A guide to relaxation Information for patients
Relaxation Why is relaxation helpful? v When we are stressed, our muscles tense up. This tension causes uncomfortable bodily feelings such as headaches and backache. v The aches and pains of tension can cause worry, making us even more anxious and tense. v When we are tense/anxious our body system speeds up - relaxation slows us down again. v If we can learn to turn on the bodily feelings of relaxation we can turn off the symptoms of tension. You can t experience relaxation and tension at the same time. Everyday relaxation It is a good idea to try and change your day-to-day activities in such a way as to include something relaxing every day. It is helpful to try and set aside some time every day for relaxing and unwinding. If possible this should be for a minimum of 30 minutes a day. If you live with other people you might need to train them gradually to accept that you would like to be left alone at certain times each day. For some people just managing to have 30 minutes on their own every day can make a great deal of difference. There are a number of things you can do that you might find relaxing. You might have to experiment to see which has the most relaxing effect on you. Why not try some of these suggestions and see what effect they have on you. There may well be some other ideas that suit you better. Try them and see what is best for you. 2 A guide to relaxation
Relaxing activities, some suggestions: v Have a long hot bath - maybe try some aromatherapy oils in it v Read an easy book v Listen to some soft music v Lie on your bed and imagine spending a million pounds v Yoga v Go for a walk v Swim v Cycle Exercise Physical effort helps to reduce anxiety by using up some of the build up of adrenalin stress hormones. Exercise can therefore make you feel better. Summary A final word Relaxing is about slowing things down. Everyone is different - experiment until you find your best way to relax. Ten minutes out of a busy day is a good investment for your health and well-being. A guide to relaxation 3
Relaxation Relaxation is a very powerful tool. When people are stressed over a long period of time, they can often wake up feeling tense and go to bed feeling tense. Therefore they don t always recognise that they are feeling tense. We do not expect you to be relaxed all the time (everyone needs some tension in their body to walk, sit, even hold themselves upright!). However, by helping you to learn to relax, you can help to reduce you overall stress levels. Also, by giving you an experience of feeling relaxed, you will begin to be able to differentiate between feeling relaxed and feeling tense. What we want you to do is to learn to look out for when you feel tense. Therefore when you are in a stressful situation, you can recognise that you are tense and take charge of the situation by applying relaxation techniques. A final point to note about relaxation is that practise makes perfect! Relaxation can be very powerful, but, like any skill, you need to practise it to perfect it. Research has demonstrated that the ability to relax improves the quality of life for everybody who experiences psychological difficulties, regardless of whether they feel depressed and/or anxious. Therefore we want everyone to learn to relax as it will benefit you all. Over the rest of this booklet, you will be introduced to three relaxation techniques: v Muscular relaxation v Visual imagery v Diaphragmatic breathing Some people prefer different strategies to others, and we hope that you can identify the method which works best for you. 4 A guide to relaxation
Muscular Relaxation Whilst there are many relaxation techniques available, some of which you may already be using, e.g. yoga, exercise etc... the method of relaxation that we are going to suggest you use is known as Muscular Relaxation. This is a technique that helps you become aware of tension in your body. By practising the exercises you will tune in and recognise signs of tension more readily. As a result, by recognising the bodily symptoms of tension earlier, you will be able to prevent further tension from building up by putting your relaxation skills in to practice. Muscular relaxation uses the pendulum method, if you want a pendulum to swing in the opposite direction you first have to pull it back. Practice therefore involves tightening up the muscle groups first and then letting them go - tensing then relaxing. You will work systematically through your body tensing and relaxing muscles. A guide to relaxation 4
Possible Problems With Muscular Relaxation Given that the initial stages of this method require that you tense your muscles, people who have serious physical/medical conditions, e.g. back problems, may be unsure whether they should carry out these exercises. If you are worried, consult your GP first. People who suffer from pains in their joints, e.g. those caused by arthritis, may not be able to use the pendulum method as it may hurt to tense up before letting go. If this is a problem for you, you can learn to relax just by focusing on each muscle group in turn and relaxing the muscles. Some people may find that the sensations they experience when they first begin using relaxation alarming. They may feel like they are about to lose control rather than sinking into the state of calmness and restfulness they expected. This sometimes happens because our bodies have got used to being tense and being relaxed can come as a bit of a shock to the system! However, if you proceed at your own pace it does not take long to realise that nothing alarming happens when you do relax. Relaxation CDs are widely available. You may also download freely available relaxation guides on the internet. The following are particularly helpful: v http://www.glasgowsteps.com/self-help.jsp This website contains a range of self help materials and free audio tracks. v http://www.livinglifetothefull.com This website has four relaxation audio track to download along with a wide range of self help materials. 6 A guide to relaxation
If you prefer to read a relaxation script and practice yourself without a CD then you can use the relaxation script below. 1. Start by getting into a comfortable position. Close your eyes. Place the feet flat on the floor, legs uncrossed and your hands resting comfortably at your side or on your lap. 2. Reading the instructions below (the script ), allowing plenty of time for pauses, (if you wish) into a recorder and play it back for your use: 3. Begin by noticing your breathing, noticing your abdomen rise and fall with each breath. (Allow a pause) As your breathing becomes more relaxed and restful, take your awareness down to your feet. We will start this process with the muscles in the feet and toes. When I say tense you will tense the muscles in the feet by curling the toes down and holding for a count of four full seconds and then will release the muscles in the feet when I say release, and will repeat this process two times in various muscle groups throughout the body. Ready...So, with your awareness in the feet and toes now tense the feet and hold for one... two... three...four..., and release. Notice the difference between a tense muscle and a relaxed muscle as you go through the process. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in the feet. With each tense and release cycle, you will notice it becomes easier and easier to release and relax each muscle group...now again, bring your awareness to the feet and toes and tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. A guide to relaxation 7
4. Now, we will move our awareness to the lower legs... to the calf area. When I say tense, we will tense these muscles by pointing the toes towards the knees, and again holding for a count of three, and then releasing the calf muscles. Ready...So, with your awareness in the calf muscles now tense the calves and hold for one... two... three...four..., and release. Notice the difference between a tense muscle and a relaxed muscle as you go through the process. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in the calves. With each tense and release cycle, you will notice it becomes easier and easier to release and relax each muscle group...now again, bring your awareness to the calves and tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. 5. Notice the muscles in the thighs. When I say tense, we will tense the muscles in the thighs by pressing the back of the legs in the bottom of the chair and holding for a count of four seconds and then release. Ready...So, with your awareness in the thighs now tense and hold for one... two... three...four..., and release. Notice the difference between a tense muscle and a relaxed muscle as you go through the process. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in the thighs. With each cycle, you notice it becomes easier and easier to release and relax each muscle group...now again, bring your awareness to the thighs and tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. 8 A guide to relaxation
6. Now, notice the muscles in the abdomen and low back. When I say tense, we will tense the muscles in the abdomen by imagining that we are trying to touch the belly button to the spine, pressing the low back to the chair and holding for a count of four seconds and then release. Ready...So, with your awareness in the abdomen, now tense and hold for one... two... three... four..., and release. Notice the difference between a tense muscle and a relaxed muscle again. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in the low back and abdomen. With each cycle, you notice it becomes easier and easier to release and relax each muscle group...now again, bring your awareness to the abdomen, tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. 7. Bring your awareness to the muscles in the right arm. When I say tense, we will tense the muscles in the right arm by curling the arm up towards your bicep and holding it as if you are lifting a weight and holding it to your chest, holding for a count of four seconds and then release. Ready...So, with your awareness in the arm now tense and hold for one... two... three...four..., and release. Notice the difference between a tense muscle and a relaxed muscle as you go through the process again. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in the arm. With each cycle, you notice it becomes easier and easier to release and relax each muscle group...now again, bring your awareness to the arm and tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. A guide to relaxation 9
8. Now, bring your awareness to the muscles in the right hand. When I say tense, we will tense the muscles in the right hand by clenching it into a tight fist, holding for a count of four seconds and then release. Ready...So, with your awareness in the hand, now tense and hold for one... two... three...four..., and release. Notice the difference between a tense muscle and a relaxed muscle as you go through the process again. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in the arm. With each cycle, you notice it becomes easier and easier to release and relax each muscle group...now again, bring your awareness to the hand and tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. 9. Bring your awareness to the muscles in the left arm. When I say tense, we will tense the muscles in the left arm by curling the arm up towards your bicep and holding it as if you are lifting a weight and holding it to your chest, holding for a count of four seconds and then release. Ready...So, with your awareness in the arm now tense and hold for one... two... three...four..., and release. Notice the difference between a tense muscle and a relaxed muscle as you go through the process again. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in the arm. With each cycle, you notice it becomes easier and easier to release and relax each muscle group...now, bring your awareness to the arm and tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. 10 A guide to relaxation
10. Now, bring your awareness to the muscles in the left hand. When I say tense, we will tense the muscles in the left hand by clenching it into a tight fist, holding for a count of four seconds and then release. Ready... So, with your awareness in the left hand, now tense and hold for one... two... three...four..., and release. Notice the difference between a tense muscle and a relaxed one. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in the arm. With each cycle, you notice it becomes easier and easier to release and relax each muscle group... again, bring your awareness to the hand and tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. 11. Notice the muscles in the upper back, around the shoulder blades. When I say tense, we will tense the muscles in the upper back by pressing the shoulder blades together and holding for a count of four seconds and then release. Ready...So, with your awareness in the shoulder blades, now tense and hold for one... two... three...four..., and release. Notice the difference between tense and relaxed as you go through the process. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension. With each cycle, you notice it becomes easier and easier to release and relax each muscle group...now again, bring your awareness to the upper back and tense and hold for one... two... three...four, and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. A guide to relaxation 11
12. Notice the muscles in the shoulder area and neck. When I say tense we will tense the muscles in the neck by pressing the shoulders towards the ears and holding for a count of four seconds and then release. Ready...So, with your awareness in the neck and shoulders, now tense and hold for one... two... three...four..., and release. Notice the difference between a tense muscle and a relaxed muscle as you go through the process. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in this area... it becomes easier and easier to release and relax each muscle group...now again, bring your awareness to the shoulders and tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. 13. Bring your awareness to the chin and jaw area. When I say tense we will tense the muscles in the jaw by pressing the chin into the chest, gently and holding for a count of four seconds and then release. Ready...So, with your awareness in the chin and around the jaw area, now tense and hold for one... two... three...four..., and release. Again, noticing the difference between a tense muscle and a relaxed muscle as you go through the process. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in this area. With each cycle, you notice it becomes easier and easier to release and relax each muscle group...now again, bring your awareness to the jaw and tense and hold for one... two... three...four..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. 12 A guide to relaxation
14. Now, bring your awareness to the facial muscles. When I say tense, please tense the muscles in the face by furrowing the brow and squeezing the muscles together as if you ve just eaten a very tart, sour lemon and holding for a count of four seconds and then release. Ready...So, with your awareness in the face now tense and hold for one... two... three...four..., and release all the muscles in the face. Notice the difference between a tense muscle and a relaxed muscle as you go through the process. Remembering to inhale through the nose and exhale through the mouth, releasing any residual tension in the face. With each cycle, you notice it becomes easier and easier to release and relax each muscle group... Now again, bring your awareness to the face, tense and hold for one... two... three... face..., and release... inhaling through the nose and exhaling through the mouth, relaxing even more with each breath. A guide to relaxation 13
Visual Imagery Visualisation as a relaxation exercise is simply imaging a relaxing scene, and feeling the resulting relaxation. In the following example, I have used a beach, but you may adapt the script to be anything that works for you or your child. You may prefer the story to be a walk in the woods, culminating in laying in a meadow for instance. Close your eyes and try to imagine yourself at the seaside. You are walking down the beach to the seashore. The sun is shining, it s warm, with a gentle breeze. You walk slowly along the water s edge, looking around you. You see the seagulls soaring above, in the clear blue sky. In the distance, you see the sails of a yacht, sailing gently along. You are beginning to feel tired, so you walk up a beach a little way, and lie down in the soft sand. You are looking up at the sky, with the occasional wispy white cloud float calmly by. You feel the sand beneath you - how soft and warm it is. You can hear the sounds around you - the seagulls calling and waves breaking gently onto the sand. The sound of the sand and pebbles as the waves go back out again. You can feel the gentle warm breeze on your face and in your hair. You feel yourself sinking down into the sand a little as it support your whole body. Your body is feeling heavy and floppy. Feel yourself breathing and let your breaths slow down, you are breathing slowly and deeply, letting your tummy rise up and you breathe in. You lay there for a while, hearing the waves, feeling the soft warm sand beneath you. When you want to, count back from 5 to 1, then open your eyes, wiggle your toes and fingers, stretch, then gently sit up. 14 A guide to relaxation
Diaphragmatic Breathing The diaphragm is the most efficient muscle of breathing. It is a large, dome-shaped muscle located at the base of the lungs. Your abdominal muscles help move the diaphragm and give you more power to empty your lungs. Diaphragmatic breathing is intended to help you use the diaphragm correctly while breathing to: v Strengthen the diaphragm v Decrease the work of breathing by slowing your breathing rate v Decrease oxygen demand v Use less effort and energy to breathe Diaphragmatic breathing technique 1. Lie on your back on a flat surface or in bed, with your knees bent and your head supported. You can use a pillow under your knees to support your legs. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe. A guide to relaxation 15
2. Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible. 3. Tighten your stomach muscles, letting them fall inward as you exhale through your mouth. The hand on your upper chest must remain as still as possible. When you first learn the diaphragmatic breathing technique, it may be easier for you to follow the instructions lying down, as shown here. As you gain more practice, you can try the diaphragmatic breathing technique while sitting in a chair, as shown. 16 A guide to relaxation
To perform this exercise while sitting in a chair: 1. Sit comfortably, with your knees bent and your shoulders, head and neck relaxed. 2. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe. 3. Tighten your stomach muscles, letting them fall inward as you exhale through your mouth. The hand on your upper chest must remain as still as possible. Note: You may notice an increased effort will be needed to use the diaphragm correctly. At first, you ll probably get tired while doing this exercise. But keep at it, because with continued practice, diaphragmatic breathing will become easy and automatic. How often should I practice this exercise? At first, practice this exercise 5-10 minutes about 3-4 times per day. Gradually increase the amount of time you spend doing this exercise, and perhaps even increase the effort of the exercise by placing a book on your abdomen. A guide to relaxation 17
Relaxation As A Practice Learning to relax takes time. It is something for which you may have lost the knack and, therefore, like learning any new or lost skill, it will take time and effort to develop again. Remember, learning to control your body reactions and to take charge of them is important in both preventing and relieving psychological difficulties, particularly anxiety. 1. Learn to relax at you own pace, you may not pick it up straight away. 2. Take the time to relax, do not do other odd jobs instead 3. Find a time to practice when you feel calm. 4. Your mind will wander when trying to relax. This is normal, just let the thought pass and continue with relaxing. 5. Set aside at least half an hour a day to practice relaxation. 6. Decide on a regular time of day to practice. 7. Try to find a place where you will not be disturbed. 8. Make yourself warm and comfortable. 9. Never practice in the car whilst you are driving. 10. Keep a record of your progress. 18 A guide to relaxation
Further help v Yoga/Pilates classes run by North Lanarkshire Council Leisure Centres. Tel: (01236) 762 871, (01698) 750 130 (payment required) v For other possible local classes see your local newspaper or your local library v Lanarkshire Links Tel: (01698) 265 232 Helplines v Breathing Space - mental health helpline (Daily: 6pm-2am)...Tel: 0800 83 85 87 v Depression Alliance...Tel: 0845 123 23 20 v Samaritans - confidential support for anyone in a crisis 24 hours...tel: 08457 90 90 90 Textphone:...Tel: 08457 909192 v SANEline...Tel: 08457 67 8000 Websites v http://www.lanarkshirementalhealth.org.uk/ Lanarkshire Mental Health and Wellbeing Information Site. v http://www.aworldofaromatherapy.com v http://www.glasgowsteps.com/self-help.jsp Self help booklets on psychological problems, including depression, anxiety, etc v http://www.livinglifetothefull.com A general self help site offering advice on a wide range of issues. It helps you to understand your behaviour and thoughts, and offers help on healthy living, better sleep, relaxation, etc. A guide to relaxation 19
v http://www.moodjuice.scot.nhs.uk Offers information and advice to those experiencing troublesome thoughts, feelings and actions. Books The following books are available to buy or can be found in your local library: v Aitken, Cara Surviving post natal depression ISBN 1853028614 v Brewer, Sarah (2000) Simply Relax: The Beginner s Guide to Relaxation Duncan Baird ISBN: 1900131293 v Butler, G and Hope, T (1995) Manage Your Mind Oxford ISBN: 0192623834 (Chapter 11: Learning to Relax) v Greenberger, Dennis Mind over mood (1995) ISBN 0898621283 v Hauri, Peter & Linde, Shirley No more sleepless nights (1996) ISBN 0471149047 v Wilson, Paul (1999) Little Book of Calm Penguin ISBN: 0140285261 v Worwood, Valerie Ann (1997) The Fragrant Mind Bantam ISBN: 0553407996 (An easy read.) v Worwood, Valerie Ann (1991) The Fragrant Pharmacy Bantam ISBN: 0553403974 (An easy read. Complete guide.) 20 A guide to relaxation
NOTES A guide to relaxation 21
Booklets/leaflets available on the following: v Anger v Anxiety v Bereavement v Depression v Hyperventilation v Panic (short version and long version) v Relaxation v Self-Harm v Self-Help websites v Sleep v Stress v Trauma v How to solve problems: a simple DIY technique v Worry Copies of any of the above booklets are available free of charge from: 22 A guide to relaxation
To cut out and keep: Controlling your breathing THINGS TO REMEMBER v breathe in slowly to the count of four, one elephant, 2 elephant, 3 elephant, 4 elephant v hold your breath for the count of four v breathe out slowly counting elephants A guide to relaxation 23
Helplines v Breathing Space - mental health helpline (Daily: 6pm-2am)...Tel: 0800 83 85 87 v Depression Alliance...Tel: 0845 123 23 20 v National Debt-line...Tel: 0808 808 4000 v Samaritans - confidential support for anyone in a crisis 24 hours...tel: 08457 90 90 90 Textphone:...Tel: 08457 909192 v SANEline...Tel: 08457 67 8000 Published by: Mild/Moderate Mental Health Project Pub. date: November 2008 Review date: November 2009 Issue No: 01 Produced by: MMMHP Contact: Telephone: PIL.RLAXTN.41091.P Design - Medical Illustration, NHS Lanarkshire