Anxiety and Panic Attacks In Emphysema/ Chronic Obstructive Pulmonary Diseases (COPD)

Vijai P. Sharma, Ph.D., psychologist

Chapter 10

Physical and Mental Relaxation

  • Identify the Difference between Relaxation and Tension
  • Three Types of Physical and mental relaxation exercises
  • "Full" Relaxation Methods (15-20 minutes)
  • "Short" Relaxation Methods (5 to 10 minutes)
  • Quick Relaxation Methods (1-2 minutes)

Identify the Difference between Relaxation and Tension

People mean different things by the word, "relax." For some people, relaxing means coming home from work, taking their shoes off, sipping that drink, reading the paper or watching TV. Sitting in the recliner is relaxation for some people while for some relaxation is that nap they sneak in during the day. Not being mad and upset all the time is relaxation for others. Actually, physical and mental relaxation means undoing the physical and mental stress or tension one is experiencing at the time.

There are people who are really apprehensive of the word relaxation. They view it with suspicion and hesitancy. They fear that if they begin to relax, they will become lazy, unproductive, and lose the "fight" in them. Nothing could be further from the truth. Relaxation can nourish you, make you stronger and help you fight better with any challenge/s you might face.

We do not always recognize that we are tense even when we are tense. Most people who have been habitually tense have been that way for many years. Tension and stress has become the natural state of their body and mind. They are unaware of the tension they carry it with them day and night, literally, twenty four hours a day and seven days a week. If one were to ask them, "Are you tense?" They would say "No! I'm okay," because they have not truly experienced relaxation and thus do not know any different.

Benefits of Relaxation

I often wonder when so many effective relaxation methods are available today, why do people go for sleeping pills and chemical relaxants. Relaxation techniques can help us to sleep and feel better. The effect of sleeping pills and chemical relaxants wears off over time as one develops tolerance for them. "The more you use them, the more you lose them" as the saying goes. With relaxation techniques, the more you use them, the more effective they become. When you can deepen your relaxation, you can enjoy it even more. And unlike the sleeping pills or other chemical relaxants, there are no bad side effects of relaxation!

Regular practice of mental and physical relaxation may help you to breathe more easily and may also relieve part of your breathing discomfort.

Three Types of Physical and mental relaxation exercises

Learning Objectives

  • Identify the Difference between Relaxation and Tension "
  • Learn three Types of Physical and mental relaxation exercises
    1. "Full" Relaxation Methods (15-20 minutes)
    2. "Short" Relaxation Methods (5 to 10 minutes)
    3. "Quick" Relaxation Methods (1-2 minutes)

It takes about 15 to 20 minutes to do a "full relaxation" session. In the beginning, it is more effective to learn relaxation by using full relaxation methods. If the stress level, pain or another type of challenge is really high, do even two or three full sessions a day. One session a day is "good," two times "better" and three times is "excellent."

Once basic relaxation skills are acquired, you may practice "short relaxation" session for 5-10 ten minutes for most of the time and do full relaxation methods once or twice a week.

As short methods are learned, "quick relaxation" method for 1 to 2 minutes can be practiced many times a day and as time permits, practice full and short methods as many times as you want or need in order to manage your stress and maintain a relaxed attitude as you go about the business of the day. Quick methods take the "wind out of the sail" of the stress ship. When you are actually in the middle of a challenging situation and things are happening, you can apply quick methods right then and there, in the face of the situation.

Helpful Tips

  • Review all the techniques provided in the following pages. Out of all the techniques, adopt one "full relaxation" method, one "short relaxation" and one method of "quick relaxation" and practice them daily several times a day.
  • It is the best thing you can do for your breathing!
  • Record and Play: You may tape the scripts of the relaxation sessions in your own voice and play them during your relaxation session. After sufficient practice these words will become part of you and then you wouldn't need to play the tape.

"Full" Relaxation Methods (15-20 minutes)

Preparation for Relaxation

Relaxation exercise can be done lying down or sitting down. If you prefer to lie down, make sure you have proper pillow support under your neck and low back or knees if needed. Lie if you prefer, sitting, make yourself comfortable. Sit with arms and hands in the lap or the thighs, back, neck and head straight but relaxed.

Affirmation (You may silently or out loud say to yourself with conviction)

"I do my best to relax physically and mentally in spite of such annoying problems as the outside noise, cough, shortness of breath or pain. Thoughts, feelings and sensations may interrupt me but I can quickly bring my mind to the part of the body I want to relax. Staying relaxed and calm, I simply bring my attention to each part of the body.

Progressive Relaxation

"Feet relax….Relaxing soles of the feet, toes and ankle joints…. Legs from ankle joints to knee joints….From knee joints to thigh joints.
Relaxing pelvis….abdomen….mid-section ….and chest.
Relaxing, hips…the low back….mid-back….and now the upper back.
The whole upper body relaxes…front….back….from inside….from outside…the entire upper body relaxes." Aaah! (Sigh while exhaling)

"Relaxing shoulders, shoulder pads and the shoulder blades…now the space between the shoulder blades.
Relaxing the upper arms from shoulder joints to elbow joints….
Upper arms and elbows lower down towards the hips…
Forearms to wrists…
Hands relax all the way down to the finger tips.
The top of my hands and palms relax.
Nice, lazy, relaxing feeling of warmth and heaviness…from finger tips all the way up through the arms and shoulders….
The back of the neck and head relaxes.
All the tiny, tiny and large muscles in my neck and throat relax.
Feeling of relaxation spreads over to the nape of the neck….back of the head….over the entire scalp….Down to my forehead.
Forehead feels smooth and shiny like the touch of lavender or cool breeze.

"The feeling of relaxation flows down my face.
Nostrils relax and feel more open than before.
Any blockages in the upper part of nose relax and shrink.
Sinuses relax and open up.
My jaw relaxes.
Gums, teeth, tongue, hard and soft palate, and the throat relax from inside.

"I observe my breathing without trying to change it in any way."
While inhaling, silently saying, "in."
While exhaling, silently saying, "out."
"In"…..and "Out"
"In"…..and "Out"
"In"…..and "Out"
"In"…..and "Out"
"In"…..and "Out."

"I can imagine as if the breath enters through the crown of my head…and exits through the feet. Breathing in as if through the crown of the head and breathing out through the toes and the soles of the feet.
Inhaling "Inn.…" exhaling "Ouutt…."
Inhaling "Inn.…" exhaling "Ouutt…."
Inhaling "Inn.…" exhaling "Ouutt…."
Inhaling "Inn.…" exhaling "Ouutt…."
Inhaling "Inn.…" exhaling "Ouutt…."

"Neck and shoulders become more relaxed and loose.
Shoulders back and down….shoulder blades slightly lowered towards the mid-back.

"Diaphragm is soft, relaxed and increased in length.
It contracts and relaxes and breathes me.
When I exhale, my diaphragm goes up higher than ever before and pushes up against the bottom of my lungs.
It expels the air more completely.
I can picture my diaphragm attached to my lower ribs as a sheath separating abdomen from lower chest.
I can feel the diaphragm moving in all the three dimensions, up and down, sideways and back to front.
As my diaphragm moves the lower ribs also move. Muscles between the ribs are becoming strong and flexible, helping my ribcage to move.

"I exhale softly and slowly. Diaphragm on both sides goes up like two domes pushing at the bottom of the lungs. The center of the diaphragm goes up and massages my heart at the same time. As the diaphragm moves up, lower ribs slightly lower down towards the hips. I exhale and feel the diaphragm moving up towards the lungs.

"Observing effortlessly and calmly. As I breathe IN softly and gently, my diaphragm goes down….side ribs spread out and up like the little wings on both sides. My ribcage lifts, lumbar curve arches…at the same time, abdomen between the navel and the breastbone tip lengthens.

Whole Body Breathing

"Whole body breathing! Ten relaxing breaths!
Ten….Inhaling as if through the head going down all the way into the toes. Exhaling, starting with toes, going up and out as if through the crown of the head.
Nine…. Inhaling from crown to the toes and exhaling from toes to the crown.
Eight…Inhaling crown to toes…Exhaling toes to the crown.
Seven…In through the crown…Out through the crown.
Six…In through the crown…Out through the crown.
Five…In….Out…
Four…In….Out…
Three…In….Out…
Two…In….Out…
One…In….Out…
Whole body breathing from head to toes!

Visualization

Picture for a few minutes in your "mind's eye" any of the following:

Think about the place you would like to be right now

Or, the time of your life you loved and enjoyed most?

Spend as much time as you have at your disposal. Savor that time and place in your mind and occasionally return to whole body breathing.

Relaxed Breathing

Relax your body, relax your breathing and relax your mind!

Take a few minutes now and just do relaxed breathing. Relaxed breathing is smooth, rhythmic and consistent flow of breath. Inhale and exhale slowly and gently.

Regular practice of relaxed breathing over time can help towards regulating your breath.

"STRING" or "SWITCH" RELAXATION TECHNIQUE

Lie flat on your back.
1. Raise the arms and drop them 18 inches away from the body with an exhaling breath-palms facing up.
2. Raise the legs a few inches and drop them with the feet falling about 18 inches apart, with the toes pointing out.
3. Let your body sink into the floor. Take a few deep relaxing breaths and each time let your body sink more into the floor as if the force of the gravity is pulling your body into the earth.
4. Keep the mind alert and observe the flow of the breath. With every exhaling breath feel as if tension is flowing out from the muscles and joints. With each inhalation stay passive. Do not create tension. Try to relax further with each succeeding exhalation.
5. Focus your mind on the soles of your feet, top of your feet, the toes, the space between the toes, and then the ankle joints. Imagine that the "strings" at the ankle joints are cut off, or the "switch" is turned off, cutting off the current as in the case of a light, leaving the ankles and feet totally loose and relaxed.
6. Decide which example works better for you, the "string" or the "switch." Use it consistently for other parts of the body as you proceed.
7. Scan the lower legs, the shins and the calves, right up to the knee joints. Cut off the strings or turn off the switch in the knees.
8. Scan the entire upper legs, front and the back of the thighs, up to the hip joints including the pelvis and the buttocks. Use "string" or the "switch" imagery.
9. Scan the pelvis and lower abdomen internally and externally, string or switch.
10. Scan the midsection, internally and externally, string or switch.
11. This time as you breathe in, scan your chest and rib cage moving with the in breath and as you breathe out, let the chest collapse completely.
12. Scan your upper chest and neck joint. Use string or switch.
13. Scan your neck, back of the head and around the head. Feel the skin of the head stretching and becoming loose. Let the forehead, face, eyes, nose, jaws, and cheeks cut loose from the string or switched off. Scan your nostrils, the septum in the middle and the nose from inside. Feel the cool breath going in and warm breath flowing out.
14. With the next outbreath, feel the whole body from head to toes becoming more loose, cut off or switched off.
15. Scan the collarbone, shoulder pads (trapezius and deltoid muscles) and shoulder joints. Use the string or the switch imagery. Scan the arms from shoulder joints down to the elbow joints. Cut the string or switch off. Scan the forearms, from elbow joints to the wrists and hands including the ten fingers right down to the finger tips.
16. As you breathe out, imagine the whole body loosing all the tension and resistance, melting or evaporating into nothingness. Let the rest of the body fade into oblivion or vanish as you simply note the breath flowing in and out.
17. Allow the body to be totally passive and stilled as if there is no life in it, just like the corpse would be without any tension. Observe the body without attachment, as if it were a corpse.
18. When you are ready to come out of Shavasana, take a couple deep and slow breaths. Wiggle your hands and feet. Rub your palms gently but briskly to generate warmth in your palms and cup your eyes with the palm.
Turn on the side, fold your legs and sit up.

31/61 POINT BODY SCAN

1. Lie in relaxation pose.
2. Relax completely for next 12 to 15 breaths. Take your time
3. Bring your attention to the point between the eyebrows and think of the number "1". Keep the attention fixed on that point for one to two seconds. In the same manner, continue concentrating on the points and corresponding numbers through point 31.
4. Practice this for several weeks. When you can do the 31-point body scan without the mind wandering, proceed to the 61-point body scan.
5. If you are right handed, begin the body scan on the right side. If you are left handed, begin it from the left. Be consistent. If you first do the right arm, then also do the right leg first and vice versa.
6. Practice the body scan after relaxation.

THIRTY-ONE POINTS BODY SCAN

1. Eyebrow Center
2. Throat Center
3. Right Shoulder Joint
4. Right Elbow
5. Right Wrist
6. Right Thumb
7. Right Index Finger
8. Right Middle Finger
9. Right Ring Finger
10. Right Small Finger
11. Right Wrist
12. Right Elbow
13. Right Shoulder Joint
14. Throat Center
15. Left Shoulder Joint
16. Left Elbow
17. Left Wrist
18. Left Thumb
19. Left Index Finger
20. Left Middle Finger
21. Left Ring Finger
22. Left Small Finger
23. Left Wrist
24. Left Elbow
25. Left Shoulder Joint
26. Throat Center
27. Heart Center
28. Right Nipple Center
29. Heart Center
30. Left Nipple Center
31. Heart Center
(Beginners may stop here. When you feel you can maintain your concentration beyond the 31 points, you may do the 61-points body scan).

SIXTY-ONE POINTS BODY SCAN

For the points 1-31 body scan, refer to the "Thirty-One Point Body Scan"

32. Solar Plexus Center
33. Pelvic Center
34. Right Hip Joint
35. Right Knee
36. Right Ankle
37. Right Large Toe
38. Right Second Toe
39. Right Third Toe
40. Right Fourth Toe
41. Right Small Toe
42. Right Ankle
43. Right Knee
44. Right Hip Joint
45. Pelvic Center
46. Left Hip Joint
47. Left Knee
48. Left Ankle
49. Left Large Toe
50. Left Second Toe
51. Left Third Toe
52. Left Fourth Toe
53. Left Small Toe
54. Left Ankle
55. Left Knee
56. Left Hip Joint
57. Pelvic Center
58. Solar Plexus Center
59. Heart Center
60. Throat Center
61. Eyebrow Center

"Short" Relaxation Methods (5 to 10 minutes)

Preparation for Short Relaxation

After 20-30 practices of "full relaxation" sessions, you may begin utilizing the short relaxation.

This relaxation exercise can be done lying down or sitting down. If you prefer to lie down, make sure you have proper pillow support under your neck and low back or knees if needed. Lie if you prefer, sitting, make yourself comfortable. Sit with arms and hands in the lap or the thighs, back, neck and head straight but relaxed.

Body Scan--Putting the Mind into the body

Scan and relax one body part at a time and silently say to yourself the name of the body part just scanned

  • Eyes, ears, nose, cheeks, lips, inside mouth, palate, throat and guts, silently saying "face."
  • Right arm and hand silently saying "right arm"
  • Left arm and hand saying "left arm"
  • Scan shoulders, neck and head "shoulders, neck and head"
  • Entire right side of the body "right body"
  • Entire left side of the body "left body"
  • Scan the lower body "lower body"
  • The upper body "upper body"
  • Scan the entire body "whole body"

"Joints" Breathing--Putting the breath and the mind into the body

We all know that we breathe in and out through the nose and if the nose is blocked we breathe through the mouth. So just for the sake of relaxation exercise, if I ask you to "Breathe in as if through the crown of your head and breathe out as if through your toes" it would sound silly. Wouldn't it? But, it is a relaxation exercise and we use our imagination a lot to relax the body and the mind. So, do the exercise "as if" it is true. Remember as children how we played "Let's pretend" games? Play the "game" and enjoy it.

Basic Instruction

Each time inhale "as if" inhaling through the crown of your head. So, the inhalation will always be through the crown.

However the point of exhalation will change each time. Therefore, each time you may exhale "as if" through a particular joint. I will say the name of the joint you are supposed to exhale from. Then you exhale from the joint specified.

Let's begin

Inhale through the crown

Exhale as if through the toes

Inhale crown-exhale toes 1
Inhale crown-exhale toes 2
Inhale crown-exhale toes-3

Inhale through the crown

Exhale as if through the ankle joints

Inhale crown-exhale ankles 1
Inhale crown-exhale ankles 2
Inhale crown-exhale ankles-3

Inhale through the crown

Exhale as if through the knees

Inhale crown-exhale knees 1
Inhale crown-exhale knees 2
Inhale crown-exhale knees-3

Inhale through the crown

Exhale through the hip joints

Inhale crown-exhale hips 1
Inhale crown-exhale hips 2
Inhale crown-exhale hips-3

Inhale through the crown

Exhale as if through the pelvis and perineum

Inhale crown-exhale pelvis 1
Inhale crown-exhale pelvis 2
Inhale crown-exhale pelvis 3

Inhale through the crown

Exhale as if through the solar plexus and lumbar area

Inhale crown-exhale solar plexus 1
Inhale crown-exhale solar plexus 2
Inhale crown-exhale solar plexus-3)

Inhale through the crown

Exhale as if through the heart area

Inhale crown-exhale heart 1
Inhale crown-exhale heart 2
Inhale crown-exhale heart-3

Inhale through the crown

Exhale as if through the pit of the throat

Inhale crown-exhale throat 1
Inhale crown-exhale throat 2
Inhale crown-exhale throat-3

Inhale through the crown

Exhale as if through the center of the eyebrows

Inhale crown-exhale center of the eyebrows 1
Inhale crown-exhale center of the eyebrows 2
Inhale crown-exhale center of the eyebrows-3

Back to exhaling as if through the toes!

Inhale crown-exhale toes 1
Inhale crown-exhale toes 2
Inhale crown-exhale toes-3
Inhale crown-exhale toes 4
Inhale crown-exhale toes 5

Inhale….and exhale through the left side of the body
Inhale…and exhale through the right side of the body

Inhale…and exhale through the center of the body
Inhale….and exhale through the upper body

Inhale…and exhale through the lower body

Inhale….and exhale through the outer side of the body

Inhale….exhale through the inside of the body

Whole body breathes 1

Whole body breathes 2

Whole body breathes 3

Whole body breathes 4

Whole body breathes 5

My breath lengthens vertically

Quick Relaxation Methods (1-2 minutes)

Preparation for Quick Relaxation

After you have had adequate practice of the "full relaxation" and "short relaxation" sessions, you may begin utilizing the quick relaxation method.

It is important that you continue practicing both the full relaxation and short relaxation methods as well. Without the continuation of the full and short relaxation exercises, quick relaxation method is not likely to be very effective.

Quick relaxation exercise can be done lying down or sitting down.

Three exercises are provided here, the "balloon technique," "elevator technique" and the "switch off technique." Each one takes a minute or two. Do the one that works best for you.

1. Balloon Technique

Remember when the air escapes out of the balloon, how the balloon shrinks and becomes totally flaccid, soft and limp. So, imagine you have air tubes in your hands and feet. Now exhale as if the whole air escapes from your "body balloon."

Try again. Take in a breath, fill up the air in the body balloon, squeeze (tighten) the whole body from toes to head and release. Exhale as if all the air escapes out of those tubes. Let the whole body become loose and limp just like the balloon emptied out of the air.

Take as many rounds of this exercise as you like.

2. Elevator Technique

Imagine you are standing, sitting or lying down in your own private elevator on the seventh floor.

Take in a breath and exhale. While exhaling imagine and feel the elevator comes down to the 6th floor.

Take in a breath and exhale. While exhaling imagine and feel the elevator comes down to the 5th floor.

Take in a breath and exhale. While exhaling imagine and feel the elevator comes down to the 4th floor.

Take in a breath and exhale. While exhaling imagine and feel the elevator comes down to the 3rd floor.

Take in a breath and exhale. While exhaling imagine and feel the elevator comes down to the 2nd floor.

Take in a breath and exhale. While exhaling imagine and feel the elevator comes down to the ground floor.

As you come down to the ground floor, "see" the elevator opening out to a beautiful scenery that makes you totally refreshed and energized.

3. Switch Off Technique

You may try the switch off technique at night before going to bed.

Imagine your body is a multi storey house. Start from the top floor, the "head room." You are to go from the top floor to the bottom floor, the feet, switching the lights off in each room.

Thus, while exhaling switch off the lights of the head room and come down to the middle room, the "mid-chest" room.

Inhale. While exhaling switch off the lights of the mid-chest room and come down to the "waist room."

Inhale. While exhaling switch off the lights of the waist room and come down to the "leg room."

Inhale. While exhaling switch off the lights of the leg room and come down all the way to the bottom floor the "toe room."

Feel all the lights are off, it is dark, quiet and very relaxing. The whole body and the mind are relaxed.

4. Tension release and relaxation

In order to relieve tension and stress, imagine your tension is something like tight and twisted ropes spread throughout your body. As you exhale, those ropes inside you are slowly untwisting. Or tension is that dirty and blackened liquid swirling out of your body, draining downward until it totally drains out through your toes. Gentle music can enhance the effect. While breathing out, let the whole torso become loose and relaxed.

After a round or two of relaxing the whole body, bring your arms overhead and lightly stretch the abdominal and pelvic area. Relax the abdomen externally and internally. Breathe softly and gently diaphragmatically.

5. Inhale and tense, exhale and release

1. Lie flat on the back, feet about 24 inches apart, hands about 18 inches from the sides of the body, and palms facing upward.

2. Scan your body and exhale fully.

3. Draw in a deep breath and simultaneously tense all the muscles of the body while lifting the arms, head, and legs from the floor.*

4. Try to balance on the lower back while holding your breath.

5. Hold this pose for 5 seconds after the inhaled deep breath.

6. Release the tension from all the muscles, gently dropping the body down to a relaxed position on the floor.

7. Exhale while gently pulling the abdomen in.

8. Inhale, allowing the ribcage moving up the breath filling in both lungs evenly.

9. If you still feel tense, repeat the steps from 1 to 8.

10. Gently roll the legs, arms, and body from side to side a few times and relax in Savasana.

*Helpful Hints

Beginners may do the arms and head together first, and then the legs separately.

If you are flexible and have a strong back, you may place your hands on your waist.

Primary involvement of muscles

Muscles strengthened: Abdominal muscles, hip flexors and knee extensors.

Benefits

Leads to relaxation of the whole body and prepares for Savasana.

Cautions

People with heart disorders or hypertension (high blood pressure) should not hold their breath during this pose.

Continue to Chapter 11

Return to Chapter 9



Copyright 2009, Mind Publications 
Posted January 2009
 

 

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