadequate job is likely to be very anxiety-provoking. Interpreting the same look as tiredness or preoccupation with personal problems will not be as frightening.

 

 

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Stress researchers Lazarus and Folkman (1984) have argued that stress begins with your appraisal of a situation. You first ask how dangerous or difficult the situation is and what resources you have to help you cope with it. Anxious, stressed people often decide that (1) an event is dangerous, difficult, or painful and (2) they don’t have the resources to cope.

FIGHT-OR-FLIGHT RESPONSE

Walter B. Cannon, a physiologist, laid the groundwork for the modern meaning of “stress” at Harvard in the beginning of the twentieth century. He was the first to describe the “fight-or- flight response” as a series of biochemical changes that prepare you to deal with threat or danger. Primitive people needed quick bursts of energy to fight or flee predators like saber-toothed tigers. You can thank this response for enabling your ancestors to survive long enough to pass on their genetic heritage to you. Think of occasions in your life when the fight-or-flight response served you well, such as when you had to respond quickly to a car that cut in front of you on the freeway or when you had to deal with an overly aggressive panhandler. These days, however, when social custom prevents you from either fighting or running away, this “emergency” or “stress response” is rarely useful.

Hans Selye (1978), the first major researcher on stress, was able to trace what happens in the body during the fight-or-flight response. He found that any problem, imagined or real, can cause the cerebral cortex (the thinking part of the brain) to send an alarm to the hypothalamus (the main switch for the stress response, located in the midbrain). The hypothalamus then stimulates the sympathetic nervous system to make a series of changes in the body. These changes include the following: The heart rate, breathing rate, muscle tension, metabolism, and blood pressure all increase. The hands and feet become cold as blood is directed away from the extremities and digestive system into the larger muscles that can help to fight or run. Some people experience butterflies in their stomachs. The diaphragm and anus lock. The pupils dilate to sharpen vision and hearing becomes more acute.

Regrettably, during times of chronic stress when the fight-or-flight physiological responses continue unchecked, something else happens that can have long-term negative effects. The adrenal glands secrete corticoids (adrenaline or epinephrine, and norepinephrine), which inhibit digestion, reproduction, growth, tissue repair, and the responses of the immune and inflamma- tory systems. In other words, some very important functions that keep the body healthy begin to shut down.

Fortunately, the same mechanism that turns the stress response on can turn it off. This is called the relaxation response. As soon as you decide that a situation is no longer dangerous, your brain stops sending emergency signals to your brain stem, which in turn ceases to send panic messages to your nervous system. Three minutes after you shut off the danger signals, the

 

 

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fight-or-flight response burns out. Your metabolism, heart rate, breathing rate, muscle tension, and blood pressure all return to their normal levels. Herbert Benson (2000) suggests that you can use your mind to change your physiology for the better, improving your health and perhaps reducing your need for medication in the process. He coined the term “the relaxation response” to refer to this natural restorative response.

CHRONIC STRESS AND DISEASE

Chronic or persistent stress can occur when life stressors are unrelenting, as they are, for example, during a major reorganization or downsizing at work, while undergoing a messy divorce, or coping with chronic pain or disease or a life-threatening illness. Chronic stress also takes place when small stressors accumulate and you are unable to recuperate from any one of them. As long as the mind perceives a threat, the body remains aroused. If your stress response remains turned on, your chances of getting a stress-related disease may be increasing.

Researchers have been looking at the relationship between stress and disease for over a hundred years. They have observed that people suffering from stress-related disorders tend to show hyperactivity in a particular “preferred system,” or “stress-prone system,” such as the skel- etomuscular, cardiovascular, or gastrointestinal system. For example, chronic stress can result in muscle tension and fatigue for some people. For others, it can contribute to stress hypertension (high blood pressure), migraine headaches, ulcers, or chronic diarrhea.

Almost every system in the body can be damaged by stress. When an increase in corti- coids suppresses the reproduction system, this can cause amenorrhea (cessation of menstruation) and failure to ovulate in women, impotency in men, and loss of libido in both. Stress-triggered changes in the lungs increase the symptoms of asthma, bronchitis, and other respiratory condi- tions. Loss of insulin during the stress response may be a factor in the onset of adult diabetes. Stress suspends tissue repair and remodeling, which, in turn, causes decalcification of the bones, osteoporosis, and susceptibility to fractures. The inhibition of immune and inflammatory systems makes you more susceptible to colds and flu and can exacerbate some specific diseases such as cancer and AIDS. In addition, a prolonged stress response can worsen conditions such as arthri- tis, chronic pain, and diabetes. There are also some indications that the continued release and depletion of norepinephrine during a state of chronic stress can contribute to depression and anxiety.

The relationship between chronic stress, disease, and aging is another area of research. Experts in aging are looking at the changing patterns of disease and the emergence of degen- erative disorders. Over just a few generations, the threat of infectious diseases such as typhoid, pneumonia, and polio has been replaced with such “modern plagues” as cardiovascular disease, cancer, arthritis, respiratory disorders like asthma and emphysema, and a pervasive incidence of

 

 

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depression. As you age normally, you expect a natural slowing down of your body’s functioning. But many of these mid- to late-life disorders are stress-sensitive diseases. Currently, research- ers and clinicians are asking how stress accelerates the aging process and what can be done to counteract this process.

SCHEDULE OF RECENT EXPERIENCE

Thomas Holmes, MD, and his research associates at the University of Washington found that people are more likely to develop illnesses or clinical symptoms after experiencing a period of time when they’ve had to adapt to many life-changing events (1981).

Dr. Holmes and his associates developed the Schedule of Recent Experience, which allows you to quantify how many changes you’ve experienced in the past year and consider how these stressful events may have increased your vulnerability to illness. The main purpose of this scale, however, is to increase your awareness of stressful events and their potential impact on your health so that you can take the necessary steps to reduce the level of stress in your life.

Instructions: Think about each possible life event listed below and decide how many times, if at all, each has happened to you within the last year. Write that number in the Number of Times column. (Note that if an event happened more than four times, you would still give it a 4 in that column.)

Event Number of Times

x Mean Value

= Your Score

1. A lot more or a lot less trouble with the boss. x 23 =

2. A major change in sleeping habits (sleeping a lot more or a lot less or a change in time of day when you sleep).

x 16 =

3. A major change in eating habits (eating a lot more or a lot less or very different meal hours or surroundings).

x 15 =

4. A revision of personal habits (dress, manners, associa- tions, and so on).

x 24 =

5. A major change in your usual type or amount of recreation.

x 19 =

6. A major change in your social activities (e.g., clubs, dancing, movies, visiting, and so on).

x 18 =

7. A major change in church activities (attending a lot more or a lot less than usual).

x 19 =

 

 

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8. A major change in the number of family get- togethers (a lot more or a lot fewer than usual).

x 15 =

9. A major change in your financial state (a lot worse off or a lot better off).

x 38 =

10. Trouble with in-laws. x 29 =

11. A major change in the number of arguments with spouse (a lot more or a lot fewer than usual regarding child rearing, personal habits, and so on).

x 35 =

12. Sexual difficulties. x 39 =

13. Major personal injury or illness. x 53 =

14. Death of a close family member (other than spouse). x 63 =

15. Death of spouse. x 100 =

16. Death of a close friend. x 37 =

17. Gaining a new family member (through birth, adoption, oldster moving in, and so on).

x 39 =

18. Major change in the health or behavior of a family. x 44 =

19. Change in residence. x 20 =

20. Detention in jail or other institution. x 63 =

21. Minor violations of the law (traffic tickets, jaywalking, disturbing the peace, and so on).

x 11 =

22. Major business readjustment (merger, reorganization, bankruptcy, and so on).

x 39 =

23. Marriage. x 50 =

24. Divorce. x 73 =

25. Marital separation from spouse. x 65 =

26. Outstanding personal achievement. x 28 =

27. Son or daughter leaving home (marriage, attending college, and so on).

x 29 =

28. Retirement from work. x 45 =

29. Major change in working hours or conditions. x 20 =

30. Major change in responsibilities at work (promotion, demotion, lateral transfer).

x 29 =

 

 

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31. Being fired from work. x 47 =

32. Major change in living conditions (building a new home or remodeling, deterioration of home or neighborhood).

x 25 =

33. Spouse beginning or ceasing to work outside the home. x 26 =

34. Taking out a mortgage or loan for a major purchase (purchasing a home or business and so on).

x 31 =

35. Taking out a loan for a lesser purchase (a car, TV, freezer, and so on).

x 17 =

36. Foreclosure on a mortgage or loan. x 30 =

37. Vacation. x 13 =

38. Changing to a new school. x 20 =

39. Changing to a different line of work. x 36 =

40. Beginning or ceasing formal schooling. x 26 =

41. Marital reconciliation with mate. x 45 =

42. Pregnancy. x 40 =

Your total score

Copyright © 1981 by Thomas H. Holmes, MD, The University of Washington Press Edition, 1986. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98185.

Scoring:

• Multiply the mean value by the number of times an event happened, and enter the result in the Your Score column.

• Add up your scores to get your total score and enter it at the bottom of the schedule. (Remember, if an event happened more than four times within the past year, give it a 4 in the Number of Times column. A 4 is the highest number that can be used in the Number of Times column.)

According to Dr. Holmes and his associates, the higher your total score, the greater your risk of developing stress-related symptoms or illnesses. Of those with a score of over 300 for the past year, almost 80 percent will get sick in the near future; of those with a score of 200 to 299, about 50 percent will get sick in the near future; and of those with a score of 150 to 199, only about 30 percent will get sick in the near future. A score of less than 150 indicates that you have a low chance of becoming ill. So, the higher your score, the harder you should work to stay well.

 

 

How You React to Stress

7

Because individuals vary in their perception of a given life event as well as in their ability to adapt to change, we recommend that you use this standardized test only as a rough predictor of your increased risk.

Stress can be cumulative. Events from two years ago may still be affecting you now. If you think that past events may be a factor for you, repeat this test for the events of the preceding year and compare your scores.

PREVENTION

Here are some ways you can use the Schedule of Recent Experience to maintain your health and prevent illness. You can use it to:

1. Remind yourself of the amount of change that has happened to you by posting the Schedule of Recent Experience where you and your family can see it easily.

2. Think about the personal meaning of each change that’s taken place for you and try to identify some of the feelings you experienced.

3. Think about ways that you can best adjust to each change.

4. Take your time when making decisions.

5. Try to anticipate life changes and plan for them well.

6. Pace yourself. Don’t rush. It will get done.

7. Take time to appreciate your successes, and relax.

8. Be compassionate and patient with yourself. It is not uncommon for people to become overwhelmed by all the stresses in their lives. It takes a while to put into effect coping strategies to deal with stress.

9. Acknowledge what you can control and what you cannot control and, when possible, choose which changes you take on.

10. Try out the stress-management and relaxation techniques presented in this book and incorporate the ones that work best for you into your personalized stress-management program.

 

 

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8

SYMPTOMS CHECKLIST

The major objective of this workbook is to help you achieve symptom relief using relaxation and stress reduction techniques. So that you can determine exactly which symptoms you want to work on, complete the following checklist.

After you’ve used this workbook to master the stress reduction techniques that work best for your symptoms, you can return to this checklist and use it to measure your symptom relief.

Instructions: Rate your stress-related symptoms below for the degree of discomfort that they cause you, using this 10-point scale:

Slight discomfort Moderate discomfort Extreme discomfort

1 2 3 4 5 6 7 8 9 10

Symptom

(Disregard those that you don’t experience)

Degree of discomfort (1-10) now

Degree of discomfort (1-10) after mastering relax-

ation and stress reduction techniques

Anxiety in specific situations Tests Deadlines Competing priorities Interviews Public Speaking Other

 

 

 

 

Anxiety in personal relationships Spouse Parents Children Other

 

 

 

 

Worry

Depression

Anxiety

Anger

Irritability

Resentment

Phobias

 

 

How You React to Stress

9

Fears

Muscular tension

High blood pressure

Headaches

Neck pain

Backaches

Indigestion

Muscle spasms

Insomnia

Sleeping difficulties

Work stress

Other

Important: Physical symptoms may have purely physiological causes. You should have a medical doctor eliminate the possibility of any such physical problems before you proceed on the assump- tion that your symptoms are completely stress-related.

TACTICS FOR COPING WITH STRESS

As a member of modern society, you have available to you a variety of methods to cope with the negative effects of stress. Doctors can treat your stress-related symptoms and diseases. Over-the- counter remedies can reduce your pain, help you sleep, keep you awake, enable you to relax, and counter your acid indigestion and nervous bowels. You can consume food, alcohol, and recre- ational drugs to help block feelings of discomfort. You may have diversions such as TV, movies, the Internet, hobbies, and sports. You can withdraw from the world into your home and avoid all but the most necessary contact with the stressful world around you.

Our culture rewards people who deal with their stress by working harder and faster to produce more in a shorter time. There are people who thrive in our rapid-paced culture who are referred to as “type A” personalities. The type A personality is a term that was coined in the 1970s to describe people who have a strong sense of time urgency, can’t relax, are insecure about their status, are highly competitive, and are easily angered when they don’t get their own way. The classic study of type A personality was the twelve-year-longitudinal study of over 3,500

 

 

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healthy middle-aged men reported by Friedman and Rosenman in 1974 and estimated that type A behavior doubled the risk of coronary heart disease. Although this popular concept has received a great deal of interest in health psychology, recent research (Williams 2001) has indicated that only the hostility component of type A personality is a significant health-risk factor.

In 2006 an article presented in the American Journal of Cardiology (Denollet, et al.) discussed how certain personal traits can hurt heart health and proposed a new personality construct, referred to as type D or “distressed” personality. Type D behavior is characterized by the tendency to experience negative emotions (anger and hostility) and to inhibit these emotions while avoid- ing social contact with others. Both negativity and social withdrawal are associated with greater cortisol (a hormone that is closely related to cortisone in its physiological effects), increased reac- tivity to stress and risk for coronary heart disease and other stress-related diseases. However, it is anyone’s guess whether the type D label will have the staying power that the type A label has had.

In contrast to anxious, chronically stressed people, certain individuals are less vulnerable to stress, according to University of Chicago research psychologist Suzanne Kobasa, and colleagues (1985). These “stress-hardy” individuals have a lower frequency of illness and work absenteeism. They view stressors as challenges and chances for new opportunities and personal growth rather than as threats. They feel in control of their life circumstances, and they perceive that they have the resources to make choices and influence events around them. They also have a sense of com- mitment to their homes, families, and work that makes it easier for them to be involved with other people and in other activities. According to Herbert Benson and Eileen Stuart, authors of The Wellness Book (1993), the incidence of illness is lowest in individuals who have these stress-hardy characteristics and who also have a good social support system, exercise regularly, and maintain a healthy diet.

In his popular book Emotional Intelligence (1995), Daniel Goleman refers to emotionally healthy people as individuals who consistently demonstrate self-awareness, self-discipline, and empathy. Goleman asserts through his book that “emotional intelligence” contributes to a person’s ability to cope with stress.

In her book The Tending Instinct (2002), psychologist Shelley E. Taylor discusses how we are biologically programmed to care for one another. In her research, Taylor discovered that studies involving the “fight-or-flight response” involved only male subjects. She set out to see whether men and women deal with stress differently, and if so, how. She found that in times of stress, people (especially women) who are driven to turn to their social support group to give and receive support—instead of running or fighting—are much less likely to experience a prolonged stress response. Her theory is known as “tend and befriend.” Taylor says, “Social ties are the cheapest medicine we have” (p. 165).

 

 

How You React to Stress

11

TACTICS FOR COPING WITH STRESS INVENTORY

Before you embark on a program of change, it is important to consider how you currently manage your stress.

Instructions: Listed below are some common ways of coping with stressful events. Mark those that are characteristic of your behavior or that you use frequently.

1. I ignore my own needs and just work harder and faster.

2. I seek out friends for conversation and support.

3. I eat more than usual.

4. I engage in some type of physical exercise.

5. I get irritable and take it out on those around me.

6. I take a little time to relax, breathe, and unwind.

7. I smoke a cigarette or drink a caffeinated beverage.

8. I confront my source of stress and work to change it.

9. I withdraw emotionally and just go through the motions of my day.

10. I change my outlook on the problem and put it in a better perspective.

11. I sleep more than I really need to.

12. I take some time off and get away from my working life.

13. I go out shopping and buy something to make myself feel good.

14. I joke with my friends and use humor to take the edge off.

15. I drink more alcohol than usual.

16. I get involved in a hobby or interest that helps me unwind and enjoy myself.

17. I take medicine to help me relax or sleep better.

18. I maintain a healthy diet.

19. I just ignore the problem and hope it will go away.

20. I pray, meditate, or enhance my spiritual life.

 

 

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12

21. I worry about the problem and am afraid to do something about it.

22. I try to focus on the things I can control and accept the things I can’t.

Adapted from the “Coping Styles Questionnaire.” © 1999 by Jim Boyers, Ph.D., Kaiser-Permanente Medical Center and Health Styles, Santa Clara, CA.

Evaluate your results: The even-numbered items tend to be more constructive tactics and the odd-numbered items tend to be less constructive tactics for coping with stress. Congratulate yourself for the even-numbered items you checked. Think about whether you need to make some changes in your thinking or behavior if you checked any of the odd-numbered items. Consider experimenting with some even-numbered items you haven’t tried before. This workbook will assist you in making these changes.

KNOWING YOUR GOAL

The goal of stress management is not merely stress reduction. After all, wouldn’t life be boring without stress? As mentioned earlier, there is a tendency to think of stressful events or stressors only as negative (such as the injury or death of a loved one), but stressors are often positive. For instance, getting a new home or a promotion at work brings with it the stress of change of status and new responsibilities. The physical exertion of a good workout, the excitement of doing something challenging for the first time, or the pleasure of watching a beautiful sunset on the last day of your vacation are all examples of positive stress.

Distress or negative stress occurs when you perceive that the challenge facing you is dan- gerous, difficult, painful, or unfair, and you are concerned that you may lack the resources to cope with it. You can actually increase your ability to deal with distress by integrating into your everyday life positive activities such as solving challenging problems, practicing regular exercise workouts and relaxation techniques, staying in touch with enjoyable social contacts, following sensible dietary practices, and engaging in optimistic and rational thinking, humor, and play.

Performance and efficiency actually improve with increased stress, until performance peaks as the stress level becomes too great. Stress management involves finding the right types and amounts of stress, given your individual personality, priorities, and life situation, so that you can maximize your performance and satisfaction. By using the tools presented in this workbook, you can learn how to cope more effectively with distress as well as how to add more positive stress or stimulating challenges, pleasure, and excitement to your life.

 

 

How You React to Stress

13

SYMPTOM-RELIEF EFFECTIVENESS

Now that you’ve identified the major sources of your stress, your stress-related symptoms, and your current tactics for dealing with stress, it is time to choose one or two symptoms that bother you the most and select the techniques that you will use to relieve them. Defining and achieving a specific goal will give you a sense of accomplishment and motivate you to continue using the tools and ideas that give you the positive change you are seeking. Because everyone reacts differently to stress, we can’t tell you which techniques will work best for you. However, the chart on the following pages will give you a general idea of what to try first and where to go from there.

Chapter headings for each stress reduction method are across the top, and typical stress- related symptoms are listed down the side. As you can see, more than one stress reduction tech- nique can be effective for treating most symptoms. The most effective techniques for a particular symptom are marked with a boldface X, while other helpful techniques for the same symptom are indicated by a smaller and lighter x.

The techniques fall into roughly two categories: relaxation techniques that focus on relaxing the body, and stress reduction techniques that condition the mind to handle stress effectively. Your mind, body, and emotions are interrelated. In seeking relief from stress, you will obtain the best results by using at least one technique from each of these two broad categories. For example, if your most painful stress symptom is general anxiety, you might practice progressive relaxation and breathing exercises to calm your body and work on the exercises from chapter 12 on refuting irrational ideas and chapter 13 on facing worry and anxiety to reduce your mental and emotional stress. If your results on the Tactics for Coping with Stress Inventory indicate that you do not engage in regular physical exercise and/or your diet is not good, you will also want to refer to chapters 19 on nutrition and 20 on physical exercise to learn how improving these tactics can reduce your general anxiety.

 

 

The Relaxation & Stress Reduction Workbook

14

SYMPTOM-RELIEF EFFECTIVENESS CHART

 

 

 

 

 

 

 

 

T ec

hn iq

ue s

Sy m

pt om

s B

re at

hi ng

P ro

gr es

si ve

R

el ax

at io

n M

ed it

at io

n V

is ua

liz at

io n

A pp

lie d

R el

ax at

io n

Se lf-

H

yp no

si s

A ut

o-

ge ni

cs B

ri ef

C

om bi

na ti

on

Te ch

ni qu

es

Fo cu

si ng

A nx

ie ty

i n

sp ec

ifi c

si tu

– at

io ns

( te

st s,

d ea

dl in

es ,

in te

rv ie

w s,

p re

se nt

at io

ns )

X X

x x

X x

x X

A nx

ie ty

i n

yo ur

r el

at io

n- sh

ip s

(s po

us e,

c hi

ld re

n,

bo ss

) X

x x

x X

G en

er al

a nx

ie ty

a nd

w

or ry

X X

X x

X x

x x

D ep

re ss

io n

X X

x

H os

ti lit

y, a

ng er

, ir

ri ta

bi l-

it y,

r es

en tm

en t

X x

x X

x X

P ho

bi as

, fe

ar s

X X

x X

x

M us

cu la

r te

ns io

n X

X x

x x

X x

H ig

h bl

oo d

pr es

su re

x X

X X

x

H ea

d ac

he s,

n ec

k pa

in ,

ba ck

ac he

s x

X X

X X

X x

x

In di

ge st

io n

x X

x X

X x

In so

m ni

a, s

le ep

in g

di ffi

cu lt

ie s

x X

X X

x x

W or

k st

re ss

X X

X X

X

C hr

on ic

p ai

n X

x X

X x

X X

x X

 

 

How You React to Stress

15

 

 

 

 

 

 

 

 

T

ec hn

iq ue

s

Sy m

pt om

s R

ef ut

in g

Ir ra

ti on

al

Id ea

s

Fa ci

ng

W or

ry a

nd

A nx

ie ty

C op

in g

Sk ill

s T

ra in

in g

fo r

Fe ar

s

A ng

er

In oc

ul at

io n

G oa

l Se

tt in

g an

d T

im e

M an

ag em

en t

A ss

er ti

ve ne

ss

T ra

in in

g W

or k-

St re

ss

M an

ag em

en t

N ut

ri ti

on E

xe rc

is e

A nx

ie ty

i n

sp ec

ifi c

si tu

– at

io ns

( te

st s,

d ea

dl in

es ,

in te

rv ie

w s,

p re

se nt

at io

ns )

x X

X X

x

A nx

ie ty

i n

yo ur

r el

at io

n- sh

ip s

(s po

us e,

c hi

ld re

n,

bo ss

) x

X x

X

G en

er al

a nx

ie ty

a nd

w

or ry

X X

x X

x x

X

D ep

re ss

io n

X x

X x

X

H os

ti lit

y, a

ng er

, ir

ri ta

bi l-

it y,

r es

en tm

en t

X X

X X

x X

P ho

bi as

, fe

ar s

x X

X x

x x

x

M us

cu la

r te

ns io

n x

x X

H ig

h bl

oo d

pr es

su re

x x

x X

X

H ea

d ac

he s,

n ec

k pa

in ,

ba ck

ac he

s x

x X

In di

ge st

io n

x x

X x

In so

m ni

a, s

le ep

in g

di ffi

cu lt

ie s

x X

W or

k st

re ss

X x

x x

X

C hr

on ic

p ai

n x

X x

x X

 

 

The Relaxation & Stress Reduction Workbook

16

Read chapter 2 before you move on to other chapters. Body awareness is the key to every- thing else in this workbook, and without it you cannot use any of these techniques effectively.

FURTHER READING

Amundson, M. E., C. A. Hart, and T. A. Holmes. 1986. Manual for the Schedule of Recent Experience (SRE). Seattle: University of Washington Press.

Benson, H. 1985. Beyond the Relaxation Response. New York: Penguin Publishers.

———. 2000. The Relaxation Response. New York: HarperCollins Publishers.

Benson, H., and E. Stuart. 1993. The Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness. New York: Simon & Schuster.

Denollet, J., S. S. Peterson, C. J. Vrints, and V. M. Conraads. 2006. Usefulness of type D per- sonality in predicting five-year cardiac events above and beyond current symptoms of stress in patients with coronary heart disease. American Journal of Cardiology 97(7):970-973.

Friedman, M., and R. Rosenman. 1974. Type A Personality and Your Heart. New York: Knopf

Goleman, D. 1995. Emotional Intelligence. New York: Bantam Books.

Kobasa, S., S. Maddi, M. Puccetti, and M. Zola. 1985. Effectiveness of hardiness, exercise and social support as resources against illness. Journal of Psychosomatic Research 29:525–533.

Lazarus, R. S., and S. Folkman. 1984. Stress Appraisal and Coping. New York: Springer Publishing.

Lorig, K., H. Holman, D. Sobel, D. Laurent, V. Gonzalez, and M. Menor. 2006. Living a Healthy Life with Chronic Conditions. Palo Alto, CA: Bull Publishing.

Martin, P. R. 1998. The Healing Mind: The Vital Links between Brain and Behavior, Immunity and Disease. New York: St. Martin’s Press.

McBrooks, C., K. Koizumi, and J. O. Pinkston, eds. 1975. The Life and Contributions of Walter Bradford Cannon 1871–1945. Albany: State University of New York Press.

Ornstein, R., and D. Sobel. 1995. Healthy Pleasures. Cambridge, MA: Perseus Press.

———. 1999. The Healing Brain. New York: Major Books.

Rabin, B. 1999. Stress, Immune Function and Health: The Connection. New York: Wiley-Liss.

 

 

How You React to Stress

17

Sapolsky, R. M. 2004. Why Zebras Don’t Get Ulcers: A Guide to Stress, Stress-Related Diseases, and Coping. New York: W. H. Freeman.

Selye, H. 1978. The Stress of Life. New York: McGraw-Hill.

Sobel, D. S., and R. Ornstein. 1997. The Healthy Mind, Healthy Body Handbook. New York: Time-Life Books.

Taylor, S. 2002. The Tending Instinct. New York: Times Books.

Williams, R. B. 2001. Hostility: effects on health and the potential for successful behavioral approaches to prevention in treatments. In Handbook of Health Psychology, edited by A. Baum, T. A. Revenson, and J. E. Singer. Mahwah, New Jersey: Erlbaum.

 

 

 

2

Body Awareness

In this chapter you will learn:

* How the mind and body interact * How to recognize tension in your body * Exercises to recognize and let go of tension in your body

BACKGROUND

The ability to recognize how your body reacts to the stressors in your life can be a powerful skill. Most people are more aware of the weather, the time of day, or their bank balance than they are of the tension in their own bodies or their personal stress response. Your body registers stress long before your conscious mind does. Muscle tension is your body’s way of letting you know that you are stressed, and body awareness is the first step toward acknowledging and reducing that stress.

You inevitably tense your body when you experience stress. When the stress is removed, the tension will also go away. Also, chronic muscular tension occurs in people with particular beliefs or attitudes and tends to tighten specific muscle groups. For example, a woman who believes that it is bad to express anger is likely to have chronic neck tension and pain, while a man experiencing a lot of anxiety about the future may develop chronic stomach problems. This chronic muscular tension restricts digestion, limits self-expression, and decreases energy. Every contracted muscle blocks movement.

Differentiating between your external awareness and internal awareness in order to separate the world from your physical reaction to it is important. External awareness includes all stimulation to the five senses from the outside world. Internal awareness refers to any physical sensation, feeling, emotional discomfort, or comfort inside your body. Much of the tension in your body isn’t felt because most of your awareness is directed toward the outside world. Below, you will learn about exercises designed to locate and explore your body tension.

The importance of body states, their effect on consciousness, and their relationship to stress have been emphasized for many centuries by Eastern philosophies such as Zen, hatha yoga, and Sufism. During the last century, the work of Wilhelm Reich, originally a student of Freud,

 

 

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20

kindled Western psychiatry’s interest in the body’s interaction with emotional conditions. Two other therapies that concentrate on the body and its relationship to emotional stress are Fritz Perls’ Gestalt therapy and Alexander Lowen’s bioenergetic therapy. Both of these therapies work closely with the mind-body relationship. Becoming aware of how your body responds to stress will give you some important information about your personal stress response that you can then use to develop a stress-management plan.

BODY INVENTORY

The following exercises promote body awareness and will help you identify areas of tension in your body.

Internal Versus External Awareness

1. First focus your attention on the outside world. Start sentences with “I am aware of.” (For example, “I am aware of the cars going by outside the window, papers moving, the coffee perking, the breeze blowing, and the blue carpet.”)

2. After you’ve become aware of everything that is going on around you, shift to focusing your attention on your body and your physical sensations—your internal world. (For example, “I am aware of feeling warm, my stomach gurgling, tension in my neck, my nose tickling, and a cramp in my foot.”)

3. Shuttle back and forth between internal and external awareness. (For example, “I am aware of the chair pressing against my buttocks, the circle of yellow light from the lamp, my shoulders hunching up, the smell of bacon.”)

4. Practiced during your free moments throughout the day, this exercise allows you to sepa- rate and appreciate the real difference between your inner and outer worlds.

Body Scanning

Close your eyes. Starting with your toes and moving up your body, ask yourself, “Where am I tense?” Whenever you discover a tense area, exaggerate it slightly so you can become even more aware of it. Be aware of the muscles in your body that are tense. Then, for example, say to yourself, “I am tensing my neck muscles … I am hurting myself … I am creating tension in my body.” Note that all muscular tension is self-produced. At this point, be aware of any life situation that may be causing the tension in your body and think about what you could do to change that.

 

 

Body Awareness

21

Letting Go of Your Body

Lie down on a rug or a firm bed and get comfortable. Pull your knees up until your feet rest flat on the floor (or bed) and close your eyes. Check yourself for comfort. (This may require shifting your body around.) Become aware of your breathing. … Feel the air move into your nose, mouth, and down your throat into your lungs. Focus on your body and let all of the parts come into your awareness spontaneously. What parts of your body come into awareness first? What parts are you less aware of? Become aware of which parts of your body you can feel easily and which parts of your body have little sensation. Do you notice any difference between the right and left side of your body? Now become aware of any physical discomfort you are feeling. Become aware of this discomfort until you can describe it in detail. Focus and be aware of what happens to this discomfort. It may change. … Scan your body for any residual tension or dis- comfort and let it go with each exhalation. Continue letting go for five to ten minutes, allowing your body to take over.

STRESS-AWARENESS DIARY

Some parts of the day are more stressful than others, and some stressful events are more likely to produce physical and emotional symptoms than others. Certain types of stressful events often produce characteristic symptoms. For this reason, keeping a record of stressful events, as well as symptoms that may have been a stress reaction, is useful. Make extra copies of the blank form on the next page for your own diary.

Keep a stress-awareness diary for two weeks. Make a note of the time that a stressful event occurs and the time you notice a physical or emotional symptom that could be related to the stress.

 

 

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22

STRESS-AWARENESS DIARY

Date: Day of the week:

Time Stressful Event Symptom

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Body Awareness

23

The following stress-awareness diary was recorded one Monday by a department store clerk:

Time Stressful Event Symptom

8 A.M. Alarm doesn’t go off, late for work, only had time for coffee

Slight headache, jittery

9:30 A.M. Boss reprimands me for being late

9:50 A.M. Worry, depression, shallow breathing

11 A.M. Customer is rude and insulting

11:15 A.M. Anger, tightness in stomach.

12:20 P.M. Only have 10 minutes for lunch, eat some chips

2:30 P.M. Slight headache

3 P.M. Presentation to senior manager Nervous, sweating

5 P.M. Heavy commute, late for dinner with family

6 P.M. Argument with son Anger, pounding headache

6:35 P.M. Wife defends son Anger, tension in neck, back, and stomach

10 P.M. Worrying, not able to sleep

As you can see, the diary identifies how particular stresses result in predictable symptoms. An interpersonal confrontation and just coffee for breakfast is followed by stomach tension. Rushing may cause vasoconstriction (tightening of the blood vessels), and eating virtually nothing all day is likely to cause low blood sugar for this individual, who, not surprisingly, experiences anger and various physical symptoms when he arrives home to face more confrontation. You can use your stress-awareness diary to discover and chart your stressful events and characteristic reactions.

As you use these body-awareness exercises, you will begin to recognize where your body stores muscular tension. When you allow yourself increased awareness, you can find ways to let go of the tension you discover. Along with the release of tension, you will experience increased energy and a sense of well-being.

To keep a convenient record of how you feel before and after your relaxation exercises, use the following Record of General Tension.

 

 

The Relaxation & Stress Reduction Workbook

24

RECORD OF GENERAL TENSION

Rate yourself on this 10-point scale before and after you do your relaxation exercise.

1 totally relaxed

no tension

2 very relaxed

3 moderately

relaxed

4 fairly relaxed

5 slightly relaxed

6 slightly tense

7 fairly tense

8 moderately

tense

9 very tense

10 extremely tense

Week of

Before session

After session

Comments

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Your increased awareness of your body’s response to stressful events is an integral part of learning how to manage the stress in your life, as opposed to letting it manage you. This chapter will help you begin that process.

 

 

Body Awareness

25

FURTHER READING

Benson, H. 2000. The Relaxation Response. New York: Harper Paperbacks.

Benson, H., and E. Stuart. 1993. The Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness. New York: Simon & Schuster.

Borysenko, J. 1993. Minding the Body, Mending the Mind. Reading, MA: Bantam Doubleday Dell Publications.

Goleman, D., and J. Gurin, eds. 1995. Mind Body Medicine: How to Use Your Mind for Better Health. Yonkers, NY: Consumer Reports Books.

Jaffe, D. 1982. Healing from Within. New York: Bantam Books.

Knaster, M. 1996. Discovering the Body’s Wisdom. New York: Bantam Books.

Lorig, K., H. Holman, D. Sobel, D. Laurent, V. Gonzalez, and M. Menor. 2000. Living a Healthy Life with Chronic Conditions. Palo Alto, CA: Bull Publishing.

Lowen, A. 1994. Bioenergetics. New York: Viking-Penguin.

Perls, F., and F. S. Perls. 1973. The Gestalt Approach and Eye Witness to Therapy. New York: Science and Behavior Books.

Scheller, M. D. 1993. Growing Older, Feeling Better. Palo Alto, CA: Bull Publishing.

 

 

 

3

Breathing

In this chapter you will learn to:

* Use breathing to increase your awareness of your inner experience * Use breathing to release tension and relax * Use breathing to reduce or eliminate symptoms of stress

BACKGROUND

Breathing is the fundamental necessity of life that most people take for granted. With each breath of air, you obtain oxygen and release the waste product: carbon dioxide. Poor breathing habits diminish the flow of these gases to and from your body, making it harder for you to cope with stressful situations. Certain breathing patterns may actually contribute to anxiety, panic attacks, depression, muscle tension, headaches, and fatigue. As you learn to be aware of your breathing and practice slowing and normalizing your breaths, your mind will quiet and your body will relax. Breath awareness and good breathing habits will enhance your psychological and physical well- being, whether you practice them alone or in combination with other relaxation techniques.

Let’s examine a breath. When you inhale, air is drawn in through your nose, where it is warmed to body temperature, humidified, and partially cleansed. Your diaphragm, a sheetlike muscle separating the lungs and the abdomen, facilitates your breathing by contracting and relax- ing as you breathe in and out.

Your lungs are like a tree with many branches (bronchial tubes) that carry air to elastic air sacs (alveoli). The alveoli have the balloonlike ability to expand when air is taken into the lungs and contract when air is let out. Small blood vessels (capillaries) surrounding the alveoli receive oxygen and transport it to your heart.

Your heart pumps oxygenated blood to all parts of your body. An exchange takes place in which blood cells receive oxygen and release carbon dioxide, a waste product that is carried back to your heart and lungs, and then exhaled. This efficient method of transporting and exchanging oxygen and carbon dioxide is vital to sustain life.