Meeting the Challenges of
Long-Term Illness
Relaxation
By Bruce Campbell
Stress can be a challenge for anyone,
but it can be doubly difficult for people with CFIDS or fibromyalgia.
Chronic illness adds new stressors to the common challenges of everyday
life. The new stresses include the discomfort of symptoms, isolation,
financial pressure, strained relationships and uncertainty about the
future. And if that was not enough, CFIDS and fibromyalgia are very
stress-sensitive illnesses, which seem to reset our “stress
thermostat” so that the effects of a given level of stress are greater
than they would be for a healthy person. In summary, not only are your
stresses multiplied because you are ill, you are more vulnerable to the
effects of stress. All this makes stress management a central challenge
to living successfully with chronic illness.
Managing Stress: Two Approaches
Like other aspects of CFIDS and
fibromyalgia, stress is a part of the illness that can be managed. And
it is an area in which there can be a big payoff for your efforts,
because the effects of stress on symptoms and on quality of life is so
great. By using stress management techniques such as those described in
this article and the next one, you can learn how to interrupt the cycle
in which symptoms and stress reinforce one another.
In responding to stress, there are two
major approaches that may be helpful: stress reduction and stress
avoidance. The first involves retraining yourself, learning how to
respond differently to stressors so that they do not have the same
effect as in the past. The second approach is preventive, taking
measures to avoid stressful circumstances. Because stress is so
pervasive in chronic illness, I recommend you consider using a variety
of techniques to combat it, experimenting to find which are most
effective for you.
Stress Reduction
Often, how we view and react to a
stressor determines how much stress we experience. For example, if you
worry in response to an increase in symptoms, you may tense your
muscles. Muscle tension can create pain, draining energy and causing
fatigue. By learning to relax, you can lessen muscle tension and ease
symptoms. This is one example of how to reduce the impact of stressors
by changing your response. The rest of this article shows you how to use
relaxation as a stress reducer. The next article will describe six other
ways to reduce stress and also describe ways to prevent stress.
Relaxation
Relaxation offers a profound antidote
to stress. When we become stressed in the face of challenge, we often
respond with a fight-or-flight reaction. Adrenaline flows and we feel
charged up. If the
challenge is short-lived, the initial reaction is followed by
relaxation. If, however, you feel yourself to be under constant threat,
as you may if you are always in pain, your body stays in a state of
tension. Relaxation counteracts the effects of the fight-or-flight
response.
Relaxation means letting go.
Physically, it involves releasing muscle tension and breathing more
slowly and regularly. Emotionally, it consists of nurturing a sense of
equanimity. Mentally, it means observing and releasing worry-filled
thoughts.
Relaxation Techniques
The techniques described below
illustrate several different approaches to relaxation. They are useful
both for stress reduction and for managing pain. Because we are
different, some techniques work well for one person and other techniques
work better for another. In particular, techniques using imagery seem
very helpful to some people, but not useful to others. You might try
several techniques to see what works for you. Also, you may find that a
particular technique works for a while, then becomes ineffective. If
that happens, try something else. Also, you may find less formal
approaches can helpful as well. These include exercise, baths and hot
tubs, massage and acupuncture, and listening to relaxation tapes.
It usually takes several weeks of
practice to develop skill in using a technique, so allow some time
before expecting results. To be fair, you should practice four or five
times a week, setting aside for each session ten to 20 minutes when you
won’t be disturbed.
1) Relax by Focusing on Your
Breathing
When we are under tension and stressed
out, our breathing can become shallow or we may hold our breath.
Breathing in a deep, relaxed way can reduce your tension and help you
relax. Here’s one way to do that, by focusing on your breath. You can
use it alone as a stress reduction technique or in combination with
other practices, such as those you will read about below.
Sit or lie down in a quiet place where
you won’t be disturbed for a few minutes. Focus your attention on your
breathing. Take in a long, slow breath through your nose, hold it one or
two seconds, then breathe out through your mouth. The key idea is to
concentrate your attention on your breathing, keeping it slow and easy.
If you discover that your mind has wandered and your are thinking about
something else, just return your attention to your breath. As you
breathe in a slow and easy way, you should feel your body relax and a
sense of calmness replace anxiety. If you feel dizzy, stop the technique
and breathe normally.
Once you feel confident about using
this technique, you might try using it whenever you feel under tension
or notice that your breathing has become shallow. For example, it might
help you calm down when you are caught in traffic, stuck in line, or in
a heated discussion. The basic principle is to focus on your breathing
in order to slow down anxious or negative thoughts and to reduce the
adrenaline flowing through your body. Simply noticing your breathing can
often reduce anxiety. Sometimes even taking one deep breath and letting
it out slowly can reduce anxiety. But do not use this technique if it
distracts you from paying attention to the task at hand, such as
driving.
2) The Body Scan
The body scan is a technique helps you
relax your whole body. It is associated with Jon Kabat-Zinn, the
director of the Stress Reduction Clinic at the University of
Massachusetts Medical Center. He recommends that you do it lying down,
but any comfortable position is OK. You begin by spending a few minutes
focusing on your breath, visualizing it going deeply into your body and
then out again.
After several minutes, direct your
attention to the toes of one foot, becoming aware of any sensations you
feel there. You do not try to relax your toes, but rather just
concentrate your attention on that part of your body. Paradoxically,
that is often sufficient to bring about relaxation. If you find your
mind has wandered, bring your attention back to your breathing and to
the bottom of your foot. After 20 seconds or so, move your attention to
the bottom of the foot. Again, don’t try to relax it, just become
aware of any sensations that might be present. Then move on to the top
of the foot, the ankle and the calf. When your mind wanders, bring it
back to your breath and to the part of your body you are focusing on.
Gradually work through your whole
body, moving up one leg to the hip, then doing the other leg starting
with the toes. Then move on to the stomach, chest and back, followed by
the hands, arms and shoulders. Lastly, focus on the neck, jaw, mouth,
eyes, scalp. The technique has two keys: 1) focus your attention on one
body part at a time without consciously trying to relax it; and 2)
return your attention to the body when your mind wanders.
This technique can also be used for
falling asleep, because it helps distract you from thoughts and worries
by keeping your attention on your body.
3) The Relaxation Response
A technique for creating a state of
deep rest is the relaxation response, a tool developed by Dr. Herbert
Benson of Harvard. To elicit the relaxation response, you need to do two
things. First, you repeat a word, sound, phrase, prayer, image or
physical movement. He calls
this an object or mental device to focus on. You can repeat a word or
sound (like “relax” or “One”), say a prayer, look at a symbol
like a flower, or concentrate on a feeling such as peace or love.
Second, you adopt what Benson calls a
passive attitude. This is the most important element. As you focus on
your mental device, you will experience distracting thoughts, images or
feelings. And you may be surprised by how difficult it is to keep your
mind focused. But don’t worry. It is natural to lose your mental
focus; everyone does. When you find that you have become distracted,
simply return to your point of focus. You might consider refocusing
yourself by first moving your attention to your breath and then
returning to your point of focus. Do this whenever you discover that
your attention has drifted away from your point of focus. This
non-judgmental response to distractions is the heart of the relaxation
response.
How can you know if you have
successfully elicited the relaxation response? Benson suggests that you
will become aware that you are in a pleasant state like the feeling you
might have lying on the beach on a warm summer day or the sense of
detached relaxation you feel just before falling asleep.
Follow these steps to elicit the
relaxation response.
1. Get comfortable. Go to a
quiet place where you won’t be disturbed, assume a comfortable posture
and close your eyes. (Sitting is generally preferable, but not
required.)
2. Relax your body. Beginning
at your feet and moving gradually up to your head, relax the muscles in
your body. You might include in your scan of the body your feet, ankles,
calves, thighs, stomach, chest, back, hands, arms, shoulders, neck, jaw,
mouth, eyes, scalp.
3. Become aware of your breathing.
Spend a short time following your breath. Feel it come in through your
nose and go out through your mouth.
4. Concentrate on your point of
focus. On each out-breath, say your chosen word or focus on your
chosen symbol or feeling.
5. Continue for ten to 20 minutes.
If you find yourself distracted from your point of focus, return your
attention to your breathing and your focus word or phrase.
When you finish, sit quietly for a few minutes.
