Helpful Skills

The following information is offered as an introduction to some basic relaxation and thought challenging techniques that are often used by psychologists. For more information on any of these techniques, we reccommend consulting our on-line bookstore or one of the therapists listed on the Directory of Providers of the Health Psychology Network.

Diaphragmatic Breathing:

Learning to breathe correctly is one of the easiest and most effective methods for learning how to relax. Although breathing is automatic, as we grow older we sometimes develop the habit of taking short shallow breaths. This often results from increased muscle tension in times of stress. This type of breathing delivers less oxygen to your body and can cause your chest and shoulder muscles to work even harder. However, you can train yourself to breathe in a way that helps you to relax. Diaphragmatic breathing is a technique that requires you to use the muscles in your diaphragm and abdomen when you breathe. The diaphragm is a domed-shaped muscle located between your chest cavity and stomach cavity. During correct breathing the diaphragm is tightened and pulls the lower part of your lungs down so that more air can be inhaled. As you inhale, your abdomen/belly swells, the rib cage expands, and at the end of the inhalation the upper chest expands. If you ever watch a baby or a small child sleep you will notice that it is their belly – not their chest – that rises and falls as they breathe. Diaphragmatic breathing consists of the following steps:

  1. Setting up a Relaxation Area: Find a quiet place where you will not be disturbed. If needed, take the phone off the hook and tell others to give you this time alone. Loosen any tight clothing, or change into clothes you feel very comfortable wearing. Next, sit in a chair with your feet flat on the floor and your hands in your lap or on the arms of the chair. Make sure you start out in a comfortable position.
  2. Monitoring: Place one hand on your abdomen and one hand on your chest. Take a normal breath in and notice which hand moves the most. Most likely it will be the hand on your chest and this indicates that you tend to breathe from your chest as mentioned. Now try to take a breath from your abdomen - you might feel as though you are pushing your stomach out as you inhale and that is the way it should feel.
  3. Practice: Now close your eyes if you are comfortable doing so. Take a deep breath in through your nose slowly for a count of three and then exhale for a count of three from your mouth. Your exhalation should be as long in duration as your inhalation. If you start to feel dizzy when breathing, breathe less deeply and at a more normal rate. You will need to practice this daily for 15 minutes. The more you do it, the easier it will become. After a week of practice you will begin to notice that you are breathing more deeply without even trying.

The next step is to begin doing your breathing in different places like your car, while waiting for an appointment with your doctor, or right before going to bed. You should also try doing it at different times of day such as early in the morning, the afternoon and the evening. Instead of practicing your breathing for 15 minutes, try doing it for 5 minutes. You will begin to notice that you need less time in order to feel nice and relaxed. Like learning to ride a bike, once you learn to breathe correctly you will start doing it automatically. Here are some statements you might try saying in your mind as you do the breathing exercise:

  • With each breath you feel your body sinking into the chair.
  • With each breath, scan your body looking for any place where you might be holding tension and let that area relax.
  • With each breath your body feels heavier and warmer.
  • With each breath you feel yourself becoming more relaxed and calm.
  • As you find yourself becoming more relaxed you realize that you can feel this way whenever you want, just by taking the time to breathe deeply.

Progressive Muscle Relaxation (PMR):

Have you ever noticed when muscles in your neck, shoulders or back are tense? These are common places that we carry tension. Some of us have been carrying around this tension for so long that we don’t even notice it anymore. The purpose of PMR is to teach you a way to relax and to help you to develop an awareness of when your muscles are relaxed vs. when they are starting to become tense. The reason this is important is that if you are able notice the tension early you can reduce it before it leads to other problems (e.g., headache, stress, muscle soreness). By going through one muscle group at a time, tensing the muscle for a few seconds, and very gradually releasing the tension, deeper than normal levels of muscle relaxation can be reached. The basic procedure may take a few attempts to get used to but once it is mastered your muscles can be relaxed rapidly.

How to Begin

As you did when preparing to do your breathing exercises, make yourself as comfortable as possible in a seated position. Loosen any tight clothing or jewelry and remove your shoes. Reduce as many distractions around you, such as TVs, radios or telephones. Sit up straight with good posture, hands resting in your lap or on the arms of the chair. Begin taking some nice deep relaxing breaths. Begin by tensing and relaxing the specific muscle groups listed below. As you perform these exercises, notice the difference in how that muscle feels when it is relaxed compared to being tense. Do not tense muscle groups that are injured. If at any time you feel any pain or discomfort, discontinue that portion of the PMR and move to a different muscle group.

Relaxation of the feet (Perform twice on right and left)
Flex your feet by pulling your toes up toward your knees while your feet are on the floor.
Feel the tension building in your feet and hold it for 4 seconds.
Release the tension slowly paying close attention to the different sensations.
Take a deep breath and as you exhale, say the word “relax” and release the tension.

Relaxation of the calves (Perform twice on right and left)
Contract the calf muscles by lifting the heel of your foot.
Feel the tension build and hold it for 4 seconds.
Release the tension gradually by letting your heels return to the floor, noticing the different sensations.
Take a deep breath and as you exhale, say the word “relax” and release the tension.

Relaxation of the knees and upper thighs (Perform twice on right and left)
Extend your leg out straight and tense your thigh muscle
Feel the tension building in your thigh and hold it for 4 seconds.
Take a deep breath and as you exhale, say the word “relax” and release the tension.

Relaxation of the abdomen:
Observe your abdomen rising and falling with each breath
Inhale and tense the abdomen (stomach muscles)
Feel the tension and hold it for 4 seconds.
Take a deep breath and as you exhale, say the word “relax” and release the tension.

Relaxation of the hands (Perform twice on right and left)
Tightly clench your right fist for about five seconds.
Focus on the sensations in your hand and study the feelings of muscular tension.
Release the tension slowly and gradually paying close attention to the different sensations.
Take a few moments to allow the feelings of relaxation to develop.
Focus on the contrast; try to feel just how different the sensations of deep relaxation are.

Relaxation of the forearms (Perform twice on right and left)
Turn palms face up, make a tight fist, and curl it towards you
Feel the tension build and hold it for 4 seconds.
Take a deep breath and as you exhale, say the word “relax” and release the tension

Relaxation of the biceps (Perform twice on right and left)
Bring your fist in towards you shoulder and tighten you bicep muscle.
Feel the tension build and hold it for 4 seconds.
Take a deep breath and as you exhale, say the word “relax” and release the tension

Relaxation of the shoulders (Perform twice on right and left)
Draw the shoulder blades together (to midline of body)
Contract the muscles across the upper back
Feel the tension build and hold it for 4 seconds.
Take a deep breath and as you exhale, say the word “relax” and release the tension

Relaxation of the jaw and facial muscles:
Clench your teeth together
Tense the muscles in the back of your jaw
Turn the corners of your mouth into a tight smile
Wrinkle the bridge of your nose and squeeze your eyes shut
Tense all facial muscles in toward the center of your face
Take a deep breath and as you exhale, say the word “relax” and release the tension

Relaxation of the forehead:
Raise your eyebrows up and tense the muscles across the forehead and scalp
Feel the tension build and hold it for 4 seconds.

Whole body muscle relaxation:
Focus on relaxation flowing from the top of your head, over your face, down the back of your neck and shoulders, over your chest and abdomen, flowing through your hips and buttocks into your thighs, knees and calves, into your ankles and feet

Continue to deep breathe for a few minutes quietly

Finishing the PMR exercise:
Take a few second to empty your mind and to allow the feelings of relaxation to spread throughout your body. Scan your body and if you find any remaining tension allow yourself to let go of it. Count backwards in your head from 3 to 1
3 - become aware of your surroundings
2 - move your feet, legs, hands, arms, rotate your head
1 - open your eyes, slowly, feeling refreshed and relaxed

In order to learn this technique you will need to practice daily. A typical PMR session may toke from 10 to 15 minutes to complete all the muscle groups.

Automatic Thoughts:

Automatic thoughts are thoughts that we have immediately after getting any kind of information. They usually occur very quickly and unless we make an effort to pay attention to them, we usually are not aware of them. Automatic thoughts often trigger a cascade of less healthy thoughts that can have an impact on how we feel emotionally and physically and how we behave. We have automatic thoughts for EVERYTHING that goes on in our world - even for very trivial kinds of things. For example, let’s say that later today you made arrangements to meet a friend of yours back at your place to have lunch. So after going on an errand, you go home and as you get closer to your door, you see that there’s a piece of paper taped to the door. What kinds of automatic thoughts do you think you might have about that?” The kinds of automatic thoughts that we have are affected by the kinds of experiences we’ve had in our lives. So, for instance, if you have a lot of friends who let you down, you might be more apt to have an automatic thought that the note was from your friend canceling your lunch. Automatic thoughts can help us to make sense of the world. For instance, going back to the previous example, pretend that when you got home, instead of finding a note attached to your door, you saw that the door was open, and you know that you locked it that morning. What kind of automatic thoughts would you have at that point? You can see how that kind of automatic thought could be helpful because it would alert you to a potentially dangerous situation.

Cognitive Errors:

People sometimes have automatic thoughts that are based on faulty assumptions or misconceptions. These are called “cognitive errors”. Psychologists often work with people to help them to identify and change cognitive errors in favor of more healthy ways of thinking. Why is this important? The way you think determines your emotions, and your emotions (e.g., anxiety, depression, anger, frustration) have an impact on your physical health. Before learning how to correct cognitive errors, it can be helpful to learn the various types of errors in thinking. Below you will find a list of cognitive errors. As you read through each of these, ask yourself if any of them apply to you or someone you know. We all think in these ways from time to time and you will probably notice that some of these ways of thinking sound very familiar.

All-or-nothing thinking: When you see things in black or white categories. If your performance falls short of perfect, you see yourself as a total failure.

Overgeneralization: When you see a single negative event as a never-ending pattern. If you do not do well at one thing, you think you are not good at anything.

Mental filter: When you pick out a single negative detail and dwell on it exclusively, so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire glass of water.

Disqualifying the positive: When you reject positive experiences by insisting they “don’t count” for some reason or another. In this way, you can maintain a negative belief that is contradicted by your everyday experiences.

Jumping to conclusions: When you make a negative interpretation of an event even though there are no definite facts that convincingly support your conclusion.

Mind reading: When you arbitrarily conclude that someone is reacting negatively to you, and you do not bother to consider other possible explanations for their behavior (they are tired, they had a rough day, etc.).

The fortune-teller error: When you anticipate that things will turn out badly, and you feel convinced that your prediction is an already established fact. This prediction may in turn affect your behavior, making it a self-fulfilling prophecy.

Binocular vision: When you distort information in such a way that no longer allows you to view the situation realistically.

Magnification: When you exaggerate the importance of things (such as your goof-up, or someone else’s achievement).

Minimization: When you inappropriately shrink things until they appear tiny (your own positive qualities or someone else’s imperfections).

Catastrophizing: When you predict extreme and horrible consequences to the outcomes of events. A turndown for a date means a life of utter isolation. Or, making a mistake at work means you will be fired for incompetence and never get another job.

Emotional reasoning: When you assume that your negative emotions necessarily reflect the way things really are. You might think, “I feel it, therefore it must be true.”

"Should” statements: When you try to motivate yourself with “shoulds” and “shouldn’ts,” as if you had to be whipped and punished before you could be expected to do anything. “Musts” and “oughts” are also offenders. The emotional consequence to this type of statement is guilt. When you direct “should” statements toward others, you feel anger, frustration, and resentment.

Labeling and mislabeling: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself: “I’m a failure.” “I’m stupid.” When someone else’s behavior rubs you the wrong way, you attach a negative label to him: “He’s an idiot.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded.

Personalization: When you see negative events as indicative of some negative characteristic of yourself, or you see yourself as the cause of some negative external event for which, in fact, you were not primarily responsible: “I didn’t get that promotion because I’m incompetent.”

Maladaptive thoughts: When you focus on something that may in fact be true, but is nonetheless not helpful to focus on excessively: “My knee hasn’t been the same since surgery” “I’m starting to lose my hair.”

Cognitive Restructuring:

Cognitive restructuring teaches individuals to change negative and unwanted emotions by learning to recognize the maladaptive thoughts that give rise to the emotions, and substituting more adaptive thoughts for them. Cognitive restructuring is based on the knowledge that our emotions (e.g., anger, sadness, or happiness) are a result of the way we think. For example, let’s imagine you are about to enter a room full of people and you begin to think to yourself that everyone is going to think that what you have to say is stupid. This might lead you to feel upset and might make you want to aviod going to the party. By using cognitive restructuring you might realize that most of the time people are interested in what you have to say and that you typically do quite well at parties. As a result of changing your thinking you might be less anxious and you might have more fun at the party.

The way you think about an event, either positive or negative, determines the emotions you experience. Negative thinking and unnecessary distress, anxiety, or worrry can impact your physical health, so it’s important that we learn to identify and change the thoughts that give rise to these emotions.

Cognitive restructuring is a process in which a person; 1) identifies an event that resulted in a negative or unwanted emotion, 2) considers the thoughts that they were having at the time of the event that led to the emotion 3) evaluates the thought (e.g., What is the evidence for the thought? What is the evidence against the thought?), and 4) if there is more evidence to suggest that the thought might not be true, the person writes down a more positive coping thought that is more consistent with the facts and evidence. This process is repeated and practiced for several events. As practice continues, individuals gain skill in changing unwanted thoughts and preventing negative emotions that can impact health.

A detailed description of the process of performing cognitive restructuring is beyond the current abilities of this website and is better carried out by a therapist who has been trained to use this technique. If you would like to learn more about cognitive restructuring, we recommend that you consider consulting one of the therapists listed on the Directory of providers of the Health Psychology Network