04 Relaxation

Practice Techniques

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The enclosed technique and procedures were developed with materials from a workbook of cognitive behavior techniques titled ‘Thoughts & Feelings’ and written by Matthew McKay, Martha Davis and Patrick Fanning. The workbook was published by New Harbinger Publications, Inc. In 1997.

Clinical Prompt

Relaxation training requires regular practice.

  • Abdominal Breathing
    • lie down and close the eyes noticing sensations in the body
    • place on hand on the chest and the other on the abdomen
    • let the breath find its own pace
    • count exhalations [1 to 10] and repeat
  • Progressive Muscle Relaxation
    • arms: hands, elbows/biceps, triceps
    • head: eyebrows, squinch face, eyes & mouth, jaw & tongue, neck
    • midsection: shoulders, arms, stomach & abdomen, back
    • legs: buttocks & thighs, inner thigh, toes
  • Simultaneous Contractions
  • Cue-controlled relaxation
    • breathe in, relax
  • Visualizing
    • comfortable place
    • peaceful scene
    • absorbing scene elements
    • eliminate gaps
    • colors, light source, temperature, smell, touch
    • perspective changes
  • Peaceful scenes
    • beach
    • forest
    • train

Introduction

Relaxation training refers to the regular practice of one or more of a group of specific relaxation exercises. These exercises most often involve a combination of deep breathing, muscle relaxation, and visualization techniques which have been proven to release the muscular tension that the body stores during times of stress.

During relaxation training sessions the child will discover that racing thoughts will start to slow, and that feelings of fear and anxiety will ease considerably. In fact, when the body is completely relaxed, it’s impossible to feel fear or anxiety. In 1975, Herbert Benson studied how the body changes when a person is deeply relaxed. During the state that Benson termed the ‘relaxation response’, he observed that the heart rate, breath rate, blood pressure, skeletal muscle tension, metabolic rate, oxygen consumption, and skin electrical conductivity all decreased. On the other hand, alpha brain wave frequency – associated with a state of calm well-being – increased. Every one of these physical conditions is exactly opposite to reactions that anxiety and fear produce in the body. Deep relaxation and anxiety are physiological opposites.

Symptom Effectiveness

When practiced regularly, relaxation training is effective in reducing general, interpersonal, and performance anxiety. The relaxation training outlined here is a key component in the protocols for treating phobias and chronic anger. The training is also recommended for ADHD, chronic muscular tension, neck and back pain, insomnia, muscle spasms, and high blood pressure.

Time for Mastery

In general, a person can experience the benefits of deep relaxation within a session or two using any of the methods described below. Often two or more methods can be combined to deepen the sense of relaxation; for instance, the child could visualize a peaceful scene while practicing deep breathing.

Abdominal breathing, progressive muscle relaxation, relaxation without tension, and cue-controlled relaxation should be learned in sequence. The client cannot do cue-controlled relaxation (the quickest and easiest of all the methods) unless they have mastered the first three. The whole sequence will take two [02] to four [04] weeks to learn, depending on length and frequency of practice sessions.

Instructions

This process will focus on highly effective techniques which, when practiced regularly, can bring about deep states of relaxation.

Initially, you’ll want the child to do the relaxation training in a quiet room where they won’t be disturbed. Later, when they are more familiar with the exercises, they can try them in more distracting and public places. One of the things you may want to do, once they have learned how and are comfortable, is to cue them to use the techniques when you see them beginning to react to a negative thought. If the child has trouble with distraction, you can use white noise the humming of an air conditioner or fan – to cover up sounds that you have no control over. A small tape player with a tape of such white noise can be made available if necessary.

When working with children, it is often helpful to set a context to which they can relate. Depending on the age and temperament of the child, it may be helpful to cast this as the beginning of a martial arts or meditation moment. When beginning the training, the child should wear loose, nonbinding clothing for practicing the relaxation techniques. Dressing in the traditional oriental costume may also help set the scene. At the start of each exercise, the child should assume a comfortable position, either lying down or sitting, in which his/her body feels well supported.

Abdominal Breathing

One group of muscles that commonly tense in response to stress are those located in the wall of the abdomen. When the abdominal muscles are tight, they push against the diaphragm as it extends downward to initiate each breath. This pushing action restricts the amount of air the person takes in and forces the air they do inhale to remain high in the top part of the lungs.

When breathing is high and shallow, the person will probably feel as though they aren’t getting enough oxygen. This is stressful and sets off mental alarm bells that they are in danger. To make up for the lack of air, instead of relaxing the abdominal muscles and taking deeper breaths, the client may take quick, shallow breaths. This shallow, rapid breathing can lead them to hyperventilate – one of the prime causes of panic.

Abdominal breathing reverses this process by relaxing the muscles that press against the diaphragm and slowing the breath rate. Three or four deep abdominal breaths can be an almost instant relaxer.

Abdominal breathing is usually easy to learn. Have the child practice the following exercise for about three minutes.

  1. Lie down and close the eyes. Take a moment to notice the sensations in the body, particularly where the body is holding any tension. Take several breaths and see what you notice about the quality of your breathing. Where is the breath centered? Are your lungs filling all the way up? Does your chest move in and out when you breathe? Does your abdomen? Do both?
  2. Have the child place one hand on the chest and the other one on the abdomen, right below his/her waist. As s/he breathes in, s/he should imagine that s/he is sending the breath as far down into the body as it will go. S/he should feel his/her lungs expand as they fill up with air. As s/he does this, the hand on the chest should remain fairly still, but the hand on the abdomen should rise and fall with each breath.
  3. Once they have the feel of it, have them continue to gently breathe in and out. Let their breath find its own pace. If the breathing feels unnatural or forced in any way, have them just maintain awareness of that sensation as they breathe in and out. Eventually any straining or unnaturalness should ease up by itself. If they have difficulty getting the hand on their abdomen to move, or if both hands are moving, have them try pressing down with the hand on the abdomen. As they breathe, have them direct the air so that it pushes up against the pressure of this hand, forcing it to rise.
  4. After breathing deeply for several breaths, they should begin to count each time they exhale. After ten exhalations, have them start the count over with one. When thoughts intrude and they lose track of the number they are on, let them simply return their attention to the exercise and start counting again from number one. Have them continue counting breaths for ten minutes, making certain that the hand on the abdomen continues to rise with each breath..

Progressive Muscle Relaxation

Progressive muscle relaxation, or PMR, is a relaxation technique that involves tensing and relaxing all the various muscle groups in the body in a specific sequence. The technique was developed by Dr. Edmund Jacobson in 1929. Realizing that the body responded to anxious and fearful thoughts by storing tension in the muscles, Jacobson found that this tension could be released by consciously tightening the muscles beyond their normal tension point and then suddenly relaxing them. He discovered that repeating this procedure with every muscle group in the body could induce a deep state of relaxation.

Jacobson’s original instructions for PMR were a complex routine, involving more than 200 different muscle relaxation exercises. Since then, researchers have discovered that a daily regimen of sixteen exercises can be equally effective. These exercises divide the body into four major muscle groups: the arms, the head, the midsection, and the legs. If the child practices PMR as outlined below, s/he will experience the physical benefits that Herbert Benson defined as the relaxation response. More importantly, if they continue to regularly practice the PMR exercises for several months, the amount of anxiety, anger, or other painful emotions that habitually come up in life will significantly diminish.

Instructions for Practicing PMR

The child should practice the following exercise for about twenty or thirty minutes daily, whether s/he feels like it or not. Help the child to understand that s/he is developing a skill—the ability to relax. In the beginning, s/he may find that it takes a long time to relax even a little bit. However, as s/he continues to practice, s/he will learn to relax more deeply and more rapidly.

As s/he goes through the exercise, s/he should repeat the tensing and relaxing cycle once for each muscle group. Tighten each group for seven seconds, and relax for twenty seconds. Each time s/he tenses a muscle group, have him/her tighten the muscles as hard as s/he can without straining. When it’s time to release the tension, have him/her let go of it suddenly and completely. S/he should notice the feeling of relaxation. Are the muscles heavy, warm, or tingly? Learning to recognize the physical signs of relaxation is a key part of the process.

The progression from one muscle group to another follows a logical sequence, and most people find that after practicing PMR a few times they can easily remember the sequence. If you do have trouble remembering the order, you may prefer to make a tape of the instructions or buy a professionally made tape.

Arms

  1. Clench both hands tightly, making them into fists. Hold the tightness for seven seconds. Pay attention to the sensations in the muscles as they contract. Now let go of the tension and notice the difference. Stay focused on the sensations you are feeling. After twenty seconds of allowing the muscles to relax, clench your fists again. Hold the tension for seven seconds, then relax for twenty seconds.
  2. Next, bend both elbows and flex your biceps. Hold this ‘Charles Atlas’ pose for seven seconds, then let go of the tension. Flex a second time, then relax. Pay attention to the physical sensations of relaxation.
  3. Tense your triceps the muscles underneath your arms – by locking your elbows and stretching your arms as hard as you can down by your sides. Let go of the tension. Flex and release a second time. Notice the sensations of relaxation.

Head

  1. Raise your eyebrows up as high as you can and feel the tension in your forehead. Hold this, then suddenly let your brow drop and become smooth. Repeat.
  2. Squinch up your entire face as though you were trying to make every part of it meet on the tip of your nose. Feel where the strain is. Then release the tension and notice the feeling. Repeat.
  3. Close your eyes tightly and smile, stretching your mouth as wide open as you can. Hold it, then relax. Repeat.
  4. Clench your jaw and push your tongue up to the roof of your mouth. Hold, then release. Repeat. Notice how the sensations change. Open your mouth into a big, wide ‘O’, Hold, then release so that your jaw goes back into a normal position. Feel the relaxation and notice the difference. Repeat.
  5. Tilt your head back as far as you can until it presses against the bottom of your neck. Hold, then relax. Repeat. Stretch your head to one side so that it rests near your shoulder; hold, relax, then repeat. Now roll your head over to the other shoulder; hold, relax, then repeat. Lift your head to its natural resting position and feel the tension drain away. Let your mouth fall open slightly. Stretch your head forward until your head is resting on your chest. Release the tension as you return your head to the resting position. Repeat.

Midsection

  1. Bring your shoulders up as high as you can – as though you are trying to touch your ears with them. Hold, then let them fall back down again. Feel the heaviness in the muscles as they relax. Repeat. Stretch your shoulders back – as though you were trying to touch your shoulder blades together. Hold the position, then let your arms drop by your sides. Repeat.
  2. Bring your arms out straight in front of you, lifting from the shoulders so that your arms are parallel with each other. Then, while keeping them straight, cross one arm over the other at a point as high up on your arms as you can. Feel the stretch in your upper back. Hold the position. Now, let your arms drop down to your sides and notice the sensation of letting go. Repeat.
  3. Take a deep breath. Before you exhale, contract all the muscles in your stomach and abdomen. Hold, then exhale and release the contraction. Repeat.
  4. Gently arch your back. Hold the tension, then relax so your back is flat again on the floor, bed, or back of the chair. Repeat.

Legs

  1. Tighten your buttocks and thighs. Increase the tension by straightening your legs and pushing down hard through your heels. Hold this position, then let go. Repeat.
  2. Tense your inner thigh muscles by pressing your legs together as hard as you can. Release, and feel the sense of ease spread throughout your legs. Repeat.
  3. Tighten your leg muscles while pointing your toes. Hold the position, then release as you return your toes to a neutral position. Repeat.
  4. Flex your toes by drawing them up towards your head as you tighten your shin and calf muscles. Hold, and then release by letting your feet hang loosely. Repeat.

Shorthand Muscle Relaxation – Simultaneous Contractions

Although the basic PMR procedure is an excellent way to relax, it takes too long to go through all the different muscle groups sequentially to make it a practical tool for on-the-spot relaxation. It is important, however, for the child to go through the basic process at least once to gain the experience of the effect. However, to relax the body more quickly, the child will then need to learn the following shorthand muscle relaxation method.

The key to shorthand PMR is learning to simultaneously relax the muscles in each of the four body areas. You will tense and hold each group for seven seconds, and then allow your muscles to relax for twenty seconds – just as you did in the full PMR exercise. As the child becomes more adept, s/he may need less time for both the tensing and relaxing parts.

  1. Make tight fists while flexing your biceps and forearms in a Charles Atlas pose. Or, if you would feel too conspicuous doing this in your current surroundings, simply tighten all the muscles in your arms as they hang straight by your sides. Hold the tension, then relax.
  2. Press your head back as far as you can. Roll it clockwise in a complete circle, then roll it once counterclockwise. As you do this, wrinkle up your face as though you were trying to make every part of it meet at your nose. Relax. Now tense your jaw and your throat muscles and hunch your shoulders up. Hold this position, then relax.
  3. Gently arch your back as you take a deep breath. Hold this position, then relax. Take another deep breath, and this time push your abdomen out as you inhale. Then relax.
  4. Point your toes up towards your face while tightening your calf and shin muscles. Hold the position, then relax. Now, curl your toes while tightening your calf, thigh, and buttock muscles. Hold this position, then relax.

Relaxation without Tension

Seven to fourteen PMR practice sessions should make the child adept at recognizing and releasing tension in your muscles. By now s/he may not need to deliberately contract each muscle before s/he relaxes it. Instead, s/he can scan the body for tension by running his/her attention through the sequence of the four muscle groups. If s/he finds any tightness, s/he simply lets go of it, just as s/he did after each contraction in the PMR exercises. S/he must stay focused and really feel each sensation. The child should work with each of the four muscle groups until the muscles seem completely relaxed. If s/he comes to an area that feels tight and won’t let go, tighten that one muscle or muscle group and then release the tension. Your client will find this method faster than the PMR shorthand procedure. It also is a good way to relax sore muscles that you don’t want to aggravate by overtensing.

Cue-Controlled Relaxation

In cue-controlled relaxation, the child will learn to relax his/her muscles whenever s/he wants by combining a verbal suggestion with abdominal breathing. First, have them take a comfortable position, then release as much tension as they can using the relaxation without tension method. Focus on the belly as it moves in and out with each breath. Make breaths slow and rhythmic. With each breath they should let themselves become more and more relaxed. Now, on every inhalation say they should say the words breathe in, and as you exhale, the word relax. Have them just keep saying, “Breathe in … relax, breathe in … relax,” while letting go of tension throughout the body. Continue this practice for five minutes, repeating the key phrases with each breath.

The cue-controlled method teaches the body to associate the word relax with the feeling of relaxation. After they have practiced this technique for a while and the association is strong, they will be able to relax the muscles anytime, anywhere, just by mentally repeating, “Breathe in … relax,” and by releasing any feelings of tightness throughout the body. Cue-controlled relaxation can give stress relief in less than a minute, and is a major component of the anxiety and anger management protocols.

Visualizing a Peaceful Scene

We all have the ability to relax by mentally constructing a peaceful scene that we can enter whenever we feel stressed. The child’s peaceful scene should be a setting that s/he finds interesting and appealing. It will be a place that will make him/her feel safe and secure when s/he imagines it – where s/he will be able to let his/her guard down and completely relax. Such a place can be real from prior experience or completely made up.

Finding Your Peaceful Scene

Have the child find a comfortable position, either sitting or lying down, and take a few minutes to practice cue-controlled relaxation. Visualization is most effective when you are completely relaxed, so be sure to take enough time so the child can relax thoroughly.

Now simply have the child ask his/her unconscious to show him/her a peaceful scene. A picture may start to form in the imagination. Or, instead of an image, s/he may “hear” a word, phrase, or sound that will start to stir an image to life. However it happens, if an image does start to show itself, don’t question it. Accept this as a setting that has a restful resonance for the child.

If a scene doesn’t start to appear, have the child choose a place or an activity that appeals. Where would you like to be right now? Out in the country? The woods? A meadow? On a boat? In a cabin? The house where you grew up? A penthouse overlooking Central Park?

Once the child’s imagination has settled on a scene, have him/her notice what objects are around in the scene. See their colors and shapes. What sounds do you hear? What scents are in the air? What are you doing? What physical sensations are you feeling? Try to notice everything about the scene. You may find that parts of your scene remain unclear or hazy no matter how hard you try. This is perfectly normal. Don’t be disappointed if the scene doesn’t appear in 3-D Technicolor right away. With practice, the child will be able to draw out the details and make the scene more vivid.

Visualization Skills

Visualization is a skill. Like many skills such as drawing, cabinet making, or sewing, some people are initially more adept at it than others. You may be a person who can sit down and re-create a scene so clearly that you feel like you’re actually there. Or you might find it difficult to see anything at all.

Even if you aren’t a natural at visualization, you can develop this skill with practice. The following guidelines will help you bring your visualizations to life.

  1. Once an image appears, if there are any gaps in the scene—if one part seems hazy or void of any image at all—put all of your concentration on that area and ask, “What is it?” Hold your attention on that area and see if it starts to clear. Whatever appears in your imagination, even when the image is fuzzy or blank, watch it as intently as you can.
  2. It is important to make your imagined scene as “real” as possible. One way to accomplish this is by adding as much detail as you can gather from at least three of your five senses. Visually, you can bring out the shapes in your scene by running your attention over the outline of the images as though you were tracing them with a pencil. Notice the colors in your scene. Are they vivid or faded? Locate the light source. How does light falling on an object affect its color? What areas are in shadow? Try to notice everything you could actually see if you were there.
  3. Pay attention to the information you would gather through your other senses. What sounds would you hear if you were actually there? What would the environment smell like? What can you feel through your sense of touch? Are there areas that are hot or cold? Is a breeze blowing? If you are sitting or lying down in your scene, can you feel the pressure on the parts of your body that contact the ground? Run your hand over various objects and notice their texture and the sensations this action creates in your body.
  4. Pay attention to the perspective from which you are viewing the scene. Are you viewing it as though you are an outsider looking in? The clue to the “outside looking in” perspective is when you actually see an imagined “you” in your scene. If you do, you need to shift perspective so that your view is what you’d see if you were actually in the scene. For example, if you imagine yourself lying underneath some trees, instead of seeing a reclining “you” on the ground, shift your perspective so that you see only the branches of the trees against a clear blue sky. By seeing things from a perspective inside the scene, you will draw yourself completely into the image and make it easier to feel that you are living the scene rather than just viewing it.
  5. When unrelated thoughts intrude, notice their content and then return your attention to the scene you are creating.

Examples of Peaceful Scenes

The following examples may give the child an idea of how to put scenes together. After talking to the child for a while, you should have a sense of what is appealing to them. From the following examples, you can help them ‘fill in’ the details of a favorite place.

The Beach

You have just descended a long flight of wooden stairs and now find yourself standing on a stretch of the most pristine beach you have ever seen. It is wide and stretches as far as you can see in either direction. You sit down on the sand and find that it’s white and smooth, warm and heavy. You let the sand sift through your fingers and it seems almost liquid. You lie on your stomach, finding that the warm sand instantly conforms to the shape of your body. A breeze touches your face. The soft sand holds you. The surf rumbles as it rises into long white crests that break towards you, then dissolve on the sand’s edge. The air smells of salt and sea life, and you breathe it in deeply. You feel calm and safe.

The Forest

You are in a forest, lying down in a circle of very tall trees. Underneath you is a cushion of soft, dry moss. The air is strongly scented with laurel and pine, and the atmosphere feels deep, still, and serene. You drink in the warmth of the sun as it streams through the branches, dappling the carpet of moss. A warm wind rises. The tall trees around you sway and bend, and the leaves rustle rhythmically with each gust. Each time the breeze swells, every muscle in your body becomes more and more relaxed. Two songbirds warble in the distance. A chipmunk chatters above. A sense of ease, peace, and joy spreads from head to toe.

The Train

You are riding in a private car at the very end of a long train. The entire ceiling of the car is a dome of tinted glass, and the walls of the car are glass, creating the illusion that you are out in the open, flying through the vast countryside. A plush couch sits at the far end, with two overstuffed chairs opposite and a coffee table in the middle—complete with your favorite magazines. You sink deeply into one of the chairs, push off your shoes, and put your feet on the table. Outside an ever receding panorama: mountains, trees, snowcapped peaks, a lake shimmering in the distance. The sun has almost set and the sky is washed in purples and reds, filled with towering red-orange clouds. And as you gaze, you ease into the rhythm of the clacking wheels and feel the lull of the rocking train.