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These various techniques are often practiced and demonstrated in therapy sessions with a trained professional. In addition, the person learning the techniques would need to continue to practice them on a regular basis, outside of the therapy sessions.

Relaxation or progressive relaxation

In progressive relaxation, a person is instructed to tighten and then relax various muscles. A person either lies down or sits in a chair with his or her head support ed. Each muscle group (such as face muscles, arm mus- n cles, leg muscles, etc.) is tensed for five to seven seconds £5.

and then relaxed for 20 to 30 seconds. This helps the per- 3

son recognize the feeling of tense and relaxed muscles. 5

This entire procedure is repeated one to five times, and c usually starts with the face muscles and moves down- 0

ward to the foot muscles. When relaxation is used with 3

chronic pain and childbirth, the techniques focus the per- £

son's attention on breathing and relaxing muscles as a i distraction from the pain. For mastery, relaxation tech- -§

niques are typically practiced every day for one to two s weeks. A person may engage in these techniques anywhere from 15 minutes to an hour per session. Sometimes, a person will record and replay instructions on tightening and relaxing various muscle groups until the person becomes familiar with the muscle groups and establishes a routine in which he or she is comfortable.

Visualization and imagery

The basic premise behind visualization and imagery is that one's thoughts become reality. For example, if one thinks anxious thoughts, then he or she will become tense. The principles behind visualization and imagery maintain that a person can use his or her imagination to be persuaded to feel a certain way or do anything that is physically possible to do. There are three basic types of visualization: programmed, receptive, and guided visualization.

In programmed visualization, the person creates a vivid image including sight, taste, sound, and smell. The person then imagines a goal he or she wants to attain or some type of healing that is desired. In the visualization, the goal is achieved, or the healing occurs.

An idea underlying both receptive visualization and guided visualization is that the person is seeking an answer to a life question or resolution to an issue, and the answer or resolution is within the person, but is buried or inaccessible to him or her because of fear, doubt, or anxiety. These techniques are similar to dream interpretation and free association techniques used in psychoanalysis or psychodynamic therapy. For example, an individual wonders whether he should remain in his current position. A proponent of these techniques would maintain that "deep down," below the level of conscious thought or subconsciously, the man knows what he really wants to do, but he is not allowing himself to listen to his desires or to act—he is blocking the message his subcon-sciousness is sending him. The goal of these techniques is to enable the person to relax and focus enough to receive that message, so that the person can do what needs to be done. In receptive visualization, the person creates a peaceful scene in his or her mind. For example, the person might imagine being on a beach. After the

<u image is formed, the person asks a question and waits for .¡y the answer. To continue the example above, the man j= imagines a beach, and he asks himself the question,

« "Should I leave my job?" He continues to relax and

= remain in the scene, and he may "hear" an answer blow-

"■g ing in the breeze or "see" a boat sailing away, which may

-o be symbolic of his wish to leave his job.

In guided visualization, the person creates a very vivid image, as in programmed visualization, but omits = some important elements. The person then waits for the subconscious to supply the missing pieces. For example, a computer programmer may wonder if she should stay in her present job or return to school for an advanced degree. In engaging in guided visualization, she may visualize her cubicle at work, the pictures on her desk, the feel of her desk chair, the sounds of people outside her cubicle typing and talking, but she will omit an element from the scene. In this case, she may omit her computer. She will then wait to see what her subconscious uses to replace her computer. This woman may find in her visualization that her computer has been replaced by books, which may represent her desire to return to school.

Visualization and imagery exercises work best when a person is relaxed. Visualization and imagery exercises are typically practiced two to three times a day for 10 to 20 minutes at a time. How quickly a person will see results can vary. Many times people report immediate symptom relief. However, the goals a person sets for him or herself, the power of a person's imagination, and the willingness to practice can all influence how rapidly benefits can be obtained. Some people find it helpful to tape record and replay detailed descriptions of what they want to visualize or imagine.

Diaphragmatic breathing

Diaphragmatic breathing can typically be learned in minutes; however, the benefits may not be recognized until after several months of persistent practice. When breathing from the diaphragm, clients are often told to lie down on a rug or blanket, with their legs slightly apart, arms to the sides, not touching the body, and eyes closed. Attention is brought to the client's breathing by placing one hand on the chest and the other hand on the abdomen area. The client is then instructed to breathe through the nose and exhale out the mouth. Each time the client breathes in, he or she should try to breathe deeper. This should be practiced for a minimum of five minutes once or twice a day. Over a few weeks of practice, the time period engaged in diaphragmatic breathing should be increased to 20 minutes and the activity can be performed while lying down, sitting, or standing.

Stress inoculation

As people go about their daily lives, they often have thoughts in which they are talking to themselves. Stress inoculation involves this self-talk in helping clients decrease their anxiety and stress. Stress inoculation therapy works on the basis of turning the client's own thought patterns into a "vaccine" against stress-induced anxiety. The first step is to develop a list of stressful situations and arrange them from least to most stressful. Once anxiety-producing situations are identified, the client is taught to curb the anxiety-provoking thoughts and replace them with more positive coping thoughts. Once these new thoughts are learned, they can be tried out in real situations. The time it takes to replace old habitual thoughts with new thoughts can vary depending on the amount of practice and commitment to make this change.

Meditation

There are various forms of meditation. Depending on the type used, the person focuses his or her attention in slightly different ways. For example, Zen meditation focuses on breathing, whereas in transcendental meditation, the person makes a sound or says a mantra selected to keep all other images and problems from intruding on his or her thoughts. With practice, a person can reach a meditative state and obtain its benefits within a few minutes.

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