Feeling calm may seem like an experience enjoyed by people without anxiety, but not by you. How can they be so blessed? Are they just lucky, or are you cursed? Although it sounds impossible when you are suffering from anxiety, the good news is that you can learn to relax and be calm. You have that capacity built into your body.
As you learned in chapter 3, your autonomic nervous system has two branches: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system activates your body; your parasympathetic nervous system calms it down. In this chapter, you’ll relearn to tap into the talents of your parasympathetic nervous system.
Normally, the sympathetic and the parasympathetic nervous systems balance each other out. But when you suffer from anxiety, your sympathetic branch learned to dominate. Too much activation makes you anxious. You want to bring the two branches back into balance. To heal your anxiety, you need tap into the skills of your parasympathetic nervous system, so you can calm down.
Your parasympathetic nervous system has a counterbalance to the fight-or-flight response. Dubbed the relaxation response by Harvard professor Herbert Benson, it describes your body’s parasympathetic nervous system in action. The relaxation response slows down your breathing and helps lower your heart rate and metabolism.
Notice in the following chart how the relaxation response and the fight-or-flight response balance each other out.
| FIGHT-OR-FLIGHT RESPONSE (SYMPATHETIC NERVOUS SYSTEM) | RELAXATION RESPONSE (PARASYMPATHETIC NERVOUS SYSTEM) |
| ↑ Heart rate | ↓ Heart rate |
| ↑ Blood pressure | ↓ Blood pressure |
| ↑ Metabolism | ↓ Metabolism |
| ↑ Muscle tension | ↓ Muscle tension |
| ↑ Breathing rate | ↓ Breathing rate |
| ↑ Mental arousal | ↓ Mental arousal |
For thousands of years, people in societies across the globe have developed techniques to induce the relaxation response and activate the parasympathetic nervous system—without knowing of their existence. Referred to as prayer and meditation, these practices were devised to engender spirituality and a sense of inner peace.
Over the past century, a number of practices were developed by mental health professionals to achieve calmness. Some of these, such as progressive relaxation, are generally referred to as relaxation techniques, while others fall under the broad categories of self-hypnosis, visual imagery, prayer, and meditation. All of these methods promote relaxation and a sense of inner peace. Although the names and terminology are different, they are based on the same principles and physiology.
There are elements common to most forms of prayer, meditation, relaxation exercises, and hypnosis. They are:
1. Breathing rhythmically. Deep, deliberate, and focused breathing allows you to slow your heartbeat and to center your attention on relaxation. You learned how to do abdominal breathing in the previous chapter.
2. Focused attention. Much of anxiety is about nervous anticipation of the future. When you gently focus your attention on the here and now, you transform your experiences into rich and calm experiences. Gentle focused attention activates your frontal lobes to exert their ability to inhibit the overreactivity of your amygdala. Some practices include a “point focus.” Focusing on your breathing or on a word, such as a mantra, while meditating can help you stay focused in the present.
3. A quiet environment. A quiet environment gives you the opportunity to learn relaxation without distractions. Later, when you are unable to practice in a quiet environment, you can relate back to the way you felt in the quiet place to help you stay focused.
4. An accepting and nonjudgmental attitude. By shifting away from rigid expectations and to an accepting attitude, you’ll appreciate reality as it is, rather than what you fear it could be. In other words, by not “trying too hard” to relax, you take the pressure off yourself and can relax. Consequently, you’ll free yourself to adjust to whatever happens. When you let yourself experience the here and now, instead of fearing the future, you’ll be more relaxed and present.
5. A relaxed posture. This can include sitting in a relaxed posture or stretching, as you would when practicing yoga (see page 90).
6. Observation. By quietly observing each experience, you detach from the compulsion to immediately react to it. Observation allows you to detach from anxiety, by seeing your experiences “from a distance,” as if you were not directly affected by them. When you observe your experiences in a nonjudgmental fashion, you simply note what is occurring at the time. Taking the vantage point of an observer, instead of a victim, allows you to detach from the anxiety.
7. Labeling. Labeling what you experience accesses your left frontal lobe and its positive emotions. This works if you remain in an accepting and nonjudgmental attitude as a detached observer.
These common principles can lower your anxiety by helping you “let go” of sympathetic nervous system arousal. Shifting your attention to accept and observe the present moment, while simultaneously breathing deeply, promotes relaxation. As a consequence, situations you once associated with anxiety can be experienced with a relaxed attitude. Each principle by itself can help defuse anxiety. When combined, they are particularly powerful in putting you at ease.
Remember that trying too hard to relax actually makes you more tense. Letting go of sympathetic arousal by widening your attention to observe and accept each experience engages your body’s ability (through the parasympathetic nervous system) to calm down. By allowing yourself to relax, instead of trying to relax, you reduce tension so that you can relax.
Here’s an example. Try not to think of purple elephants. By forcing yourself to keep purple elephants out of your mind, you fight with yourself and invariably think of purple elephants. Now, focus on something else, such as yellow kangaroos. Tell yourself that if purple elephants pop into your mind, it’s okay. Simply observe and accept that when purple elephants come to mind, you’ll let them in and then just let them go. As you shift your attention to yellow kangaroos, you probably won’t think about purple elephants as much, because you let go of the effort to keep purple elephants out of your mind.
Similarly, when you try too hard to keep from being anxious, you make yourself more tense. By focusing on cultivating relaxation skills, instead of trying hard to relax, your anxiety can melt away, because you have widened your focused attention to include acceptance, observance, and a nonjudgmental attitude.
Progressive relaxation is a popular traditional relaxation technique. It involves tensing and releasing muscle groups, such as your fingers or toes, while simultaneously breathing deeply. Although the seven common principles are traditionally not part of this exercise, I recommend that you include them. When you practice, try not to tense too hard; you want to feel the tension, not give yourself a cramp. Perform the exercise slowly. Don’t rush through it as if it were an aerobic exercise.
1. Lie down in a comfortable position. Splay your toes and tense the muscles in your feet. Count to ten, then release the muscles. Notice and enjoy the flow of relaxation for at least 20 seconds. Repeat the tensing, holding, and releasing three times.
2. Splay your fingers and hold for 10 seconds. Release your muscles and, for 20 seconds, notice the relaxing feelings. Repeat this sequence three times.
3. Repeat this progressive relaxation technique for each body part—your calf muscles, forearms, thighs, upper arms, upper legs, pelvic area, stomach muscles, chest muscles, shoulders, neck, and your entire face and scalp—until your entire body is relaxed.
4. Once you have completed the exercise, breathe easily and notice how the muscles in your body feel limp and relaxed. Imagine them being twice as heavy and that your mind is light as air. Think of the relaxation at the end of the exercise as an extended period, so that the calm feelings carry into the next hour.
Although this method is a useful technique for dissipating daytime anxiety, it is not effective for combating insomnia, because the tensing portion of the technique does not dissipate enough for sleep.
However, you can modify the exercise by forgoing the tensing portion and instead repeating the following phrases as you focus on each body part.
My feet feel warm and heavy . . .
My ankles feel warm and relaxed . . .
My hips feel relaxed and heavy . . .
My abdomen feels warm and relaxed . . .
My chest feels relaxed . . .
My neck feels comfortable and relaxed . . .
My hands feel heavy and warm . . .
My arms feels warm and relaxed . . .
My forehead feels smooth and relaxed . . .
My jaw feels relaxed and comfortable . . .
My whole body feels heavy, relaxed, and comfortable . . .
Your imagination is a powerful tool, and it can be used to heal your anxiety. You use your imagination every day for periodic daydreaming, so you might as well make it work for you, instead of against you. Don’t forget that, in your daydreams, you’re the main actor as well as the scriptwriter. This means that you can change the storyline to fit your goal of achieving relaxation.
Just as you can imagine the worst, you can also imagine positive experiences. For this reason, imagery is a relaxation technique that has gained popularity in the past thirty years. The therapeutic practice of imagery involves visualizing being in a tranquil place that gives you a sense of peace.
Find a quiet environment and get comfortable. Close your eyes and slow your breathing. Now imagine that relaxing environment and sooth yourself with the imagery. Below is a calming scenario to get you started. Later, you can create any calming scenario you like.
Imagine yourself walking on a secluded beach. The sun is warm on your skin, and there is a gentle sea breeze. You can smell the tang of the sea air. Watch the waves roll in, one after the other, and notice the deep blue color of the sea out beyond the surf. Stop and examine a tide pool; study the pebbly arms of a starfish and the waving fronds of the sea anemones. Embrace all of the visual, auditory, and tactile sensations of the experience: the mist, the crash of the waves, the texture of the sand under your feet. Hear the sound of the surf as it ebbs and flows; make it match every inhalation and exhalation of your breath. Concentrate on a flock of pelicans flying by in formation and taking your anxiety with it. Here are some other scenarios you can use to relax.
The mountain meadow. Imagine yourself in a mountain meadow in the fall. Smell the aroma of the pines and feel the coolness of the gentle mountain breeze. The leaves of the aspens clatter, and, as you gaze over to them, you notice that they are turning gold in the crisp autumn air. The sight of a mountain peak on the horizon invites your fascination.
Floating on a river. Imagine yourself on a raft floating down a river. You don’t feel like paddling in any particular direction; instead, you let the easy current take you down river. The trees along the river invite your attention. Three deer graze below the canopy of a huge oak.
Imagery can take you away from the anxiety of the day. If you fully absorb yourself in the calming imaginary scenes, you can soothe and refresh yourself. You will feel calm as well as revitalized. Imagery can be used in any meditative or self-hypnotic exercise. Think of transforming your everyday daydreaming into an exercise in engendering a calming feeling of peace and relaxation.
Beth, a graduate student in English literature, came to my anxiety class after a series of panic attacks. She tried using imagery to calm herself down, visualizing herself on a deserted beach. But, before long, she began to hyperventilate and imagined herself running ahead of some villain she couldn’t see. When I asked her to interrupt the hyperventilation by using abdominal breathing, the image of running down the beach faded.
Beth tried again and once again imagined herself walking on the beach. Although the panic and the running were gone, she still felt some free-floating anxiety. For Beth, the idea of walking alone on the beach was not soothing. I asked her to imagine a few couples sitting quietly nearby, about fifty yards (forty-five meters) apart. The presence of other people seemed to calm her. I suggested she try the imagery exercise again later using the deserted beach scene, so that she could work on her anxiety about being alone in an exposure exercise (see chapter 8).
The couples anchored in two different spots on the beach gave Beth a sense of security. This initial image helped establish a soothing image. Next, I asked her to incorporate into the exercise the seven principles of relaxation. She had the breathing principle down, and, once she included the other six principles, the beach scene became not only a useful place to “go” when she wanted a “brief vacation” but also a place to practice the seven principles, so she could use them in her daily life. Soon, just reminding herself of the beach scene helped her put the seven relaxation principles into play and feel more at ease.
Hypnosis is a form of relaxation that uses breathing, imagery, focused attention, and increased receptivity to suggestion and direction, led by one trained in hypnotherapy. Self-hypnosis is a method of relaxation and absorption that you induce in yourself. It is easier to do than you might assume.
You might be familiar with “highway hypnosis.” Like many people, you probably have driven down the highway, lost in thought. Suddenly, you wonder, “Where did the last ten miles go?” Somehow, you managed to drive that distance on autopilot. Highway hypnosis is an example of how focused attention can take you away from your immediate environment. Although I am not suggesting that you become accomplished at highway hypnosis, it illustrates how easily you can get into a trance state of mind and put your power of concentration to work for you. First, however, you have to dispel the myths that have developed about hypnosis.
Myth: Hypnotic subjects are under the hypnotist’s control.
Truth: You are actually in control. That’s what self-hypnosis is all about.
Myth: The same techniques are used for all people.
Truth: You can use whatever works for you.
Myth: A person in a hypnotic trance will be unconscious and not remember anything.
Truth: You will remember what you want to remember.
Myth: You can’t get out of the trance without a ritual.
Truth: It’s easy to shift your attention out of a trance.
When practicing self-hypnosis, it is particularly important to remind yourself that you can “step out of the way,” so that your body can relax itself. If you allow your body to do what is natural, the process of self-hypnotic relaxation can unfold naturally.
A simple self-hypnotic experience that I teach uses focused breathing and counting down from 10 to 1.
As the numbers decrease, imagine the parts of your body relaxing with each exhalation. Try the following steps, using any of the phrases that fit for you.
10. . . I am allowing the tension to leave my body with every exhalation.
9 . . . I am feeling my body becoming heavy.
8 . . . Sounds, physical sensations, and worried thoughts are occurring around my external self, not deep within myself.
7 . . . I am descending deeper within myself, as if I am going down an escalator.
6 . . . I don’t need to fight the relaxation. I can visualize myself drifting with the current down the river. I won’t swim upstream, where anxiety lies.
5 . . . I am falling deep within myself and gently swaying back and forth, like a feather that drifts to the ground without tension.
4 . . . I am deep within myself without worry.
3 . . . I am letting go of the old world of anxiety.
2 . . . Relaxation and I are one.
1 . . . I am at peace with myself in the present moment.
Now introduce calming posthypnotic suggestions:
I’m learning to put anxiety behind me.
I no longer need to put myself on hyperalert.
There’s a calmer part of me that is expanding.
Being calm and focused will be my natural state.
Most religions have literature, including manuals, on meditation and prayer. Within Hinduism, Buddhism, Sufism, Judaism, and Christianity, meditation and prayer have a long tradition and have been practiced for thousands of years. The practitioners generally had pious intentions, and the psychological benefits were not well known until the twentieth century, when the positive effects of meditation and prayer were thoroughly researched and found to have a wide range of health benefits, including anxiety reduction. For example, experienced meditators were found to be talented at lowering their blood pressure and slowing down their brain waves. Today, meditation is taught in many medical centers, including my own.
Most types of meditation involve allowing your mind to clear while focusing on your breathing. Clearing your mind occurs by concentrating on a few words, referred to as a mantra, such as Sat Nam. For example, you repeat the word “Sat” on the inhalations and the word “Nam” on the exhalations. By concentrating on the mantra and on your breath, your mind clears and your body relaxes.
Meditation and prayer are embraced by most religious traditions, which suggests that shifting your attention beyond personal concerns, in an attempt to lose a sense of self-identifying awareness and appreciate a wider consciousness, holds great value. The effort to move beyond the personal to the transpersonal is consistent with a theology that conceptualizes our existence as only a small part of the totality of existence. In meditation, when you sense the “wider reality”—that you are but a small part of a greater whole—you detach from the day-to-day attention to your worries. Prayer, when practiced not to achieve some reward, but to simply be closer to God, promotes a deep sense of inner peace. Many methods of praying involve repeating a phrase or entire verses, such as the Lord’s Prayer. Like mantras, these phrases serve to direct your attention away from your worries and tension.
If you belong to a church, temple, or mosque, go often to engage in prayer for the purpose of relaxation and the peaceful feelings that you get from the experience. Or you can practice prayer anywhere you choose. Use the seven relaxation principles and give yourself the time to enjoy the anxiety reduction.
All these relaxation exercises require that you set aside some time for regular practice. It can be useful to structure it into your day. Use the following worksheet to monitor your daily efforts and feelings before and after you practice. This will draw attention to how often you practice relaxation exercises and motivate you to practice more often.
| FORM OF RELAXATION | DAY OF THE WEEK | LENGTH OF TIME | MY FEELINGS BEFORE | MY FEELINGS AFTER |
Joel complained about constant stress at work and had been suffering from GAD, with free-floating anxiety, tension, insomnia, and constant worries. To deal with his anxiety, Joel thought he would try meditation. He was referred to my anxiety class after telling his therapist that he “couldn’t seem to get the hang of it.”
When asked to describe his method of meditation, he said, “I sit down in that lotus position, and, at first, all I can think about is how my legs ache. Then my mind goes a mile a minute. The more I try to slow it down, the harder it gets.”
Joel had a tendency toward trying to maintain control over every aspect of his life, which contributed to his GAD and his lack of success with meditation. The long-term goal was to help him let go of that compulsion.
With Joel in mind, I led the class in an overview of the seven principles of relaxation. As we practiced them, I noticed that Joel tended to breathe shallowly. This was the first bad habit that needed to be changed. Once he learned to breathe abdominally, I suggested that he forget about using the lotus position to meditate and instead sit in a comfortable chair. He responded by saying, “But the people I’ve seen meditating in books sit in the lotus position!” I suggested that he go with what works, not with what he assumed to be the “correct” method.
I encouraged him to simply observe his experience while meditating and shift to an accepting and non-judgmental attitude about any nuance or experience he encountered, a technique referred to as mindfulness meditation. For example, rather than say, “My neck hurts,” he was to simply note that he was experiencing pain in his neck. When he tried this, he discovered that the pain in his neck faded away. When he felt some free-floating anxiety and worries nagged him like a pesky housefly, he didn’t try to suppress them, but instead labeled them: “Oh, there’s a few worries and some anxiety.” Once he labeled his observations, the intensity of his anxiety and the repetition of those worries drifted away.
Joel’s meditation style transitioned from using a mantra to using mindfulness meditation.
Mindfulness meditation, a type of meditation derived from Buddhism and also referred to as Vipassana or insight meditation, has been widely used in the treatment of anxiety. This technique does not utilize a mantra or praying phrases. Instead, the focus is on breathing, observing, accepting, and employing a nonjudgmental attitude.
When you practice mindfulness meditation, you observe and accept the thoughts, physical sensations, and emotions as they come in and out of your consciousness. You maintain a nonjudgmental attitude as you take a step back from your thoughts, physical sensations, and feelings, seeing them rise and fall back.
Mindfulness meditation has been used in the treatment of general medical problems, such as chronic pain. Instead of trying to block the pain, chronic pain sufferers learn to observe and accept the pain. This concept may seem strange, especially when considering pain. Why accept the pain? Doesn’t it bring on more pain? The short answer is no. Actually, you’ll have less pain. Mindfulness training can alter how your brain functions and lower your reactivity to pain, because you’re not trying to fight it. By observing and accepting the pain, you detach from its intensity.
Overall mindfulness practice has been shown to alleviate stress and cultivate positive feelings, such as the reduction of anxiety. One of the key ways to lower anxiety is through the connections between your prefrontal cortex and your amygdala. These connections play a significant role in your resilience and the ability to maintain positive emotions in the face of adversity.
The areas of your brain that can defuse anxiety and tame your amygdala are the same areas that are activated during mindfulness meditation. One of these areas is your middle prefrontal cortex, which provides you with the skill of self-observation and has been described as the center of awareness. Long-term meditators are reported to have increased thicknesses of the middle prefrontal cortex as well as an enlarged right insula. The right insula is an area of the cortex that monitors your body functions and, accordingly, how your body feels emotion. The middle prefrontal cortex and the right insula are the areas associated with empathy and self-awareness. The increased thickness of the middle prefrontal cortex is correlated with years of practice and reflects the neuroplasticity that occurred to strengthen this area, so that it works more efficiently.
When you narrate your experience, there is a shift in activation to the left prefrontal cortex. Because your left prefrontal cortex is action-oriented, this activation allows you to put a positive spin on your experiences. When you activate your left hemisphere, there is a greater emphasis on approaching life and facing anxiety, rather than avoiding it, which occurs when you activate your withdrawal-oriented right hemisphere.
Mindfulness involves the use of words, such as “this is a little anxiety,” to label your emotional states. Labeling your emotions activates your frontal lobes, especially your left frontal lobe, and reins in the overreactivity of your amygdala.
In India, yoga has been practiced to promote health and a sense of inner peace for a few thousand years. There are many different types of yoga. The most common is called Hatha Yoga. It is a method of stretching and meditation that can help you deal with anxiety. Hatha Yoga uses a series of poses, in combination with meditation and deep breathing.
More than thirty-five years ago, I stayed briefly in some yoga ashrams in various parts of the world and learned how the poses and meditation worked together. Since then, I have paid close attention to the forty years of research with accomplished yogis that has shown the benefits of yogic techniques. These techniques lead to calming and control over a number of body functions, such as slowing the heart rate down and slowing brain waves as measured by EEG. Small wonder that yoga is taught not only in health clubs and community centers but in medical centers, as well.
Although this book cannot serve as a tutorial on yoga—you can find many fine manuals and classes that serve that purpose—there are some common principles that you can put into practice right now. For example, many traditional yoga postures are essentially stretches, which means you can use your own or those you learned in the previous chapter. Combine the stretches with the breathing and meditative exercises to create a hybrid yoga. Practice your hybrid yoga or traditional yoga to calm yourself.
Carol initially came to the class to get help in dealing with panic attacks. After using the anxiety-reduction techniques detailed in this book, her panic attacks faded away. She began with progressive relaxation, then moved to self-hypnosis and meditation with a mantra. Each of these three methods provided a good part of the foundation on which she could build a versatile form of relaxation.
As an elementary school teacher and the mother of two preteens, Carol led a very busy life. In fact, when she first came to the class, she wasn’t sure if she had the time to attend regularly. Fortunately, she did commit to scheduling in the time and attended ten sessions. At the eleventh session, she said she wanted to learn how to incorporate what she’d learned about relaxation into her busy schedule.
Carol liked all the relaxation techniques but knew that the demands on her time were so great that, although scheduling in relaxation sounded like a good idea, in practice, she would never get around to it. Coming to the class was different, because there was a social expectation to attend. But structuring in relaxation time at home was much more difficult. There was always something to attend to, a paper to grade or dinner to cook.
She began to incorporate many of the seven principles into her daily life by adopting a mindfulness practice. Even while grading papers, she worked to be completely present, breathing deeply, practicing hybrid yoga.
She returned two months later to report to the class that her regular practices of “Mindful Living,” as she put it, had made her life richer and more enjoyable. “It is hard to believe that I was a person plagued by panic attacks and constant anxiety.”
Like Carol, you may say to yourself, “I don’t have time to do all this!” But not all relaxation exercises require a lot of time. You only need a few moments to slow down your breathing and drop your shoulders. You can remind yourself throughout the day to take a few moments to relax by placing a blue dot on your wristwatch or computer. When you see the dot, stop for five seconds to collect yourself, breath deeply, and meditate. Alternatively, you can identify certain objects as cues to relax. A doorknob or a desk drawer can serve as a reminder to take just a few moments and relax.
Regardless of the type of relaxation technique that appeals to you, regard relaxation as an important skill to cultivate to perfection. Begin to structure relaxation into your day, and pick a particular time to practice—ten to forty minutes before or after going to work or school, for example. Making time for relaxation anoints it as an activity that’s as important as sitting down to dinner. You can make it a ritual in which you do certain things to prepare for it. These preparations can resonate with a deep sense of calmness. For example, sit on your bed and meditate for ten minutes before stepping into the shower. However you practice relaxation, it is an important antidote to anxiety. It activates your parasympathetic nervous system to help you calm down and enjoy healing your anxiety.
Every day, do something to cultivate the skills made possible by your sympathetic nervous system. Use any or all of the techniques that you learned in this chapter. Remember that repetition leads to developing habits, and these techniques lead to good habits. Therefore, you should perform more than one relaxation exercise per day. Use the following worksheet to monitor your daily efforts. This exercise helps drive home the importance of relaxation and structuring it into your daily routine. (See page 65 for the worksheet.)
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