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Overcoming Stress, Worry and Low Mood Course

Participant Workbook

Workshop 1

• To introduce leaders, participants and set group rules. • To increasing understanding of stress, worry, low mood, anxiety and

depression. • To outline the CBT model of anxiety and depression • For each participant to score their levels of anxiety and depression. • To teach progressive muscle relaxation

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Section 1: Introduction On this course we discuss overcoming stress, worry and low mood. Some of you will feel this is a good way of describing how you feel in the past/now. For others, their feelings may seem more extreme. It is important to understand we are all vulnerable to these feelings and many people will feel overwhelmed by them at some point in their life. We do not discuss the causes of low mood, anxiety and stress in detail on the course, this is because regardless of cause, there are many things you can do to gain control and manage these feelings in a way that improves your quality of life. The first workshop is mainly about recognising anxiety/ low mood and in the forthcoming 5 weeks we will be teaching you how you can overcome them.

The Continuum of stress and low mood Everyone experiences low mood and stress from time to time, in fact this is totally normal. Many people find that at some point in their lives this becomes more overwhelming and distressing, possibly resulting in depression or anxiety. It is important to understand that many others will also feel this way. Stress overwhelming anxiety Low mood clinical depression

1. What is Low Mood -Depression? Depression comes in many forms and has many causes. For many people that experience depression, things are not as simple as feeling low or down- they will also feel stressed, tense, nervous or anxious. Depression is often, but not always associated or triggered by a difficult life situation, for example:

• Major life events, particularly around loss e.g. death of a loved one, job loss, relationship breakdowns.

• Limited social contact and socially isolation • Stress at work, in relationships or with poor physical health e.g. long term or

painful illness

However there is a great deal which is still poorly understood about depression, particularly about the causes and the reasons why the same difficult life situation will trigger depression in one person, but not in another. You do not really need to know the causes of depression to effect positive changes.

Recognising the signs and symptoms of depression If you are clinically depressed you would have at least two of the following symptoms for at least 2 weeks.

• An unusually sad mood that does not go away • Loss of enjoyment and interest in activities that used to be enjoyable

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• Tiredness, fatigue or lack of energy

And at least 4 of the following symptoms:

• Loss of confidence in themselves or poor self-esteem • Feeling guilty when they are not at fault

• Suicidal/self-harming thoughts (Wishing you were dead), plans or acts • Difficulty concentrating or making decisions

• Moving/speaking more slowly or, sometimes becoming agitated and unable to settle • Having sleeping difficulties (e.g early morning wakening) or, sleeping too much • Loss of interest in food or, sometimes eating too much (weight loss or gain)

In addition to these, people who are depressed often have other symptoms such

as:

• Pessimism or hopelessness about the future • Feeling bad about yourself

• Decreased sex drive • Mood variation during the day (often worse first thing in morning)

• Worry, anxiety and rumination

• Feelings of worthlessness or low self-esteem • Anger, irritability and frustration

• Being overwhelmed and feelings of not being able to cope This list of symptoms allows us to recognise depression, however in order to understand depression and the impact it has on us it can be useful to put these symptoms into four categories. These are:

1) Changes in Behaviour

2) Changes in Thinking 3) Changes in Emotions 4) Changes in Physical symptoms

This way of understanding depression comes from cognitive-behavioural therapy or CBT which is the approach taken in this course. CBT believes that our thinking affects our behaviour, which in turn impacts upon our emotions and physical state (or physiology). Making positive changes in one area will impact upon other areas as well.

Thinking Behaviour

Emotions Physical change Depression has an impact on all these areas, however these changes also maintain the depression. This causes a vicious cycle of inactivity, low mood, isolation, fatigue and negative thinking, which can feel like it is spiralling beyond your control. The longer it goes on the more you feel like you cannot get out of the trap. Start somewhere to do something differently and it can help to make you feel a bit more in control and break out of the depressive vicious cycle. The diagram below demonstrates this vicious cycle.

The vicious cycle of depression

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SITUATION

loss isolation conflict stress

THOUGHTS PHYSICAL/BODILY REACTIONS negative thinking changes in brain chemistry harsh self-criticism low energy unfair/unrealistic thinking altered sleep EMOTION BEHAVIOUR sadness social withdrawal anxiety reduced activity level despair poor self care discouragement limited pleasure numbness If we take these areas one by one: Thoughts • Each of us is affected differently by situations, depending on how we think about them.

• Evidence has shown that depressed individuals have very negative ways of thinking about themselves, others and the world.

• These ways of thinking can trigger, and worsen the experience of depression. Imagine a phone call that is expected from a close friend that does not happen, for example: Mr X may regard this as evidence that the friend does not want to speak to him or is bored of his moaning about being overwhelmed by feelings of despair. He feels hurt, upset and fearful of reaching out to anyone else in case they are also bored of him. His thinking is negative, unrealistic and makes him feel more depressed and behave in an avoidant way which does not give him the opportunity to find out that his thinking is faulty. Mr Y, on the other hand, may be curious about the missed call but think that the friend was busy or had forgotten. He would call the friend themselves to have the conversation that was planned and his mood would be unaffected. Emotion • When depressed we can feel not just sad but overwhelmed by feelings of despair. • A profound feeling of anxiety and often sense of impending doom can accompany these

depressed feelings, others feel numb and detached. • In the same way as your thoughts can become overwhelming and negative, your

emotions can too. Physical • Depression can lead to big changes in your physical health. • One important change is in sleep, ie sleeping too much or too little, or early morning (4

am) wakening. If sleep does not restore you a vicious cycle of exhaustion, low energy and worry about not sleeping can cause further depression.

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• The physical changes experienced with depression make it harder to cope with the demands of life. It certainly makes it hard to have the energy to do a self-help programme like this. Some people find that antidepressant medication is helpful to lift mood and can help you regain sleep and appetite.

• The changes in brain chemistry associated with depression have been demonstrated in research. However, we are still not entirely sure what comes first, for example does depression cause changes in the brain’s chemistry or vice versa.

Behaviour • Depression can have a big impact on how you behave. • It can make you withdraw from your family and friends, • stop you taking care of yourself, • stop you doing things you used to enjoy • stop you getting on with your daily duties.

• Example of how these changes in behaviour can impact on you:

Not doing the things you used to enjoy Examples Not doing hobbies Not having any fun Stopping doing something you used to enjoy Likely result Inactivity becomes a habit You stop receiving personal satisfaction.

Depression can be seen as a “ vicious cycle” that people get stuck in……………. BUT by changing the way you think and behave you can recover from depression and reduce the likelihood of relapse. We will be spending the next 5 workshops of the course showing you how to do this.

Coping with low mood or depression

• Avoid sitting or lying about doing nothing

• Identify things you used to do regularly and things which you used to enjoy

• Plan to gradually increase the routine of pleasant activities

• If a task seems too difficult, try breaking it into a series of small steps

• Above all reward yourself for your efforts

• Avoid discussions of bad feelings. Solving problems is more helpful

• If your appetite is poor, eat small quantities regularly and drink lots of fluids

• Keep to a normal sleep routine. Avoid daytime naps. At night get up if awake for

30minutes or more, and try to relax

• If you go off sex, keep some physical closeness with partner and reassure them it is

not personal but a temporary symptom.

• It is important to be active even when you do not feel like it. Getting going again

can help you feel better

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2. What is Stress /Anxiety? There is a complex relationship between stress and anxiety- we all feel stress but sometimes this goes on for such a long time that it wears us down and turns into anxiety. Signs and symptoms of stress and anxiety The effect of anxiety can be seen in three areas: our thoughts, behaviours and body: e.g Thoughts Behaviour Physical Symptoms Anticipating failure Avoidance of feared Sweating, racing (negative thinking) situations & places heart etc.

These three aspects usually overlap. For instance if you are worried about a future event this may cause you physical symptoms which in turn increase unhelpful thoughts and you may finally avoid the event altogether. When dealing with your anxiety, you can start to take control of any one area and there is usually a ripple effect across the other two. If you don’t know which physical symptoms to expect when you are stressed or anxious, it is difficult to understand what is happening to your body. Therefore it is important to understand the anxiety response fully and realise that you can learn skills to regain control and manage your anxiety. How your body changes when you are anxious: The ‘Fight or Flight’ response When we faced with situations that make us feel anxious or afraid our body interprets this as a real threat and reacts as if we are in a dangerous situation. This triggers an automatic fight or flight response where adrenaline is released into the body. This response was very useful in prehistoric times as there were many dangers such as wild animals, it helped us survive by being ready to run away (flight) or fight immediately after sensing a threat. A moderate amount of anxiety is still helpful to us in modern life e.g. when going for a job interview or sitting an exam, it can make us more alert or focused and can improve our concentration and performance. However, if the anxiety gets out of proportion to the situation or if it goes on for too long then it can become a problem. Each situation is different but for example, if we feel some anxiety when some one is aggressive to us or when crossing a busy road, this may be helpful. However if we get anxious leaving our home, going to the shop or having a conversation with another person, our anxiety response may be out of proportion to the real threat involved. So, when we are faced with anxiety provoking situations, the adrenaline released into our bodies can make us feel physically uncomfortable. The body’s reaction can make us ready to fight or more often, run away (flight) even when there is no real danger. As soon as we do this we feel better as our symptoms of anxiety decrease. Unfortunately the fear of the situation remains, so when we are faced with the same situation again we learn to avoid it, as this has made us feel better in the past. We are then left with only one rather unhelpful option of running away every time we are faced with that situation. In the long term this not only builds up problems but undermines our confidence, especially if we think upsetting or unhelpful thoughts such as: “This is really awful”; “I know I can’t cope” etc. Therefore it is much better to face your fears and learn to control the symptoms of anxiety.

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Adrenaline affects many different parts of the body, getting the body into a state of readiness to deal with threat. It is adrenaline that produces many of the uncomfortable physical feelings that are associated with anxiety, such as ‘butterflies’ in the stomach, tense muscles, rapid heartbeat and sweating. When adrenaline is released our senses also become more acute, and our thinking may change - for example we may become overly aware of danger and ignore evidence that could reassure us. Increased adrenaline affects the body in a number of ways (first column) which causes physical symptoms of anxiety (second column). When you become anxious you may experience some, or all of these symptoms: How your body changes when you are anxious

After effects = visual disturbance (eg. blurring)

Increased adrenaline makes vision sharper

Body stops producing saliva

Dry mouth, difficulty swallowing

Breathlessness, dizziness

Airways widen to let in more oxygen.

Blood in skin is diverted to muscles

Pale skin

Muscles in use, tense, ready to act faster

Tension, aches and pains in muscles, ‘shaky’ feeling

Skin sweats to cool hot working muscles

Heart pumps harder to send oxygen to muscles

Heart beats faster, palpitations

Liver releases stored energy. Blood and energy is diverted away from skin to muscles.

Stomach feels funny eg. ‘knotted’ tummy, ‘butterflies’. Nausea and sickness, diarrhoea

Sweating

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WHAT KEEPS ANXIETY GOING? Our responses to anxiety (ie what we think and what we do when we feel anxious) can actually maintain it as a problem. Vicious cycles are often created that mean the anxiety either persists or gets worse. FEAR OF FEAR Although the bodily feelings associated with anxiety are harmless, they can be unpleasant and quite frightening. When we experience anxiety symptoms we may worry that we are ill or that something bad is going to happen. This worry makes us even more anxious, which increases the physical symptoms of anxiety. This causes a vicious cycle which makes anxiety worse and stops it going away. We may also worry about becoming anxious and getting anxiety symptoms. We may say unhelpful things to ourselves such as “What if my mind goes blank”, “I’ll blush and everyone will look at me”, or “This always makes me feel dreadful”. Worrying about becoming anxious can actually bring on anxiety, and can make the anxiety symptoms appear. This leads to an increase in anxiety and so the symptoms also increase. Again, we have fallen into a vicious cycle, known as the ‘fear of fear’ cycle. Fear of fear cycle

Fear of fear or worrying about symptoms More symptoms Symptoms of anxiety (e.g. shaking, sweating etc)

More worry AVOIDING SITUATIONS THAT PROVOKE ANXIETY It is perfectly natural, when we find a situation distressing, that we will try to avoid that situation in the future. But when anxiety is a problem in our life we may find ourselves avoiding places, activities and thoughts which are not real dangers. For example, supermarkets, going to work, making eye contact, being alone, remembering certain images, using public transport. These are all important and necessary parts of everyday life, and avoiding them can be very restrictive to us and to others. Avoiding something may seem to bring relief, but it does not help in the long term:

• The relief is only temporary. Our anxiety may increase as we worry about how to avoid the situation again in the future.

• It makes the situation harder to face in the future because we believe that it will always cause anxiety.

• Gradually we grow to avoid more things.

• It starts a vicious cycle:

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Vicious cycle of avoidance

FEAR

MORE AVOIDANCE AVOIDANCE

MORE FEAR

WAYS OF THINKING You may have noticed that how we think plays an important part in fear, avoidance, and loss of confidence. The thoughts we have play a major role in increasing or decreasing our anxiety, and thinking negatively when we are feeling anxious can make things seem worse than they really are, which makes the anxiety more difficult to control. There are a number of ways of thinking that can be unhelpful and can make anxiety worse.

How can we begin to cope with anxiety?

Relaxed Breathing Good breathing is essential to our general health and for reducing stress. The way we breathe can reflect how stressed we are, in that when we are under pressure our breathing becomes rapid and shallow and we tend to use only our upper lungs. Relaxed breathing involves breathing slowly using the diaphragm. The diaphragm is the sheet of muscles below our lungs. This form of breathing uses the lower lungs and can be called stomach breathing. However if the stomach is tense the diaphragm gets restricted and relaxed breathing becomes difficult. Using only tense upper chest breathing can create several undesirable side effects:

• It causes the body to expel too much carbon dioxide • The acidity in the blood becomes too alkaline • This causes the blood vessels to narrow and the circulation of blood to the brain is

restricted • Palpitations, dizziness, feeling faint and chest pains can be a result • Panic attacks may occur • Panic attacks restrict breathing further and can lead to hyperventilation

Poor breathing can thus set up a self perpetuating cycle. However, by learning and practising diaphragmatic breathing this cycle can be broken. Diaphragmatic Breathing Diaphragmatic breathing, together with mental and physical relaxation, has been found to reduce high blood pressure and anxiety significantly. Diaphragmatic breathing counteracts all the unfortunate effects of poor breathing and is one of the most useful tools in stress management. Diaphragmatic breathing is completely ‘portable’. You can use it wherever and whenever you feel stressed and no one will know you are trying to relax as all you are doing is breathing correctly

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Breathing exercise • Find a quiet warm place to sit where you will not be disturbed for 10 minutes or so. • Sit on an upright chair with your back straight. • First become aware of how you normally breathe. Place one hand on your stomach

and the other on your chest. Breathe as you usually would and notice which hand moves, this will tell you if you are using your upper or lower lungs.

• Breathe in and out through your nose. If you can hear your breathing you are breathing too heavily.

• Then concentrate on breathing by using your diaphragm. In other words your stomach should be moving and not your upper chest.

• Now breathe in through your nose and out through your mouth slowly and calmly. • Make sure your breathing is forward and back rather than up and down. • Allow a pause before you inhale and another pause before you exhale. • Silently say the word “relax” or “calm” to yourself each time you breathe out.

Deep Diaphragmatic Breathing Please note that people suffering from chronic breathing problems such as asthma should only practice the breathing exercise described above and not the deep diaphragmatic breathing, as this may exacerbate the problem. This is the same as the exercise above but is even slower and longer and uses the whole lung capacity.

• Take a deep slow breath, filling your lungs from the bottom and continuing to the top of your upper chest to the count of four.

• Exhale to the count of six without forcing anything, just allow the breath out

naturally. This breathing should only be done 4-5 times at one time, but is a very useful technique to use to calm down or reduce tension at times of stress or crisis. Panic attacks Panic attacks are very frightening because they seem to come out of the blue. Most people describe a sudden, overwhelming sense of anxiety, including: • Feelings of absolute terror

• Very rapid breathing and heartbeat

• Dizziness or faintness

• Sweating and hot or cold flushes

• Feelings of unreality.

Coping with a panic attack • Slow your breathing and stay where you are

• Remind yourself that you are safe and that the feeling will pass • Try to distract yourself by looking hard at something nearby

• Face the situation again later.

Helpful Tips The important thing to remember is that feelings of panic will never cause you any harm. Your body is simply gearing itself up for a nonexistent danger.

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Summary: Ten Tips for Coping with Stress

• Avoid self medicating with nicotine, alcohol, coffee or pills • Take physical exercise - this is a good way to work off stress • Make time to relax every day and don’t put it off • Get enough rest and sleep to recharge your batteries • If you become ill, do not just carry on as though nothing is wrong

• Life shouldn’t be a battleground. Negotiate with people who cause you conflict • Learn to accept the things you cannot change

• Manage your time better and delegate where possible • Recognise when you are tired and do something about it Plan ahead to prevent too much pressure building up and learn to say “No”

Workbook Section 2: GOAL SETTING:

IF YOU DO WHAT YOU’VE ALWAYS DONE, YOU’LL GET WHAT YOU’VE ALWAYS GOT

The Steps to Change are as follows:

• Recognise that there is a problem • Recognise that by redirecting effort into setting up new and positive habits,

you could change your life for the better. • Accept that it took you a long time to learn to be anxious and give yourself

time to change. • Start chipping away at your goals whilst keeping your eye on the ultimate aim

of being more in control of your anxiety. We understand that you cannot change things until you know more about the problem. This is why we encourage you to keep a detailed diary of your thoughts and feelings. We want you to learn more about the way you think and behave. By recognising patterns in your behaviour you can be clear about what needs to change.

Exercise: The aim of this exercise is twofold. It will help to motivate you and to set some broad goals Hints for the exercise

▪ Be as specific as possible, the more specific the better. Instead of ‘Be less anxious’ try ‘Talk about how I feel more with my friends, Accept social invitations, attend an exercise class etc’

▪ Take at least 10 minutes to do this exercise but no more than ½ hour ▪ Try and write down as many things as possible for each question. The more

detailed and descriptive the better.

Imagine your life 6 months from now and that nothing has changed. You have not taken steps to address your problems. Write down how you would feel, what would you be doing, what impact would there be on your life?

Now write below all the actions you can start doing now to change your life. E.g. Join a gym, talk about feelings to friend, start a hobby course, do this program, etc.

Imagine your life 6 months from now and that you have done everything in the middle column. How would you feel, what would you be doing, what impact would there be on your life?

If this exercise was useful keep this sheet and look at it when you need motivating. Focus on taking a few small steps at a time, like the examples you put in the middle column to go from feeling anxious and negative to feeling more fulfilled and positive. It’s not about making an enormous change all in one go. Building up the small changes add up to a happier, more positive you.

What do I want to change? Setting Goals. The first and most important part of any self-help program is to set goals for what you want to achieve. Spend some thinking about the following questions and scribble your ideas below:

What do I want to change in my life? You may have made all sorts of previous attempts to change, but unless you have a clear plan and stick to it, change will be very difficult. Planning and selecting which areas you want to try and change is a crucial part of successfully moving forward. Before you set your goals consider the tips below: 1. Your goal must be important to you 2. Make your goal small enough to be achievable but still a challenge 3. Your goal needs to be concrete and specific. Eg if you set a goal such as “I want to be more sociable and happy.” This is too big and will not be easy to measure achievement. Break your goal down and be as specific as possible. E.g. “I aim to go out with my friends at least once per week and to telephone a friend twice a week”. 4. Involve the presence not absence of something State what you will do instead of what you won’t do. For example “I will set 15 minutes aside everyday to do relaxation exercises,” rather than “I will not think negatively anymore.” 5. A beginning rather than an end Concentrate on starting not ending the journey. Every journey starts with one small step. You climb a mountain one step at a time! 6. Goals involve hard work but the rewards are worth it! REMEMBER: It has taken you months or years to get to where you are, so it will take time for things to change. With perseverance and practice you will get there!

Write down at least two goals to work on during this program. These may change over time but it is important that you think clearly now about what you are trying to achieve. Goal 1 Goal 2

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Aims of the Course

• Recognise and monitor your own stress and mood

• Develop coping strategies and

techniques to help you to take control

• Practice relaxation/breathing

exercises as a means of controlling the stress response

• Learning to recognise whether your own thoughts are helpful or unhelpful

• Practice challenging and changing unhelpful thinking

• Recognise whether your own

behaviours are helpful or unhelpful and changing the latter

• Learn to recognise and manage

frustration, irritability and anger

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The vicious cycle of depression

SITUATION

Loss, isolation, conflict, stress

THOUGHTS PHYSIOLOGY

negative thinking low energy unfair and unrealistic thinking altered sleep harsh self criticism changes in brain

chemistry

EMOTION BEHAVIOUR

sadness social withdrawal anxiety reduced activity level despair poor self care discouragement limited pleasure numbness

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Signs of Stress Physical Emotional Tense muscles Irritable, frustrated Dry mouth Angry outbursts Headaches Anxious Restlessness Panic attacks ‘Butterflies’ in the stomach Low mood /Depressed Constipation & Diarrhoea Exhausted

Thinking/Psychological Behavioural Difficulties concentrating/ making decisions Increased smoking Loss of confidence/ self esteem Increased alcohol consumption Problems with memory Increased or decreased eating Irrational thoughts Increased or decreased sleep Negative Thoughts Nail-biting, fidgeting Social withdrawal

Worry

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Physical symptoms of stress

Dilated pupils Pallor

Heart beat increases

Increased breathing

Skin feels wet and clammy Appetite

disappears

Initial desire to pass Muscle tone water or faeces increases-

muscles feel hard

Butterflies and cramp Hands & feet

in stomach perspire

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Fear of fear cycle

Fear of fear or worrying about symptoms

More symptoms Symptoms of anxiety (e.g. shaking, sweating etc)

More worry

Avoiding situations that provoke anxiety (vicious cycle)

FEAR

MORE AVOIDANCE AVOIDANCE

MORE FEAR

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The Anxiety Spiral

THOUGHT: Here I am in a

situation that usually makes me

feel anxious and panicky.

The physical body

symptoms are triggered.

I knew it, I’m becoming anxious.

I’m starting to feel terrible. I know

I can’t cope when I am anxious.

Physical symptoms

increase.

I feel sick and dizzy and

people are looking at me.

I think I am

going to faint. Panic – Escape - Run

Symptoms of anxiety

intensify.

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Relaxation

Another key element in learning to cope with stress, worry and low mood is to take time for ourselves

and learning to relax. This may be informal relaxation e.g. watching TV or can take the form of actual

relaxation exercises

Why is relaxation helpful?

• Relaxation can slow down or turn off the symptoms aroused in our bodies by stress and

tension. If you can learn to relax you can learn to control anxiety.

• Stress causes the muscles of our bodies to tense up and this leads to uncomfortable sensations

such as aches and pains, a tight chest, and so on.

• These pains can make us worry, so increasing the tension and stress. Thus the vicious cycle

of stress is created.

• Feeling constantly tense can give rise to tiredness and fatigue, which depletes our energies.

Being able to relax is a skill we can learn, but it does not always come naturally. It therefore requires

practice and persistence to master the skill.

Some general relaxation tips

• Work out a way of including a time to relax into your daily routine. Make time for yourself.

• Make sure that you will not be disturbed while you are relaxing.

• Avoid relaxing at times when you are hungry or have just had a meal – make sure the room is

not too hot or cold.

• Don’t worry about getting it completely right – just have a go and allow it to happen.

• Breathe slowly and regularly, in through your nose and out through your mouth.

• Try to breathe using your diaphragm so that the breath is being drawn to the bottom of your

lungs.

• To begin with, relaxation should be practised once or twice daily for about twenty minutes.

You will be learning several different relaxation techniques in this course. Please keep in mind that

different types of relaxation suit different people. Therefore it is important to try all the different

styles to find out which type suits you best.

The first type of relaxation is called progressive muscle relaxation.

Progressive muscle relaxation

Progressive muscle relaxation reduces the pulse rate and blood pressure, as well as decreasing

respiration rates and psychological tension. We often do not realise which of our muscles are

chronically tense. Progressive muscle relaxation provides a way of identifying which muscle groups

are tense and distinguishing between the sensation of relaxation as opposed to tension.

Procedure It is important to relax in a position in which you feel as little tension as possible.

Lying down

It is best not to lie on something too squashy, otherwise you may be tensing muscles that you do not

mean to. You may like to support your neck and knees for greater comfort. Have your palms down

and your legs should be uncrossed.

Sitting

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If sitting in a chair you should ensure that:

a) You sit well back in the chair so your back is well supported

b) Both your feet are on the ground

c) Your legs and ankles are uncrossed

d) Your forearms supported by the chair or your hands resting on your legs

Four major areas of the body are covered:

1. Hands, forearms and upper arms

2. Head, face, throat, shoulders and neck

3. Chest, stomach and back

4. Thighs, buttocks, calves and feet

Progressive muscle relaxation can be practised lying down or sitting in a chair with your head

supported. Each muscle group is tensed up tightly for five to seven seconds and then relaxed for

twenty to thirty seconds. This procedure is repeated at least once for each muscle group. Any area

that remains tense can be tensed up to five times. It is helpful to identify those muscle groups that tend

to tense up when you get stressed so that you can pay special attention to those areas when relaxing.

To familiarise yourself with the procedure you may find listening to a tape helpful.

A list of muscles and how to tense them

After tensing and relaxing each muscle, take a deep diaphragmatic breath, melting away any

remaining tension as you breathe out.

If you suffer from neck or back problems – omit those exercises.

Hands and forearms make a fist …. and then let go.

Biceps bend your arms at the elbows and try to touch your wrists to your

shoulders …. then let go, allow your arms to return to a comfortable

relaxed position.

Triceps (back of your arms) straighten your arms as hard as you can …. and then let go.

Shoulders shrug them as if trying to make them touch your ears …. and then let

go.

Neck arch your head back …. turn your head to the right and then to the

left …. then let go.

Forehead raise your eyebrows as if surprised …. then let go.

Brow and eyelids squeeze your eyes tightly shut …. then let go.

Jaw clench your teeth together … then let go.

Tongue and throat push your tongue hard against the roof of your mouth …. and let go.

Chest take a really deep breath and hold it …. and then let go.

Stomach tense your stomach as if someone were going to punch it …. then let

go.

Hips and lower back arch your back and clench your buttock muscles …. then let go.

Legs straighten your legs and point your toes away from you …. then let

go….pull your toes

If you sense any remaining tension in a muscle, simply tense it further, relax it, take a deep breath and

sigh as you breathe out.

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PROGRESSIVE MUSCLE RELAXATION

a. Try at least 20 minutes of progressive muscle relaxation each day for the next week using this

Record of General Tension

Rate yourself on the 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.moderately tense, 8. very tense 9. extremely tense, 10.the most tense you could be

Week of Before session After session Comments

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

RELAXATION SCRIPT

To begin our relaxation, remove your shoes and if you wear glasses take them off. Loosen anything tight

and lie down on your rug. It is advisable to lie flat on your back with your legs uncrossed, your feet

slightly apart and your arms by your side; do whatever is most comfortable for you. Now slowly close

your eyes. You are now going to spend the next few minutes concentrating on your body. You will try to

feel the difference between when your muscles are tense and when they become relaxed, so that with

practice your body will begin to respond quickly and relaxation will become more spontaneous.

I am going to talk you though a series of exercises designed to help you relax, and if you wish to repeat

any of them during the session please feel free to do so in your own time. If you can’t understand any of

the instructions lie quietly until you can catch up again.

Now you can start by concentrating on your breathing …. Notice what actually happens to your body as

you breathe in and as you breathe out. Take a deep breath in slowly, hold it for a few seconds, and then

slowly breathe out. Your breathing is an important part of the process of ridding your body of all the

tension that builds up inside. So, if you can, imagine that every time you breathe in the tension is being

collected together, and that as you breathe out, the tension is being expelled from your body, leaving your

body feeling calmer and more relaxed each time. You should aim to be breathing a little deeper …. A

little slower ….and in a nice regular, rhythmical manner.

Now if you can pull your toes up toward your chin and feel the tension move into your calves, up into

your knees …. Tighten your knees and your thighs and squeeze your buttocks together so that you are

feeling tense and uncomfortable from your waist downwards. Hold that for a few second, then slowly,

each time you breathe out, let your muscles relax, let them become loose and limp …. and heavy …. Feel

the drowsiness begin to pass through your body as the tension leaves your muscles …. Leaving you

feeling calmer and more relaxed.

Updated March 2020

Continue to use your breathing to relax your stomach and chest muscles. The next time you breathe in,

exaggerate the expansion of your chest and pull your stomach muscles down very flat as if there is a

heavy weight on them …. Hold it for a few seconds, then slowly breathing out let your muscles relax and

return them to a comfortable position. Take a deep breath in, slowly hold it, slowly breathe out. Now

think about the areas where there is still tension allow this to pass from your chest through to your

shoulders, and then your elbows, down until you reach your finger tips.

Concentrate on your hands and try to collect that tension together. If you spread your fingers out as wide

as you can, see if you can push the tension away. Hold it for a few seconds, then, as you breathe out, let

your muscles become loose and limp and relaxed. Let your fingers rest lightly on the mat. Now make a

fist with your knuckles becoming white and your finger tips pressed into the palms of your hands. Feel

the tension pass through to your elbows, tighten them, and shrug your shoulders up towards your ears, so

that you are holding your arms very tight and straight. Feel how uncomfortable this is, hold it for a few

seconds then, as you breathe out slowly, feel the tension leave your shoulders, and your elbows, and

slowly let your fingers begin to uncurl. Feel them cool down as the air reaches your skin … let your arms

become loose and limp and relaxed.

The tension has now reached the area of your neck. This is a place where the muscles become very tired

and tense as they bear the weight of your head all day. It is important to reduce the pressure and pump

the tension away in a calm and controlled way. If you roll your head to the right, leave it there for a few

seconds before slowly returning your head to the middle. Take a deep breath and roll your head to the

left, hold it and then slowly return to the middle position. The drowsiness is beginning to pass into this

area now but do not forget the muscles at the front and back of your neck. Still keep supporting your

head on the mat, breathe in and point your chin to the ceiling, and stretch the muscles at the front. Hold it

for a few seconds then as you breathe out, bring your head downwards, giving yourself a double chin and

stretching the muscles at the back of your neck. Hold for a few seconds, then slowly breathe out and

slowly return your head to the middle position in your own time. Take a nice deep breath in slowly and

hold it, then slowly breathe out.

There is another area of muscle that we tend to take for granted, these are the muscles of our face and

scalp. Our facial expression often reflects how we are feeling inside. Once again we have to collect the

tension together so that it can melt away when we breathe out. When you breathe in, clench your teeth

and screw your whole face up, closing your eyes tight and wrinkling your forehead. Feel how

uncomfortable it is and hold it for a few seconds …. Then breathe out slowly and let your muscles

become loose and limp, feel them become smooth and soft and relaxed.

You are now left with your breathing and the thoughts in your head. Your muscles are relaxing and you

are in control, so now your energies can be used for your thoughts. You may like to concentrate on

something enjoyable, or to become interested in the noises around you. If there is something on your

mind that will not go away, allow it to pass through your mind in a calm way, don’t fight it just let the

tension in your head float away. The time is now yours to do as you wish. I will tell you when to finish.

Begin to wake yourself up, start by moving your fingers and toes. Gradually turn this into a big stretch.

Slowly open your eyes and look about you. Roll onto your side rather than sitting straight up, and think

about how you are feeling now.

This brings our relaxation session to an end.


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