Symptoms have many causes, which means there are many ways to manage most symptoms. If you understand the nature and causes of your symptoms, you will be able to manage them better.THERE IS A STRONG LINK BETWEEN OUR THOUGHTS, attitudes, and emotions and our mental and physical health. One of our self-managers said, “It’s not always mind over matter, but mind matters.” Although thoughts and emotions do not directly cause our chronic conditions, they can influence our symptoms. Research has shown that thoughts and emotions trigger certain hormones or other chemicals that send messages throughout the body. These messages affect how our body functions; for example, thoughts and emotions can change our heart rate, blood pressure, breathing, blood sugar levels, muscle responses, immune response, concentration, the ability to get pregnant, and even our ability to fight off other illness.
All of us, at one time or another, have experienced the power of the mind and its effects on the body. Both pleasant and unpleasant thoughts and emotions can cause the body to react in different ways. Our heart rate and breathing can increase or slow down; we may experience sensations such as sweating (warm or cold), blushing, tears, and so on. Sometimes just a memory or an image can trigger these responses. For example, try this simple exercise: Imagine that you are holding a big, bright yellow lemon slice. You hold it close to your nose and smell its strong citrus aroma. Now you bite into the lemon. It’s juicy! The juice fills your mouth and dribbles down your chin. Now you begin to suck on the lemon and its tart juice. What happens? The body responds. Your mouth puckers and starts to water. You may even smell the scent of the lemon. All of these reactions are triggered by the mind and its memory of your experience with a real lemon.
This example shows the power the mind has over the body. It also gives us a good reason to work to develop our mental abilities to help us manage our symptoms. With training and practice, we can learn to use the mind to relax the body, to reduce stress and anxiety, and to reduce the discomfort or unpleasantness caused by our physical and emotional symptoms. The mind can also greatly help relieve the pain and shortness of breath associated with various diseases and may even help a person depend less on some medications.
In this chapter we describe several ways in which you can begin to use your mind to manage symptoms. These are sometimes referred to as “thinking” or “cognitive” techniques because they involve the use of our thinking abilities to make changes in the body.
As you read, keep the following key principles in mind:
Symptoms have many causes, which means there are many ways to manage most symptoms. If you understand the nature and causes of your symptoms, you will be able to manage them better.
Not all management techniques work for everyone. It is up to you to experiment and find out what works best for you. Be flexible. This includes trying different techniques and checking the results to determine which management tool is most helpful for which symptoms and under what circumstances.
Learning new skills and gaining control of the situation take time. Give yourself several weeks to practice before you decide if a new tool is working for you.
Don’t give up too easily. As with exercise and other new skills, using your mind to manage your health condition requires both practice and time before you notice the benefits. So even if you feel you are not accomplishing anything, don’t give up. Be patient and keep on trying.
These techniques should not have negative effects. If you become frightened, angry, or depressed when using one of these tools, do not continue to use it. Try another tool instead.
Many of us have heard and read about relaxation, yet some of us are still confused as to what relaxation is, its benefits, and how to do it. Simply stated, relaxation involves using thinking techniques to reduce or eliminate tension from both the body and the mind. This usually results in improved sleep quality and less stress, pain, and shortness of breath. Relaxation is not a cure-all, but it can be an effective part of a treatment plan.
There are different types of relaxation techniques. Each has specific guidelines and uses. Some techniques are used mostly to achieve muscle relaxation, while others are aimed at reducing anxiety and emotional stress or diverting attention, all of which aid in symptom management.
The term relaxation means different things to different people. We can all identify things we do that help us relax. For example, we may walk, watch TV, listen to music, knit, or garden. These methods, however, are different from the techniques discussed in this chapter because they include some form of physical activity or require a stimulus such as music that is outside of the mind. The relaxation tools we are discussing here have us use our mind to help the body relax.
The goal of relaxation is to turn off the outside world so that the mind and body are at rest. This allows you to reduce the tensions that can increase the intensity or severity of symptoms.
Following are some guidelines to help you practice relaxation.
Pick a quiet place and time when you will not be disturbed for at least 15 to 20 minutes. (If this seems too long, start with 5 minutes. By the way, in some homes the only quiet place is the bathroom. That is just fine.)
Try to practice the technique twice daily and not less than 4 times a week.
Don’t expect miracles. Some of these techniques take practice. Sometimes it takes 3 to 4 weeks of consistent practice before you start to notice benefits.
Relaxation should be helpful. At worst, you may find it boring, but if it is an unpleasant experience or makes you more nervous or anxious, you might switch to one of the other symptom management tools described in this chapter.
Some types of relaxation are so easy, natural, and effective that people do not think of them as “relaxation techniques.”
Take a nap or a hot, soothing bath.
Curl up and read or listen to a good book.
Watch a funny movie.
Make a paper airplane and sail it across the room.
Get a massage.
Enjoy an occasional glass of wine.
Start a small garden or grow a beautiful plant indoors.
Do some crafts such as knitting, pottery, or woodworking.
Watch a favorite TV show.
Read a poem or an inspirational saying.
Go for a walk.
Start a collection (coins, folk art, shells, or something in miniature).
Listen to your favorite music.
Sing around the house.
Crumble paper into a ball and use a waste-basket as a basketball hoop.
Look at water (ocean waves, a lake, or a fountain).
Watch the clouds in the sky.
Put your head down on your desk and close your eyes for 5 minutes.
Rub your hands together until they’re warm, and then cup them over your closed eyes.
Vigorously shake your hands and arms for 10 seconds.
Call up a friend or family member to chat.
Smile and introduce yourself to someone new.
Do something nice and unexpected for someone else.
Play with a pet.
Go to a vacation spot in your mind.
These techniques take a bit longer but are quite effective.
To relax muscles, you need to know how to scan your body and recognize where you are tense. Then you can release the tension. The first step is to become familiar with the difference between the feeling of tension and the feeling of relaxation. This exercise will allow you to compare those feelings and, with practice, spot and release tension anywhere in your body. It is best done lying down on your back, but any comfortable position can be used. A body scan script can be found on page 73.
In the early 1970s a physician named Herbert Benson studied what he calls the “relaxation response.” According to Benson, our bodies have several natural states. One example is the “fight or flight” response experienced by people when faced with a great danger. The body becomes quite tense, which is followed by the body’s natural tendency to relax; this is the relaxation response. As our lives become more and more hectic, our bodies tend to stay tense for long periods of time. We lose our ability to relax. The relaxation response helps change this.
Find a quiet place where there are few or no distractions. Find a comfortable position. You should be comfortable enough to remain in the same position for 20 minutes.
Choose a word, object, or pleasant feeling. For example, repeat a word or sound (such as the word one), gaze at a symbol (perhaps a flower), or concentrate on a feeling (such as peace).
Adopt a passive attitude. This is of the utmost importance. Empty all thoughts and distractions from your mind. You may become aware of thoughts, images, and feelings, but don’t concentrate on them. Just allow them to pass on.
Here’s what you should do to elicit the relaxation response:
Sit quietly in a comfortable position.
Close your eyes.
Relax all your muscles, beginning at your feet and progressing up to your face. Keep them relaxed.
Breathe in through your nose. Become aware of your breathing. As you breathe out through your mouth, say the word you chose silently to yourself. Try to empty all thoughts from your mind; concentrate on your word, sound, or symbol.
Continue this for 10 to 20 minutes. You may open your eyes to check the time, but do not use an alarm. When you finish, sit quietly for several minutes, at first with your eyes closed. Do not stand up for a few minutes.
Maintain a passive attitude, and let relaxation occur at its own pace. When distracting thoughts occur, ignore them by not dwelling on them, and return to repeating the word you chose. Do not worry about whether you are successful in achieving a deep level of relaxation.
Practice this once or twice daily.
Our minds have trouble focusing on more than one thing at a time; therefore, we can lessen the intensity of symptoms by training our minds to focus attention on something other than our bodies and their sensations. This technique, called distraction or attention refocusing, is particularly helpful for those people who feel that their symptoms are painful or overwhelming or worry that every bodily sensation might indicate a new or worsening symptom or health problem. (It is important to mention that with distraction you are not ignoring the symptoms but choosing not to dwell on them.)
Sometimes it may be difficult to put anxious thoughts out of your mind. When you try to suppress any thought, you may end up thinking more about it. For example, try not thinking about a tiger charging at you. Whatever you do, don’t let the thought of a tiger enter your mind. You’ll probably find it nearly impossible not to think about the tiger.
Although you can’t easily stop thinking about something, you can distract yourself and redirect your attention elsewhere. For example, think about the charging tiger again. Now stand up suddenly, slam your hand on the table, and shout “Stop!” What happened to the tiger? Gone—at least for the moment.
Distraction works best for short activities or times in which symptoms may be anticipated. For example, if you know climbing stairs will be painful or cause discomfort or that falling asleep at night is difficult, you might try one of the following distraction techniques:
Make plans for exactly what you will do after the unpleasant activity passes. For example, if climbing stairs is uncomfortable or painful, think about what you need to do once you get to the top. If you have trouble falling asleep, try making plans for some future event, being as detailed as possible.
Think of a person’s name, a bird, a flower, or whatever, for every letter of the alphabet. If you get stuck on one letter, go on to the next. (These are good distractions for pain as well as for sleep problems.)
Challenge yourself to count backward from 100 by threes (100, 97, 94, …).
To get through unpleasant daily chores (such as sweeping, mopping, or vacuuming), imagine your floor as a map of a country or continent. Try naming all the states, provinces, or countries, moving east to west or north to south. If geography does not appeal to you, imagine your favorite store and where each department is located.
Try to remember words to favorite songs or the events in an old story.
Try the “Stop!” technique. If you find yourself worrying or entrapped in endlessly repeating negative thoughts, stand up suddenly, slap your hand on the table or your thigh, and shout “Stop!” You can practice this technique whenever your mind endlessly repeats negative thoughts. With practice, you won’t have to shout out loud. Just whispering “Stop!” or tightening your vocal cords and moving your tongue as if saying “Stop!” will often work. Some people imagine a large stop sign. Others put a rubber band on their wrist and snap it hard to break the chain of negative thought. Or just pinch yourself. Do anything that redirects your attention.
You might redirect your attention to a pleasurable experience:
• Look outside at something in nature.
• Try to identify all the sounds around you.
• Massage your hand.
• Smell a sweet or pungent odor.
There are, of course, many variations to these examples, all of which help you refocus attention away from your problem.
So far we have discussed short-term refocusing strategies that involve using only the mind for distraction. Distraction also works well for long-term projects or symptoms that tend to last longer, such as depression and some forms of chronic pain.
In these cases, the mind is focused not internally but externally on some type of activity. If you are somewhat depressed or have continuous unpleasant symptoms, find an activity that interests you, and distract yourself from the problem. The activity can be almost anything, from gardening to cooking to reading or going to a movie, even doing volunteer work. One of the marks of a successful self-manager is that he or she has a variety of interests and always seems to be doing something.
All of us talk to ourselves all the time. For example, when waking up in the morning, we think, “I really don’t want to get out of bed. I’m tired and don’t want to go to work today.” Or at the end of an enjoyable evening, we think, “Gee, that was fun. I should get out more often.” What we think or say to ourselves is called our self-talk. The way we talk to ourselves tends to come from how and what we think about ourselves. Our thoughts can be positive or negative, and so is our self-talk. Therefore, self-talk can be an important self-management tool when it’s positive thinking or a weapon that hurts or defeats us when it’s habitually negative thinking.
All of our self-talk is learned from others and becomes a part of us as we grow up. It comes in many forms, unfortunately mostly negative. Negative self-statements are usually in the form of phrases that begin with something like “I just can’t do …,” “If only I could …,” “If only I didn’t …,” “I just don’t have the energy …,” or “How could I be so stupid?” This type of negative thinking represents the doubts and fears we have about ourselves in general and about our abilities to deal with our condition and its symptoms. It damages our self-esteem, attitude, and mood. Negative self-talk makes us feel bad and makes our symptoms worse.
What we say to ourselves plays a major role in determining our success or failure in becoming good self-managers. Negative thinking tends to limit our abilities and actions. If we tell ourselves “I’m not very smart” or “I can’t” all the time, we probably won’t try to learn new skills because this just doesn’t fit with what we think about ourselves. Soon we become prisoners of our own negative beliefs. Fortunately, self-talk is not something fixed in our biological makeup, and therefore it is not completely out of our control. We can learn new, healthier ways to think about ourselves so that our self-talk can work for us instead of against us. By changing the negative, self-defeating statements to positive ones, we can manage symptoms more effectively. This change, like any habit, requires practice and includes the following steps:
1. Listen carefully to what you say to or about yourself, both out loud and silently. If you find yourself feeling anxious, depressed, or angry, try to identify some of the thoughts you were having just before these feelings started. Then write down all the negative self-talk statements. Pay special attention to the things you say during times that are particularly difficult for you. For example, what do you say to yourself when getting up in the morning with pain, while doing those exercises you don’t really like, or at those times when you are feeling blue? Challenge these negative thoughts by asking yourself questions to identify what about the statement is really true or not true. For example, are you exaggerating the situation, generalizing, worrying too much, or assuming the worst? Are you thinking in terms of black and white? Could there be gray? Maybe you are making an unrealistic or unfair comparison, assuming too much responsibility, taking something too personally, or expecting perfection. Are you making assumptions about what other people think about you? What do you know for a fact? Look at the evidence so that you are better able to change these negative thoughts and statements.
2. Next, work on changing each negative statement to a more positive one, or find some positive statement to replace the negative one. Write these down. For example, negative statements such as “I don’t want to get up,” “I’m too tired and I hurt,” “I can’t do the things I like anymore, so why bother?” or “I’m good for nothing” become positive messages such as “I’m feeling pretty good today, and I’m going to do something I enjoy,” “I may not be able to do everything I used to, but there are still a lot of things I can do,” “People like me, and I feel good about myself,” or “Other people need and depend on me; I’m worthwhile.”
3. Read and rehearse these positive statements, mentally or with another person. It is this conscious repetition or memorization of the positive self-talk that will help you replace those old, habitual negative statements.
4. Practice these new statements in real situations. This practice, along with time and patience, will help the new patterns of thinking become automatic.
5. Rehearse success. When you aren’t happy with the way you handled a particular situation, try this exercise:
• Write down three ways that it could have gone better.
• Write down three ways it could have gone worse.
• If you can’t think of alternatives to the way you handled it, imagine what someone whom you greatly respect would have done.
• Or think what advice you would give to someone else facing a similar situation.
Remember that mistakes aren’t failures. They’re good opportunities to learn. Mistakes give you the chance to rehearse other ways of handling things. This is great practice for future crises.
As you first do this, you may find it hard to change negative statements into more positive ones. A shortcut is to use either a thought stopper or a positive affirmation. A thought stopper can be anything that is meaningful to you. For example, a puppy, a polar bear, or a redwood tree. When you have a negative thought, replace it with your thought stopper. We know it sounds silly, but try it.
A positive affirmation is a positive phrase that you can use over and over. For example, “I am getting better every day” or “I can do this” or “God loves me.” Again, you use this to replace negative thoughts.
You may think that “imagination” is all in your mind. But the thoughts, words, and images that flow from your imagination can have very real affects on your body. Your brain often cannot distinguish whether you are imagining something or if it is really happening. Perhaps you’ve had a racing heartbeat, rapid breathing, or tension in your neck muscles while watching a movie thriller. These sensations were all produced by images and sounds on a film. During a dream, maybe your body responded with fear, joy, anger, or sadness—all triggered by your imagination. If you close your eyes and vividly imagine yourself by a still, quiet pool or relaxing on a warm beach, your body responds to some degree as though you were actually there.
Guided imagery and visualization allow you to use your imagination to relieve symptoms. These techniques will help you focus your thoughts on healing images and suggestions.
This tool is like a guided daydream. It allows you to divert your attention, refocusing your mind away from your symptoms and transporting you to another time and place. It has the added benefit of helping you achieve deep relaxation by picturing yourself in a peaceful environment.
With guided imagery, you focus your mind on a particular image. Imagery usually involves your sense of sight, focusing on visual images. Adding other senses—smells, tastes, and sounds—makes the guided imagery even more vivid and powerful.
Some people are highly visual and easily see images with their “mind’s eye.” But if your images aren’t as vivid as scenes from a great movie, don’t worry; it’s normal for the intensity of imagery to vary. The important thing is to focus on as much detail as possible and to strengthen the images by using all your senses. Adding real background music can also increase the impact of guided imagery.
With guided imagery, you are always completely in control. You’re the movie director. You can project whatever thought or feeling you want onto your mental screen. If you don’t like a particular image, thought, or feeling, you can redirect your mind to something more comfortable; you can use other images to get rid of unpleasant thoughts (for example, you might put them on a raft and watch them float away, sweep them away with a large broom, or erase them with a giant eraser); or you can open your eyes and stop the exercise.
The guided imagery scripts presented on pages 78 and 79 can help take you on this mental stroll. Here are some ways to use imagery:
Read the script over several times until it is familiar. Then sit or lie down in a quiet place and try to reconstruct the scene in your mind. The script should take 15 to 20 minutes to complete.
Have a family member or friend read you the script slowly, pausing for about 10 seconds wherever there is a series of periods (…).
Make a recording of the script, and play it to yourself whenever convenient.
Use a prerecorded tape, CD, or digital audio file that has a similar guided imagery script (see examples in the “Other Resources” section at end of this chapter).
This technique is similar to guided imagery. Visualization allows you to create your own images, which is different from guided imagery, where the images are suggested to you. It is another way of using your imagination to create a picture of yourself in any way you want, doing the things you want to do. All of us use a form of visualization every day—when we dream, worry, read a book, or listen to a story. In all these activities the mind creates images for us to see. We also use visualization intentionally when making plans for the day, considering the possible outcomes of a decision we have to make, or rehearsing for an event or activity. Visualization can be done in different ways and can be used for longer periods of time or while you are engaged in other activities.
One way to use visualization to manage symptoms is to remember pleasant scenes from your past or create new scenes. To practice visualization, try to remember every detail of a special holiday or party that made you happy. Who was there? What happened? What did you do or talk about? You can also try this by remembering a vacation or some other memorable and pleasant event.
Visualization can be used to plan the details of some future event or to fill in the details of a fantasy. For example, how would you spend a million dollars? What would be your ideal romantic encounter? What would your ideal home or garden look like? Where would you go and what would you do on your dream vacation? Another form of visualization involves using your mind to think of symbols that represent the discomfort or pain felt in different parts of your body. For example, a painful joint might be red or a tight chest might have a constricting band around it. After forming these images, you then try to change them. The red color might fade until there is no more color, or the constricting band will stretch and stretch until it falls off; these new images then cause the way you think of the pain or discomfort to change.
Visualization helps build confidence and skill and therefore is a useful technique to help you set and accomplish your personal goals (see Chapter 2). After you write your weekly action plan, take a few minutes to imagine yourself taking a walk, doing your exercises, or taking your medications. You are mentally rehearsing the steps you need to take in order to achieve your goal successfully.
You have the ability to create special imagery to help (though not cure) specific symptoms or illnesses. Use any image that is strong and vivid for you—this often involves using all your senses to create the image—and one that is meaningful to you. The image does not have to be accurate for it to work. Just use your imagination and trust yourself. Here are examples of images that some people have found useful:
For Tension and Stress
A tight, twisted rope slowly untwists.
Wax softens and melts.
Tension swirls out of your body and down the drain.
For Healing of Cuts and Injuries
Plaster covers over a crack in a wall.
Cells and fibers stick together with very strong glue.
A shoe is laced up tight.
Jigsaw puzzle pieces come together.
For Arteries and Heart Disease
A miniature Roto-Rooter truck speeds through your arteries and cleans out the clogged pipes.
Water flows freely through a wide, open river.
A crew in a small boat rows in sync, easily and efficiently pulling the slender boat across the smooth water surface.
For Asthma and Lung Disease
The tiny elastic rubber bands that constrict your airways pop open.
A vacuum cleaner gently sucks the mucus from your airways.
Waves calmly rise and fall on the ocean surface.
For Diabetes
Small insulin keys unlock doors to hungry cells and allow nourishing blood sugar in.
An alarm goes off, and a sleeping pancreas gland awakens to the smell of freshly brewed coffee.
For Cancer
A shark gobbles up the cancer cells.
Tumors shrivel up like raisins in the hot sun and then evaporate completely into the air.
The faucet that controls the blood supply to the tumor is turned off, and the cancer cells starve.
Radiation or chemotherapy enters your body like healing rays of light and destroy cancer cells.
For Infections
White blood cells with flashing red sirens arrest and imprison harmful germs.
An army equipped with powerful antibiotic missiles attacks enemy germs.
A hot flame chases germs out of your entire body.
For a Weakened Immune System
Sluggish, sleepy white blood cells awaken, put on protective armor, and enter the fight against the virus.
White blood cells rapidly multiply like millions of seeds bursting from a single ripe seed pod.
For an Overactive Immune System (allergies, arthritis, psoriasis, etc.)
Overly alert immune cells in the fire station are reassured that the allergens have triggered a false alarm, and they go back to playing their game of poker.
The civil war ends with the warring sides agreeing not to attack their fellow citizens.
For Pain
All of the pain is placed in a large, strong metal box that is closed, sealed tightly and locked with a huge, strong padlock.
You grasp the TV remote control and slowly turn down the pain volume until you can barely hear it; then it disappears entirely.
The pain is washed away by a cool, calm river flowing through your entire body.
For Depression
Your troubles and feelings of sadness are attached to big colorful helium balloons and are floating off into a clear blue sky.
A strong, warm sun breaks through dark clouds.
You feel a sense of detachment and lightness, enabling you to float easily through your day.
Use any of these images, or make up your own. Remember, the best ones are vivid and have meaning to you. Use your imagination for health and healing.
There is strong evidence in the medical literature of the relationship between spirituality and health. According to the American Academy of Family Physicians,* spirituality is the way we can find meaning, hope, comfort, and inner peace in our lives. Many people find spirituality through religion. Some find it through music, art, or a connection with nature. Others find it in their values and principles.
Many people are religious and share their religion with others. Others do not have a specific religion but do have spiritual beliefs. Our religion and beliefs can bring a sense of meaning and purpose to our life, help us put things into perspective, and set priorities. Our beliefs may help us find comfort during difficult times. They can help us with acceptance and motivate us to make difficult changes. Being part of a spiritual or religious community offers a source of support when needed and the opportunity to help others.
Recent studies find that people who belong to a religious or spiritual community or who regularly engage in religious activities, such as prayer or study, have improved health. There are many types of prayer--any of which may contribute to improved health: asking for help, direction, forgiveness, offering words of gratitude, praising, and blessing, among others. In addition, many religions have a tradition of contemplation or meditation. Prayer does not need a scientific explanation. It is probably the oldest of all self-management tools.
Although religion and spirituality cannot be “prescribed,” we encourage you to explore your own beliefs. If you are religious, try practicing prayer more consistently. Also, if you are religious, consider telling your doctor and care team. Most won’t ask. Help them understand the importance of your beliefs in managing your health and life. Most hospitals have chaplains or pastoral counselors. Even if you are not in the hospital, they will probably talk with you. Choose someone you feel comfortable with. Their advice and counsel can supplement your medical and psychological care.
There additional valuable techniques you can consider which can clear your mind, positively shift your emotional state, as well as reduce tension and stress.
Mindfulness involves simply keeping your attention in the present moment, without judging it as happy or sad, good or bad. It encourages living each moment—even painful ones—as fully and as mindfully as possible. Mindfulness is more than a relaxation technique; it is an attitude toward living. It is a way of calmly and consciously observing and accepting whatever is happening, moment to moment.
This may sound simple enough, but our restless, judging minds make it surprisingly difficult. As a restless monkey jumps from branch to branch, our mind jumps from thought to thought.
In mindfulness, you focus the mind on the present moment. The “goal” of mindfulness is simply to observe—with no intention of changing or improving anything. But people are positively changed by the practice. Observing and accepting life just as it is, with all its pleasures, pains, frustrations, disappointments, and insecurities, often enables you to become calmer, more confident, and better able to cope with whatever comes along.
To develop your capacity for mindfulness, sit comfortably on the floor or on a chair with your back, neck and head straight, but not stiff. Then:
Concentrate on a single object, such as your breathing. Focus your attention on the feeling of the air as it passes in and out of your nostrils with each breath. Don’t try to control your breathing by speeding it up or slowing it down. Just observe it as it is.
Even when you resolve to keep your attention on your breathing, your mind will quickly wander off. When this occurs, observe where your mind went: perhaps to a memory, a worry about the future, a bodily ache, or a feeling of impatience. Then gently return your attention to your breathing.
Use your breath as an anchor. Each time a thought or feeling arises, momentarily acknowledge it. Don’t analyze it or judge it. Just observe it, and return to your breathing.
Let go of all thoughts of getting somewhere, or having anything special happen. Just keep stringing moments of mindfulness together, breath by breath.
At first, practice this for just five minutes, or even one minute at a time. You may wish to gradually extend the time to ten, twenty or thirty minutes.
Because the practice of mindfulness is simply the practice of moment-to-moment awareness, you can apply it to anything: eating, showering, working, talking, running errands, or playing with your children. Mindfulness takes no extra time. Considerable research has demonstrated the benefits of mindfulness practice in relieving stress, easing pain, improving concentration, and relieving a variety of other symptoms.
This technique was developed by a physician named Charles Stroebel. It will help you deal with short-term stress such as the urge to eat or smoke, road rage, or other annoyances. It relieves muscle tightening, jaw clenching, and holding your breath by activating the sympathetic nervous system.
It should be practiced frequently throughout the day, whenever you start to feel stressed. It can be done with your eyes opened or closed.
1. Become aware of what is annoying you: a ringing phone, an angry comment, the urge to smoke, a worrisome thought—whatever.
2. Repeat the phrase “Alert mind, calm body” to yourself.
3. Smile inwardly with your eyes and your mouth. This stops facial muscles from making a fearful or angry expression. The inward smile is a feeling. It cannot be seen by others.
4. Inhale slowly to the count of 3, imagining that the breath comes in through the bottom of your feet. Then exhale slowly. Feel your breath move back down your legs and out through your feet. Let your jaw, tongue, and shoulder muscles go limp.
With several months’ practice the quieting reflex becomes an automatic skill.
Many of us suffer from what has been called “nature deficit disorder,” but it can be readily cured with regular doses of the outdoors. For thousands of years exposure to natural environments has been recommended for healing. Taking a break from artificial lighting, excessive computer and TV screen time, and indoor environments can be restorative. A brief walk in a park or a longer planned visit to a beautiful outdoor environment can restore the mind and body. Or bring nature indoors with plants, pets, and nature photography. Even a few minutes of playing with or stroking a pet can lower blood pressure and calm a restless mind.
Worrisome negative thoughts feed anxiety. Ignored problems have a way of thrusting themselves back into our consciousness. You’ll find it easier to set aside worries if you make time to deal with them.
Set aside 20 to 30 minutes a day as your “worry time.” Whenever a worry pops into your mind, write it down and tell yourself that you’ll deal with it during worry time. Jot down the little things (Did Linda take her lunch to school?) along with the big ones (Will our children be able to find jobs?). During your scheduled worry time, don’t do anything except worry, brainstorm, and write down possible solutions. For each of your worries, ask yourself the following questions:
What is the problem?
How likely is it that the problem will occur?
What’s the worst that could happen?
What’s the best that could happen?
How would I cope with the problem?
What are possible solutions?
What is my plan of action?
Be specific. Instead of worrying about what might happen if you lose your job, ask yourself how likely it is that you will lose your job. And if you do, what will you do, with whom, and by when? Write a job search plan.
If you’re anxious about getting seasick on the ocean and not making it to the bathroom in time, imagine how you would manage the situation. Ask yourself if any of this is really unbearable. Tell yourself you might feel uncomfortable or embarrassed, but you’ll survive.
Remember, if a new worry pops up during the rest of the day, jot it down. Then distract yourself by refocusing intently on whatever you are doing.
Scheduling a definite worry time cuts the amount of time spent worrying by at least a third. If you look at your list of worries later, you’ll find that the vast majority of them never materialized. Or they were not nearly as bad as you had anticipated.
Sometimes you can relieve stress and break the cycle of negative thoughts by shifting your perspective. If you find yourself upset, ask, “How important will this be in an hour, a day, a month, or a year?” This reframing often helps surface things that are really important and need action versus the more minor annoyances that capture our attention.
One of the most effective ways to improve your mood and overall happiness is by focusing your attention on what’s going well in your life. For what are you grateful? Psychologists have done research to demonstrate that people can increase their happiness by gratitude exercises. We encourage you to try these three:
Write a letter of thanks. Write and then deliver a letter of gratitude to someone who had been especially kind to you but had never been properly thanked. Perhaps it’s a teacher, a mentor, a friend, or a family member. Express your appreciation for the person’s kindness. The letter will have more impact if you include some specific examples of what the recipient has done for you. Describe how the actions made you feel. Ideally, read your letter out loud to the person, if possible, face-to-face. Be aware of how you feel, and watch the other person’s reaction.
Acknowledge at least three good things every day. Each night before bed, write down at least three things that went well today. No event or feeling is too small to note. By putting your gratitude into words, you increase appreciation and memory of your blessings. Knowing that you will need to write each night changes your mental filters during the whole day. You will tend to seek out, look for, and specially note the good things that happen. If doing this daily is too much or begins to seem like a routine chore, do it once a week.
Make a list of the things you take for granted. For example, if your chronic illness has affected your lungs, you can still be grateful that your kidneys are working. Perhaps you can celebrate a day in which you don’t have a headache or backache. Counting your blessings can add up to a better mood and more happiness.
Make a personal inventory of your talents, skills, achievements, and qualities, big and small. Celebrate your accomplishments. When something goes wrong, consult your list of positives, and put the problem in perspective. It then becomes just one specific experience, not something that defines your whole life.
This world is plagued by acts of violence. When something bad happens, it’s front-page news. As an antidote to this misery, despair, and cynicism, practice acts of kindness. Look for opportunities to give without expecting anything in return. Here are some examples:
Hold the door open for the person behind you.
Give an unexpected gift of movie or concert tickets.
Send an anonymous gift to a friend who needs cheering up.
Help someone with a heavy load.
Tell positive stories you know of helping and kindness.
Cultivate an attitude of gratefulness for the kindness you have received.
Plant a tree.
Smile and let people cut ahead of you in line or on the freeway.
Pick up litter.
Give another driver your parking space.
Be creative. Such kindness is contagious, and it has a ripple effect. In one study, the people who were given an unexpected treat (cookies) were later more likely to help others.
It’s hard work to keep our deep negative feelings hidden. Over time, this cumulative stress undermines our body’s defenses and seems to weaken our immunity. Confiding our feelings to others or writing them down puts them into words and helps us sort them out. Words help us understand and absorb a traumatic event and eventually put it behind us. It gives us a sense of release and control.
The psychologist Jamie Pennebaker described in his book Opening Up a series of studies looked at the healing effects of confiding or writing. One group was asked to express their deepest thoughts and feelings about something bad that had happened to them. Another group wrote about ordinary matters such as their plans for the day. Both groups wrote for 15 to 20 minutes a day for 3 to 5 consecutive days. No one read what either group had written.
The results were surprisingly powerful. When compared with the people who wrote about ordinary events, the ones who wrote about their bad experiences reported fewer symptoms, fewer visits to the doctor, fewer days off from work, improved mood, and a more positive outlook. Their immune function was enhanced for at least 6 weeks after writing. This was especially true for those who expressed previously undisclosed painful feelings.
Try the “write thing” when something is bothering you: when you find yourself thinking (or dreaming) too much about an experience; when you avoid thinking about something because it is too upsetting; when there’s something you would like to tell others but don’t for fear of embarrassment or punishment.
Here are some guidelines for writing as a way to help you deal with any traumatic experience:
Set a specific schedule for writing. For example, you might write 15 minutes a day for 4 consecutive days, or 1 day a week for 4 weeks.
Write in a place where you won’t be interrupted or distracted.
Don’t plan to share your writing—that could stop your honest expression. Save what you write or destroy it, as you wish.
Explore your very deepest thoughts and feelings and analyze why you feel the way you do. Write about your negative feelings such as sadness, hurt, hate, anger, fear, guilt, or resentment.
Write continuously. Don’t worry about grammar, spelling, or making sense. If clarity and coherence come as you continue to write, so much the better. If you run out of things to say, just repeat what you have already written.
Even if you find the writing awkward at first, keep going. It gets easier. If you just cannot write, try talking into a tape recorder for 15 minutes about your deepest thoughts and feelings.
Don’t expect to feel better immediately. You may feel sad or depressed when your deepest feelings begin to surface. This usually fades within an hour or two or a day or two. The overwhelming majority of people report feelings of relief, happiness, and contentment soon after writing for a few consecutive days.
Writing may help you clarify what actions you need to take. But don’t use writing as a substitute for taking action or as a way of avoiding things.
Once established, relaxation, imagery, and positive thinking can be some of the most powerful tools you can add to your self-management tool box. They will help you manage symptoms as well as master the other skills discussed in this book.
As with exercise and other acquired skills, using your mind to manage your health condition requires both practice and time before you begin to notice the benefits. So if you feel you are not accomplishing anything, don’t give up. Be patient and keep on trying.
Ben-Shahar, Tal. Happier: Learn the Secrets to Daily Joy and Lasting Fulfillment. New York: McGraw-Hill, 2007.
Benson, Herbert, and Miriam Z. Klipper. The Relaxation Response. San Francisco: Quill, 2000.
Benson, Herbert, and Eileen M. Stuart. The Wellness Book: The Comprehensive Guide to Maintaining Health and Treating Stress-Related Illness. New York: Fireside, 1993.
Borysenko, Joan. Inner Peace for Busy People: 52 Simple Strategies for Transforming Your Life. Carlsbad, Calif.: Hay House, 2003.
Boroson, Martin. One Moment Meditation. New York: Winter Road Publishing, 2009.
Burns, David D. The Feeling Good Handbook, rev. ed. New York: Plume, 1999.
Caudill, Margaret. Managing Pain Before It Manages You. New York: Guilford Press, 2008.
Cousins, Norman. Head First: The Biology of Hope and the Healing Power of the Human Spirit. New York: Dutton, 1990.
Craze, Richard. Teach Yourself Relaxation, 3rd ed. New York: McGraw-Hill, 2009.
Davis, Martha, Elizabeth Eshelman, and Matthew McKay. The Relaxation and Stress Reduction Workbook. Oakland, Calif.: New Harbinger, 2008.
Diener, Ed, and Robert Biswas-Diener. Happiness: Unlocking the Mysteries of Psychological Wealth. Malden, Mass.: Blackwell, 2008.
Dossey, Larry. Prayer Is Good Medicine. San Francisco: HarperCollins, 1996.
Emmons, Robert A. Thanks! How the New Science of Gratitude Can Make You Happier. New York: Houghton Mifflin, 2007.
Funk, Mary Margaret. Tools Matter for Practicing the Spiritual Life. New York: Continuum, 2004.
Grenville-Cleave. Introducing Positive Psychology: A Practical Guide. London: Totem Books/Icon Books, 2012
Kabat-Zinn, Jon. Coming to Our Senses: Healing Ourselves and the World Through Mindfulness. New York: Hyperion, 2005.
Kabat-Zinn, Jon. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Delta, 2005.
Kabat-Zinn, Jon. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion, 2005.
Keating, Thomas. Open Mind, Open Heart: The Contemplative Dimension of the Gospel. New York: Continuum, 2006.
Keating, Thomas, and Gustave Reininger, eds. Centering Prayer in Daily Life and Ministry. New York: Continuum, 1998.
Lyubomirsky, Sonia. The How of Happiness: A New Approach to Getting the Life You Want. New York: Penguin, 2008.
McKay, Matthew, Martha Davis, and Patrick Fanning. Thoughts and Feelings: Taking Control of Your Moods and Your Life, 4th ed. Oakland, Calif.: New Harbinger, 2007.
Ornstein, Robert, and David Sobel. Healthy Pleasures. Cambridge, Mass.: Perseus, 1989.
Peale, Norman V. Positive Imaging: The Powerful Way to Change Your Life. New York: Ballantine Books, 1996. Remen, Rachel Naomi. Kitchen Table Wisdom: Stories That Heal. New York: Riverhead Books, 2006.
Seligman, Martin. Authentic Happiness. New York: Free Press, 2004.
Seligman, Martin. Flourish: A Visionary New Understanding of Happiness and Well-Being. New York: Free Press, 2011.
Siegel, Bernie S. Help Me to Heal: A Practical Guidebook for Patients, Visitors, and Caregivers. Carlsbad, Calif.: Hay House, 2003.
Sobel, David, and Robert Ornstein. The Healthy Mind, Healthy Body Handbook (also published under the title The Mind and Body Health Handbook). Los Altos, Calif.: DRX, 1996.
Stahl, Bob, and Elisha Goldstein. A Mindfulness-Based Stress Reduction Workbook. Oakland, Calif.: New Harbinger, 2010.
Wiseman, Richard. 59 Seconds: Think a Little, Change a Lot. New York: Borzoi Books, 2009.
Association of Cancer Online Resources (ACOR): http://www.acor.org/
Greater Good Science Center: http://greatergood.berkeley.edu/
The Happiness Project: http://www.happiness-project.com/
Mental Health America, Live Your Life Well: http://www.liveyourlifewell.org/
Naparstek, Belleruth. Health Journeys Guided Imagery [audio CDs]: http://www.healthjourneys.com/
National Institute of Mental Health: http://www.nimh.nih.gov/
Regan, Catherine. and Rick Seidel. Relaxation for Mind and Body: Pathways to Healing [audio CD]. Boulder, Colo.: Bull, 2012.
StressStop: http://www.stressstop.com/
Weil, Andrew, and Martin Rossman. Self-Healing with Guided Imagery [audio CD]. Louisville, Colo.: Sounds True, 2006.