Progressive Muscle Relaxation

Last week we discussed the benefits of diaphragmatic breathing. I encouraged you to incorporate at least five minutes of deep breathing into your daily routine and see how it makes you feel. Maybe it has worked well for you, maybe it’s too early to tell, or maybe it’s not a practice that really resonates with you. There are many different exercises that can help facilitate meditation. This week, I’d like to discuss another activity called Progressive Muscle Relaxation, or PMR.

PMR is commonly incorporated into treatments for stress, anxiety, or insomnia, to name a few. It can also be used to prepare for meditation. PMR focuses on methodically tensing and relaxing various muscle groups throughout the body. Here’s how it works:

Set aside about 15 minutes for this exercise. Find a comfortable position in a chair or on a flat surface. Either will work. For each muscle group, tense the muscles for about 10 seconds while breathing in. Breathe out, and abruptly relax the group. Wait for about 15 seconds before moving on to the next muscle group.

You may wish to move from toes to head, or vice versa, it really doesn’t matter. Maybe you want to tense and relax more muscle groups by including your chest and back, or maybe you’d like to do fewer. Don’t be afraid to try different orders or muscle groups to find what feels the most natural and comfortable for you! Here’s a fairly basic template to use as a starting guideline:

  1. Forehead
  2. Jaw
  3. Neck/shoulders
  4. Arms/hands (one side, then the other)
  5. Hips/buttocks
  6. Thighs (one side, then the other)
  7. Calves (0ne side, then the other)
  8. Feet (one side, then the other)

It may be helpful to listen to an audio recording to guide you through the exercise. Again, when you search for a suitable recording, choose one that has the best voice, pace, and relaxing background sounds for you. As an example, below is a link to a guided session of PMR provided by McMaster University (Track 2): 

https://campusmentalhealth.ca/resource/mcmaster-guided-relaxation-cd/

This week, try to incorporate some PMR into your routine to see if it’s a technique you want to add to your toolbox.

This blog is not designed to diagnose, treat, or prevent illnesses or trauma, and Dr. Emick is not responsible for your use of this educational material or its consequences. Furthermore, reading this blog does not create a doctor-patient relationship. The information contained within this blog is not intended to dictate what constitutes reasonable, appropriate, or best care for any given physical or behavioral health issue, nor does it take into account the unique circumstances that define the health issues of the reader. If you have questions about the diagnosis, treatment, or prevention of a condition or illness, you should consult your personal health care professional. As always, consult with your personal health care professional before beginning or changing any fitness or nutrition program to make sure that it is appropriate for your needs. Dr. Emick reserves the right to modify her positions on a subject based upon new research or data as it presents.

 

 

Breathing Deeply

We’ve discussed the benefits of meditation before on this blog, but haven’t focused on why it’s called a practice. Simply put, it can be hard to learn to do, and requires practice to be effective. The concern I hear most from patients is they can’t even settle in to begin to practice meditation. What to do? Well, there are many ways to prepare to meditate. Today we’ll focus on deep breathing, which is also a core component of meditation. 

There are many different deep breathing exercises you can try, but before you do, you must understand the importance of HOW to breathe. If you miss this point, you won’t reap the full benefits. So let’s review the importance of oxygen in the bloodstream and the mechanics of breathing. We’ll start with a brief summary of what oxygen in the blood actually does. In short, blood transports oxygen to all the cells of the body to: 

  • Provide cells with nutrients
  • Transport hormones
  • Remove waste products 
  • Assist with metabolism

Clearly, this is an oversimplification of each of these processes, but this isn’t a lecture in anatomy and physiology! 

Most people, especially when stressed, unconsciously breathe from the chest. This form of breathing is very rapid and shallow, which can lead to low carbon dioxide levels in the blood, which can then lead to narrowing of the blood vessels that supply blood to the brain and other organ systems. That’s not what we want. We want the blood supply to be filled with oxygen so the body can function at its best. To do this, we must engage our diaphragm muscles and practice breathing from the diaphragm. This method of breathing causes us to breathe deeply and rhythmically, and has been shown to reduce stress and lower heart rate and blood pressure. Additionally, it can be helpful in reducing anxiety and panic attacks and can prevent hyperventilation.

There are many tutorials on deep breathing that you can find online, and what works for your best friend may not work for you. When you review them, choose the tutorial that has the best voice, pace, and relaxing background sounds for you. As an example, below is a link to a guided session of diaphragmatic breathing provided by McMaster University: https://campusmentalhealth.ca/resource/mcmaster-guided-relaxation-cd/

In addition to preparing for meditation, you can practice diaphragmatic breathing as a way to alleviate panic attacks or stress, or even as a daily wellness exercise. If you don’t have time for a full-blown meditation session, try setting aside some time each day to practice diaphragmatic breathing for five minutes or so. If you are feeling anxious, try the exercise for as long as you need until you feel more relaxed. Over time, diaphragmatic breathing will become second nature.

This blog is not designed to diagnose, treat, or prevent illnesses or trauma, and Dr. Emick is not responsible for your use of this educational material or its consequences. Furthermore, reading this blog does not create a doctor-patient relationship. The information contained within this blog is not intended to dictate what constitutes reasonable, appropriate, or best care for any given physical or behavioral health issue, nor does it take into account the unique circumstances that define the health issues of the reader. If you have questions about the diagnosis, treatment, or prevention of a condition or illness, you should consult your personal health care professional. As always, consult with your personal health care professional before beginning or changing any fitness or nutrition program to make sure that it is appropriate for your needs. Dr. Emick reserves the right to modify her positions on a subject based upon new research or data as it presents.

 

Mindfulness and Albert Ellis

If you’ve studied Ellis, his model, and the man himself, you might not immediately pair him with the concept of mindfulness. For those of you unfamiliar with Albert Ellis, I’ve included an excerpt from an interview done with him by Thinking Allowed Productions entitled A Guide to Rational Living so you can also be in on the joke, if you will. https://www.youtube.com/watch?v=GyRE-78g_z0

With his no-nonsense approach and use of “strong language,” Ellis hardly seems to be an advocate for mindfulness. But he actually lays the groundwork for merging the fundamental tenets of cognitive behavioral therapy (CBT) and those of mindfulness. You see, in the purest form of CBT, one only focuses on the activating event, our belief about the event, and the consequence we cause as a result of our belief. Change your belief and you’re good to go. Very clinical, very precise, with little room for exploring the actual emotion. When I was in training we jokingly referred to it as “snap out of it” therapy. While it is a very accurate and efficient model for treating specific disorders, treatment using this model does not focus on the hows and whys of our belief systems. By failing to do so, patients are often left with improvement in specific behaviors or situations, but the crux of the issue remains and often resurfaces in different arenas. You may have heard the term “dry drunk.” This is a great example of someone who has ceased to engage in a specific behavior, has not dealt with the underlying emotions that they chose to subdue with alcohol, and now pacify them with other, possibly just as harmful and ineffective behaviors. The fact of the matter is, sometimes you develop a belief from a real or actual threat or situation you have experienced. While the ABC model can teach you to not respond to certain stressors in certain ways, it does not help you to actually explore and resolve the emotions you have regarding the traumas you have experienced. As gruff as he seems at first glance, Albert Ellis paved the way for this by developing his model of Rational-Emotive Therapy. Here’s a link to a recorded session he had with an actual patient if you are interested in how he utilized RET in treatment. https://www.youtube.com/watch?v=odnoF8V3g6g

Interestingly, for as kind and soft and gentle as mindfulness sounds, it really isn’t any gentler in the long run than an interview with Albert Ellis, it just approaches the topic from a different angle. Like Ellis, mindfulness encourages a direct and honest assessment of a situation, one’s role in that situation, and one’s emotions regarding that situation. During any meditation or other mindful activity, one is not expected to suppress or deny one’s emotions, but to sit with and openly acknowledge them. For as soothing as these activities may sound, it is not at all uncommon for people to cry while meditating, practicing yoga or engaging in other mindfulness-based activities. By allowing themselves to be open, they will encounter the pains and scars from the past. Then, as Ellis suggests, they have the opportunity to openly and objectively view those situations, refute any incorrect emotions they have developed, own responsibility for the strength they have given those situations or emotions, and create new, healthier perspectives.  

This blog is not designed to diagnose, treat, or prevent illnesses or trauma, and Dr. Emick is not responsible for your use of this educational material or its consequences. Furthermore, reading this blog does not create a doctor-patient relationship. The information contained within this blog is not intended to dictate what constitutes reasonable, appropriate, or best care for any given physical or behavioral health issue, nor does it take into account the unique circumstances that define the health issues of the reader. If you have questions about the diagnosis, treatment, or prevention of a condition or illness, you should consult your personal health care professional. As always, consult with your personal health care professional before beginning or changing any fitness or nutrition program to make sure that it is appropriate for your needs. Dr. Emick reserves the right to modify her positions on a subject based upon new research or data as it presents.

 

Combating Anxiety with ABCDE

Last week, we reviewed Ellis’ ABC model as a means for understanding our negative responses to situations. As a quick refresher, it goes like this:

A-Activating event 

B-your Belief about the event

C-the Consequence (your response to our beliefs about the event)

Previously, we discussed that our negative belief about the activating event causes the negative reaction, not the event itself. This week, we’re going to discuss the D and E additions to this model, and how they can help combat our negative reactions. Let’s review and define some terms:

A-Activating event 

B-your Belief about the event

C-the Consequence (your response to our beliefs)

D: Dispute (your attempt to look at the event objectively and challenge your negative beliefs/responses to the event)

E: The Effect of challenging/defeating your initial belief.

 

So, where to begin?  When challenging/disputing a belief you hold, here are some questions to ask yourself:

  • Is the belief logical/rational? How would an objective observer view this situation?
  • What evidence do I have for and against my belief?
  • If the event isn’t all that positive, is my response to the event reasonable, or is it excessive?
  • Is this truly my belief or a belief that was taught to me by my elder(s)? For example, people often joke that, as children, if Mom was cold we all had to put on a sweater. What if your Mom was afraid of thunderstorms when you were a child? As an adult, would you then be afraid of thunderstorms yourself or would you engage in specific avoidant behaviors or express strong negative emotions when it rained because that’s what Mom always did?
  • Am I expressing a strong negative emotion/reaction that I really don’t believe but that allows me to avoid doing something I’d rather not?
  • Is my belief beneficial or disadvantageous to my ability to achieve what I want?
  • How can I change this belief?

 

Let’s start with an example from last week: fear of needles.

A- Activating event 

You need a shot or to have blood drawn.

B- your Belief about the event. 

Fill in your personal thoughts about the event here.

C: the Consequence (your response to our beliefs) 

Fill in your specific reactions here. For example, hyperventilating, panicking, becoming oppositional or just plain combative with medical personnel, avoiding medical care altogether, etc.

D: Your attempt to Dispute your belief/response 

For example: 

  • Most people don’t like to be stuck with a sharp object but, realistically, the process does not take very long and needles will not cause that much pain. 
  • Tensing up or becoming oppositional will not make the process go any faster or easier; in fact, it will do the opposite. 
  • The more I can relax, the faster and less painful the process will be. 
  • Avoiding medical care is not in my best interest. Lots of medical conditions are treatable if diagnosed early. 
  • Many other people are able to do it, so can I! 
  • To stay calm, I can (find something that works for you. Maybe it helps to not look at the needle, or maybe you feel better if you can watch. Maybe you need to do a countdown in your head, or find a distraction like listening to music or watching a video).

E: The Effect of your dispute 

Ideally, in this example, you’d feel less anxious about needles and develop positive coping mechanisms for the future. 

Bear in mind, an emotional response to a not-so-positive situation is normal, and ignoring or eliminating your emotions entirely is not the point of this exercise. It’s all about keeping things in perspective. Emotions only become problematic when they are excessive for the situation, all-consuming, or prevent you from engaging in necessary tasks. As a personal example, while I’m not afraid of needles, I have tiny little veins and often have to be stuck multiple times. Once the technician even brought in a sonogram machine to help them see my veins. It still took him three tries. Needless to say, having blood drawn is definitely not the highlight of my day. But I can, and do, let technicians draw my blood, despite my very real not so great past experiences, because the pros still outweigh the cons. Do I like it? No. Do I do it? Yes.  

The most important thing is to be mindful of your emotions and make sure they don’t become excessive or unrealistic. The next time you’re confronted with a situation you find daunting, try mapping out the ABCDE of what you’re facing, and see how your experience changes!

This blog is not designed to diagnose, treat, or prevent illnesses or trauma, and Dr. Emick is not responsible for your use of this educational material or its consequences. Furthermore, reading this blog does not create a doctor-patient relationship. The information contained within this blog is not intended to dictate what constitutes reasonable, appropriate, or best care for any given physical or behavioral health issue, nor does it take into account the unique circumstances that define the health issues of the reader. If you have questions about the diagnosis, treatment, or prevention of a condition or illness, you should consult your personal health care professional. As always, consult with your personal health care professional before beginning or changing any fitness or nutrition program to make sure that it is appropriate for your needs. Dr. Emick reserves the right to modify her positions on a subject based upon new research or data as it presents.

Understanding Anxiety: The ABCs

Denton has two universities and one community college. Classes started this week, and you can smell the anxiety in the air. Some students are worried because they finally have to take that class they’ve been putting off. Others got “that” professor. Some got “the talk” from their parents over the break and need to pull their grades up OR ELSE! It seems like the perfect time to focus on some anxiety-reducing techniques. While I love to study the neurochemistry of various disorders, including anxiety, I realize that most other people don’t. In fact, the mere thought of chemistry provokes anxiety! Or does it?

Today we’ll focus on the behavioral aspects of anxiety. Let’s start with Albert Ellis’ ABC Model, one of the models that influenced the development of cognitive behavioral therapy.

Think of a time when you have been anxious. What caused it? School, work, a breakup, finances? Maybe even something specific, like worrying about annoying a friend, or stumbling over your words during a presentation. We often perceive that certain events cause anxiety, but they don’t. Instead, it’s our negative perception of the actual or anticipated event that causes our anxiety. This is the fundamental premise of Albert Ellis’ ABC Model.

Let’s begin by defining some terms. “ABC” stands for:

A-Activating event (a negative event)

B-our Belief about the event

C-the Consequence (our response to our beliefs)

The idea behind the model is that a negative event doesn’t cause our stress or anxiety; our BELIEF about the event does.

Let’s use a common example: school is starting, and you feel unprepared:
A: School is starting

B: “I’m not ready. What if I don’t do well? People are going to think I’m stupid. My parents will kill me.”

C: Anxiety. Unable to focus, trouble sleeping, loss of ambition, fear of even starting or, conversely, not giving yourself a break from studying.

While we are focusing on anxiety today, Ellis’ model is relevant for all sorts of scenarios and responses, not just anxiety. Maybe your go-to emotional reaction is anger, depression, embarrassment, disgust, fear, or a mixture of several of these! The model is still relevant. That being said, looking at the model, what caused your anxiety? School will start no matter what, but your BELIEF is what shapes your reaction to that event.

The takeaway is, the next time you’re experiencing a behavioral consequence, don’t think about or blame the activating event. That may or may not be something you can change, but it did not cause your emotional response. Instead, think of what you can change: your beliefs about and reaction to that event. Recognize when your beliefs are irrational, unhelpful, and problematic, and how they may be creating an extreme consequence.

Let’s look at another common event that provokes anxiety in many: needles. Not all people are afraid of needles. Yet for some, the sight or even thought of a needle induces severe anxiety or even full-blown panic, while others don’t bat an eye as they watch the needle being stuck into their arm. While there are certain objects or situations that humans do appear primed to respond to negatively (Jung’s theory on the collective unconscious describes this in more detail), clearly, needles in and of themselves do not cause anxiety, or all of us would respond to them in the same way. If you are afraid of needles, it is your belief about the needle and its possible consequences that triggers your response, not the needle itself. Let’s map it out:

A: You need a shot or to have blood drawn.

B: Fill in your personal thoughts about the event here.

C: Anxiety. Fill in your specific reactions here. For example, hyperventilating, panicking, becoming oppositional or just plain combative with medical personnel, avoiding medical care altogether, etc.

Next week, we will discuss the D (dispute) and E (effect of challenging/defeating your belief) of this model, and how you can shape and change your beliefs into something more positive. In the meantime, here’s an exercise for you to try:

The next time you’re experiencing anxiety, map it out, and write your ABCs, like the school and needles examples above! It may be helpful to work backward from C to A. Consider starting a journal and mapping out your ABCs every time you feel anxious. Build an awareness of how you think, try to find patterns, and think about why you’re having the beliefs that cause your consequences.

Happy mapping!

This blog is not designed to diagnose, treat, or prevent illnesses or trauma, and Dr. Emick is not responsible for your use of this educational material or its consequences. Furthermore, reading this blog does not create a doctor-patient relationship. The information contained within this blog is not intended to dictate what constitutes reasonable, appropriate, or best care for any given physical or behavioral health issue, nor does it take into account the unique circumstances that define the health issues of the reader. If you have questions about the diagnosis, treatment, or prevention of a condition or illness, you should consult your personal health care professional. As always, consult with your personal health care professional before beginning or changing any fitness or nutrition program to make sure that it is appropriate for your needs. Dr. Emick reserves the right to modify her positions on a subject based upon new research or data as it presents.