iCope Blog

Easy Steps to Relaxation

One of the core skills in any stress management or resilience program includes some type of relaxation training. The good news is that relaxation skills are very easy to learn with a little practice. The health benefits of just doing some form of relaxation or mindful meditation are very impressive and some of these benefits will be covered in future blogs.

Before we discuss this easy relaxation procedure it sometimes helps to understand one basic part of how our autonomic nervous system controls the fight-or-flight response. We are biologically wired for the protective fight-or-flight reaction in which our bodies go into high gear to defend ourselves or to escape. When activated through adrenaline and other hormonal changes our heart rate increases, blood pressure increases, blood vessels in the hands and feet constrict, breathing rate increases, and the bronchia in our lungs dilate to let in more oxygen. This stress reaction is controlled by the sympathetic nervous system. However, something has to turn the fight-or flight reaction off – otherwise we would all collapse with fatigue! Fortunately, we also have a braking mechanism in the parasympathetic nervous system, which counteracts the fight-or-flight reaction. Here your heart rate and breathing rate slows down, blood pressure decreases, and blood flow increases to the hands and feet. These two systems work together to maintain homeostasis, or balance, in our bodily functions. Other biological changes especially in the digestive system also occur in our body as can be seen on the diagram below.

Relaxation training or mindful meditation is vital to all stress management programs because it helps induce the parasympathetic nervous system sooner rather than later to counteract the stress response. Although your fight-or-flight response will eventually subside (as long as there is no continued threat), you can help speed this process up by physically relaxing.

Research has shown that anyone can relax physically under the right set of circumstances. This typically includes a few steps like getting into a quiet space in a comfortable position, and having something pleasant or even neutral to focus upon. Relaxation skills take some time to master and generalize to everyday situations but as with most skills, you will only get better with practice.

Our modified iCope relaxation procedure, which takes about 20 minutes, is as follows: Find a quiet place where you will not be interrupted for the time needed to try this procedure.

1) Get into a comfortable position lying down on your back. You can use a recliner type chair, or simply lie down in bed.

2) Try to loosen your muscles as best as you can. Briefly pay attention to the tension throughout your body, scanning from your head all the way down to your feet. You can roll your head gently side to side and stretch your arms and hands if that helps relax the muscles.

3) Make a mental note of your stress level by rating it from 1 (very relaxed) to 10 (very stressed).

4) Slowly take a very deep breath through your nose. Breathe in deeply enough to extend your stomach and hold it for a few seconds. Then breathe out slowly through your mouth. You can put your hand on your stomach to feel it rise with each deep breath.  Repeat this for three more deep breaths.

Now close your eyes and try to keep any other thoughts out of your mind. Allow your breathing to get into a natural and comfortable pace, breathing slowly in and out. Continue to breathe deeply in through your nose and out through your mouth.

In order to get more deeply relaxed, you will want something on which you can focus your attention. Try both of the following methods at different practice times.

a) Every time you exhale simply say a word such as “cope” or “calm” to yourself, and imagine tension flowing out of your body. Focus on your word as you breathe naturally. Do this for the remainder of your practice session.

b) The other method to try at a different time is particularly good for those who can “visualize” an image with their eyes closed. Instead of focusing on a word, imagine a very peaceful and calm scene such as a sunset or a peaceful place from your past.

5) Continue breathing naturally and focusing on your word or your scene for 15-20 minutesDo not be concerned if you get distracted. This is totally normal and expected. When that happens, and it will, try to bring yourself back to the procedure and remind yourself that you want to continue focusing on your word or scene.

6) When you finish, sit quietly for a few minutes, and make a mental note of your stress level (rating it again from to 10) and what your muscles feel like when you are more relaxed. Doing your pre- and post- stress ratings will help reinforce your relaxation practice. Over time you will see decreases in stress levels during your practice.

7) Open your eyes, but do not stand up suddenly. Remain calm in your body, but alert in your mind. When you feel alert and ready to get up, do so, but try to remember the calm relaxed feelings and sensations (muscle memory) you have just experienced.

To control stress levels in your day-to-day situations where you want something less than the 15-minute procedure, simply take a minute to take 5-6 slow deep breaths whenever you notice your stress level increasing. Also, try to recall your muscle memory of the relaxed feeling you had in your practice sessions.

If you are having difficulty with the 15-20-minute practice sessions after a few attempts at trying it, use some calming music (or one of the many recordings of nature sounds that are easily available on the internet) on which to focus for 15- 20 minutes. If that is not appealing to you, try some of the guided relaxation exercises or the mindful meditation exercises below:

  • You can find three different relaxation exercises by a sport psychologist ranging from a one-minute procedure up to a 14-minute guided procedure here.
  • And you can find a pleasant 5-minute mindful meditation exercise here.

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

© 2018 Anthony R. Ciminero.

Improving Your Overall Resilience to Stress

Although we cannot control all of the daily and lifetime events that can cause us stress, we can do things that can actually improve our general resilience to the negative effects of too much stress. Various assessment devices that test for vulnerability to stress generally focus on a few key factors. Personal factors that indicate higher resilience include your skills and positive habits, adequate social supports, good physical condition, a sense of well-being, assertiveness, and avoidance of ineffective coping methods such as using too much alcohol or drugs. Other resources available to you – such as family, friends, and a spiritual connection of some sort – can also increase your resilience. If your resilience to stress is relatively high, you will be better prepared to deal with the various stressful events that could impact upon you at any time. In contrast, less resilience suggests that you are more susceptible to the negative effects of stress. If you fall into this latter category, it is in your best interest to take additional steps to increase your resilience for better health and emotional strength. Check out some of the recommendations below to see what might work for you.

Healthy habits that will help build physical stamina and help you tolerate negative stress include:

  • Eating at least one well-balanced meal per day;
  • Getting adequate sleep most days of the week (6-8 hours);
  • Having physical exertion/exercise a few times per week;
  • Maintaining your weight at a relatively healthy level; and
  • Avoiding excessive consumption of caffeine, alcohol, cigarettes, and/or drugs.

Some social factors related to confidence and positive self-esteem will also help increase your resilience. This includes maintaining a network of friends, having at least one or more close friends or family members to confide in regarding personal issues, and being able to discuss problems and express feelings openly with significant others. We should all have at least one close friend that can be called in an emergency at 3:00 AM!

Finally, there are some lifestyle patterns that can also improve your resilience to stress. Maintain balance in your life with time to enjoy fun/leisure activities while you meet your normal responsibilities at school, at work, and at home. Try to attend important social events and to have some quiet time for yourself, even if it’s only a little time, to relax and defuse from your daily hassles and pressures.

In addition to these steps, you can improve resilience further by:

  1. Developing some sort of regular type of physical and mental relaxation such as meditation, yoga, mindfulness training, or relaxation exercises (see easy 5-minute relaxation and mindful meditations);
  2. Taking time to get away from heavy demands and pressures to unwind (e.g., develop weekend hobbies or interests, taking vacation breaks when possible etc.); and
  3. Trying to avoid taking on new challenges at work or home whenever you feel over-burdened by chronic stress. This means learning how to say “no.”

It is unrealistic for anyone to follow all of these recommendations. The important point here is to make as many of these changes as you can reasonably do at this time. Taking these preventive steps in the near future to improve resilience and regularly using positive coping strategies to manage typical stressors should provide a well-balanced approach to improving your coping skills and maintaining your health and well-being.

“All you need is love. But a little chocolate now and then doesn’t hurt.”
Charles M. Schulz

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

How Stress Can Damage the Immune System

Managing stress is very important to our emotional and physical wellbeing. However, it is also clear that a potentially dangerous situation that can arise if distress becomes a chronic problem. Researchers have known for many decades that chronic stress can cause serious physiological problems such as high blood pressure, gastro-intestinal problems, and neurological problems including headache pain. In more recent years, the evidence has been mounting that stress also causes damage at the cellular level. One interesting finding is that in addition to genetic factors, significant stress can contribute to gray hair. Although there is no suggestion that a traumatic event will cause gray hair overnight, there is evidence that the cells that produce melanin, which gives hair its color, are damaged by stress. As these cells die off, as they normally do with age, the hair does not have enough melanin to give it color. Stress appears to speed up the aging process of these cells to produce a visible sign of the damage. My own grey hair after surviving Hurricane Andrew, Katrina, Wilma, and Irma is testimony to this phenomenon!

The impact of stress on hair color is interesting, but certainly not life altering. However, a more serious threat of stress on our health provides us with more motivation to handle stress in proactive ways. Chronic stress does have an adverse effect on our immune system. Since our immune system is our primary defense against everything from the common cold and flu viruses to cancer cells, it is important to be aware of your risks if your immune system is compromised. Although short-term stress can activate your immune system in a positive way, long-term stress, which produces too much cortisol and other stress hormones, can be detrimental. The process is briefly summarized below.

We all have certain cells that the immune system uses to protect us by attacking virus-infected cells, mutant cells, and transplanted tissue. Two of the types of cells that get much of the research attention are T-cells and Natural Killer (NK) cells. Much of the research with both animals and humans shows that the biochemical changes during prolonged stress can prevent T-cells from maturing in the thymus gland and will also decrease NK cell counts. This could be harmful for anyone who has a compromised immune system (e.g., HIV+ individuals, anyone with an auto-immune disorder, and those receiving chemotherapy). Fortunately, considerable research indicates that meditation or relaxation methods, rational self-talk, exercise, a good social support network, and proactive stress management skills can all increase T-cell and NK cell counts. Many of these strategies are now being used in various medical settings where improved resilience to stress will help improve the success of other treatments.

Our next blog post will be on how to improve resilience to the effects of stress. Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

How to Cope with “Normal” Stress

We used to be told the only two things guaranteed in life were death and taxes. We need to add a third item – stress. There is no way you can live without some level of stress. However, all stress is not bad. It’s when we have too much stress at any one time or that stress is high for prolonged periods that we begin to suffer negative consequences. There are emotional stress reactions such as anxiety, anger, and depression as well as physical effects including gastrointestinal, cardiovascular, and muscular symptoms.

What is this powerful force that will be with us throughout our lives? Stress is often simply defined as the physical and psychological reactions we experience when we have any type of demand or pressure placed upon us. These reactions are sometimes called the fight-or-flight response because we try to fight against the stressor (or threat) or we want to run away from it in order to protect ourselves.

Often stress is caused by real problems such as relationship or family conflicts, financial difficulties, medical problems, or job pressures. However, our worries, fears, and some beliefs that only exist in our minds will also cause stress.

Whether we realize it or not, all of us have ways to manage stress when it is bothering us. Some methods work temporarily, but can cause other problems (e.g., using too much alcohol, drugs, or food to relieve our stress). Similarly, acting out aggressively can diffuse stress, but leads to other problems. Because these methods are not effective in the long run, we need more adaptive skills to manage stress. Research over the past 40 years indicates that there are a few basic “core” skills that we can use to manage stress effectively.

The first core skill is improving your self-awareness. In essence we need to fine-tune our sensitivity to our level of stress which fluctuates throughout the day. Typically, we have learned to ignore stress until it passes some higher threshold where we are noticeably upset. The first simple step in self-awareness is learning how to gauge your stress on a scale of 1–10, where 1 is very relaxed and 10 is the maximum stress you could experience. To do this, try to rate your stress several times throughout the day until you have good awareness of when you need to take action to reduce it. You also want to learn what level of stress is good for you to perform at your best. Over time you hopefully will learn where your effective stress zone is. That zone, which is likely to be in the mid-range, becomes your target or goal when you are trying to cope with a stressful situation. Improving your awareness allows you to react to stress before it gets out of hand.

The second skill is a quick way to relax physically. A detailed method for deeper relaxation is in another blog, but for now you can try a simplified procedure. When you notice when your stress is increasing, get in the habit of taking a few “cleansing breaths.” Inhale very deeply to increase your oxygen intake, hold your breath for about 4–5 seconds, and then slowly exhale. Do this two or three times to try to relax just a little. This will not get you deeply relaxed but can help take the immediate edge off the stress.

The third and possibly most difficult skill is psychological in nature. Books are written on this method so I can only give a rough description here. This skill, called “cognitive restructuring” or simply “talking rationally to yourself,” means eliminating unreasonable or irrational beliefs or mental habits that cause you to over-react to a situation. For example, if you are a perfectionist and upset about a mistake, you might need to remind yourself that no one is perfect and it’s okay to be less than perfect. Here you try to be reasonable, flexible, and rational so that you do not over-react to stressful events. Breaking up negative mental habits takes considerable practice.

Finally, problem solving skills are needed to look for creative ways to eliminate a stressor or to find a way to cope with the problem if it cannot be resolved. Here, you want to avoid at all costs saying “there is nothing I can do” which only creates a sense of helplessness. Even when you cannot resolve a problem, there are always adaptive ways to cope with the situation.

These four skills and other stress management topics will be discussed in more detail in future blog posts. However, during the interim you can read additional material and listen to some audio segments throughout our website.

The next blog post will be on how stress can affect your immune system. Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

Coping with Major Traumatic Events

The tragedies at Parkland, Las Vegas, and Orlando represent our recent collective experience with trauma purposely inflicted by human beings on innocent children and adults. The purpose of this lengthy blog is to share as much information as we can about post-traumatic reactions and what you can do to buffer yourself and your family from the negative effects of trauma. At this writing we are less than one week after the Parkland killings and only five months past the Las Vegas massacre.

TYPICAL REACTIONS TO EXPECT

There are a number of common reactions that occur after a traumatic life threatening experience. These reactions, although much more intense, often can be grouped into the same four categories that describe our typical stress reactions:

  • PHYSICAL
  • EMOTIONAL
  • COGNITIVE
  • BEHAVIORAL

The physical reactions to trauma include the queasy stomach, nausea, sweating, rapid breathing, muscle aches, chills, cold hands or feet, and rapid heart rates. If a person stays in this state of physiological arousal for too long, they may experience other complications such as headaches, diarrhea or constipation, hyperventilation, chest pain, muscular pain, or dizziness. Sleep disruption and loss of appetite are very common. If you have any physical ailments such as a history of stroke, heart attacks, or autoimmune disorder it is recommended that you contact your physician.

The emotional reactions to trauma include differing degrees of anxiety/fear, sadness/depression, anger, grief, guilt, and helplessness. Sometimes the emotions are hard to isolate and identify. Individuals will say that they feel a general sense of being numb or overwhelmed. Although this heightened state of physical and emotional arousal is a “normal” reaction to the traumatic event, much of the counseling effort by professionals is aimed at helping people cope with these emotions in a way that minimizes any risk of long term interference with the person’s life. Simply venting your emotions is not likely to make them go away for very long although this can help vent some powerful feelings, especially anger, that the event occurred.

The cognitive effects of trauma are quite varied. Some of the most common reactions are temporary impairments of our memory, concentration, attention, and problem solving. If we witnessed the event and felt very vulnerable at the time we might have difficulty with flashbacks or nightmares of the event. Intrusive thoughts about the event or issues related to it, worries, hyper-vigilance, and mistrust of others can develop. As we begin to cope with the overall physical and emotional stress, we will often see our general cognitive abilities (e.g., attention, memory, concentration) improve as well. Because it is extremely common to be highly distractible after these traumas, we need to be especially careful in our daily activities since accidents are more likely to occur at these times.

Whenever we have to adapt to a traumatic event, we also have behavioral reactions that go along with the physiological, emotional, and cognitive changes. Some of these behavioral changes are aimed at helping us cope with the events but they may not be effective in the long run. Some people will withdraw socially while others will want to spend time close to their loved ones. Some will avoid anything that increases their anxiety and may have difficulty getting to school or work, or following through on basic responsibilities. Increases in alcohol, drugs use, and cigarette smoking also occur.

Because trauma also can involve the death of close friends or family, grief as an intense sadness can be overwhelming. Crying, agitation, and aggressive behavior can be expected just like being very depressed, anxious, and withdrawn.

Although there are some similarities in our reactions, it is important to remember that we are all individuals and there are differences to be expected. Clearly those who were closest to the danger as in a school or workplace shooting are likely to show the most extreme reactions. If a person is coping with other major losses or problems in their lives, they may have more difficulty coping with the trauma. In spite of all of these differences, there are many things we can do to help us minimize the negative effects of the trauma.

BEGINNING THE COPING PROCESS

If you have experienced a shared trauma such as a school or workplace violence incident, hopefully you have been fortunate enough to talk about the events in a critical incident stress group at school, at work, in your place of worship, or in your general community. By talking to others you have begun the healing process. If you have not had this opportunity the following guidelines should be helpful.

Talk about the event and your reactions.

Even if you do not have a formal group setting, it is important to talk about how you are reacting to the events. Withdrawal and avoidance of others may feel natural in these times, but this will slow your progress if you withdraw too much. Talk to family, friends, co-workers, and other loved ones. It is helpful to hear from others you trust that they have some of the same feelings of vulnerability, anger, and sadness. Sharing your loss or experience with others who have had similar losses can also be quite helpful.

Engage in self-care activities.

Taking care of some of your basic needs will make you more effective in your coping. Try to:

  • Get adequate rest and sleep, even though sleep might be normal for a while
  • Eat well balanced meals whenever possible
  • Drink plenty of non-alcoholic fluids, especially water
  • Stay active, exercise if possible – even if it is a brief walk
  • Find a way to relax – listening to calming music, taking a warm bath, meditation, etc.
  • Distract yourself with some pleasant activities – go to a movie, read pleasant books, watch TV, etc.
  • When feasible, return to as much normal structure in your day as possible – normalize school, work, and home routines
  • Limit exposure to news of the tragedy – stay informed but avoid becoming obsessed with the event; control your social media exposure

Take control of whatever you can.

Feeling out of control is a very unhealthy emotion and can easily lead to anxiety, depression, and potentially dangerous physiological complications. It is important to remind yourself that even though you cannot change what happened or control everything that is scary, you do have a lot of control of other things in your life. Avoid impulsive decisions that you may regret later. It is normal for anyone who is traumatized and has added vulnerability to want to escape or avoid any place that is scary. Other efforts to take control can include participating in memorial services, attending vigils or rallies to support any of your causes, and visiting friends who you know will want to see you.

Minimize other changes or demands in your life.

As discussed previously, significant changes in your life will create more stress. Therefore, it is wise whenever feasible to plan to take on new demands at the right time. This may not be possible after natural disasters like hurricanes or floods where individuals are forced by the nature of the traumatic event to make drastic lifestyle adjustments. In other situations, temporarily avoiding some stressful changes may be helpful. For example, starting a construction project on your house, changing jobs, or moving to a new residence may need to be postponed in order to balance your other stress demands.

Find an active physical outlet to relieve some of the stress.

When the time is right, defusing your physical tension can be helpful. Working out physically, doing work around your house, hitting golf balls, playing tennis or other active sports, are all healthy ways to distract yourself and to defuse your tension. Even going for short walks in your neighborhood can be helpful if more strenuous activity is not feasible. Participating in charitable causes that require physical effort (e.g., Habitat for Humanity) can also be very helpful. If it is difficult to find an active physical outlet, try the mediation and relaxation exercises on this site as a way to defuse your physical tension.

Avoid the quick fixes.

At these times, using alcohol, drugs, or food, or acting out in violent ways may temporarily occur as an easier way to relieve your tension. However, these maladaptive coping methods will cause additional problems in the long run. Again, if you find yourself relying on these methods to cope after a trauma, outside consultation with a professional could be helpful.

OUR EXPERIENCE TELLS US

Healing is gradual after a traumatic event. Generally, it takes a few weeks for things to begin to feel normal – in serious trauma like a school shooting it will take a lot longer. Do not place unrealistic expectations on yourself or your family. Everyone goes at his or her own pace. Normalizing your day to day activities is very important. Major life decisions can be postponed if possible. Our sense of security might not return to its previous levels for a long time. Any further incidents or reminders of our vulnerability will prolong this process.

Use rational thoughts to remind yourself not to overreact. You may find that you are more “edgy” or vigilant and react more strongly to sudden noises or other external stimuli. This is normal after we experience a trauma. However, you need to avoid becoming so sensitive that isolation begins. Maintain all of your positive social relationships.

The biggest challenge is to move beyond the immediate crisis stage when these events occur, and to begin to cope with the event in a positive way. By doing this you may be able to find some relief from the most intense feelings associated with the trauma. Getting actively involved in a cause that is meaningful to you can be tremendously therapeutic. Remember not to expect anyone to make you feel comfortable about your traumatic event. This will not happen. You can, however, find ways to relieve the intensity of your emotional pain and to minimize the impact of these events on the rest of your life.

If the level of distress seems unbearable for too long, consider a consultation with a professional or contact your Employee Assistance Program (EAP) or your school counselors. Sometimes the issues are so complicated that having a professional as a resource will help you handle the stressful events more quickly and effectively. This may be particularly important for those who have a personal history of other tragedies in their lives. In cases where your functioning is impaired or you sense that your heath is at risk, it is advisable to consult with your physician regarding medications.

Many of the recommendations listed above are practical in nature. Following these guidelines can be helpful in buffering yourself and your family from the immediate trauma and its resulting changes in your lives. However, trauma specialists often remind victims and rescue workers that they will be forever changed by these events. Once people experience severe trauma, they cannot perceive the world in the same way that they did prior to the traumatic event. We may see the world as less secure and less predictable. We need to find some way to gain a new and healthy perspective that makes sense to us, and that allows us to function well in spite of any new worries and anxieties. There is no single prescription regarding how to do this. Some will find their answers through self‑reflection and discussions with family and friends. Some may need guidance from their spiritual leaders to accept what happened and move on with life. Still others will find help through therapy to integrate these new experiences into their lives in such a way that the negative impact is minimized. Try to find an approach that fits your personal values and situation.