In our day-to-day lives, we have to deal with a number of stresses. The manner in which people deal with these differs considerably and is a function of personality. For some people (at least 20% of the population) such everyday stresses build tension in the body unless something is done to reduce it. A build-up of stress may make people feel on edge and can produce tension in muscles and the mind.

Relaxation training is designed to help reduce the problem-causing tension in the body. This tension may be physical, such as tension in the muscles, or it may show itself as mental distress. The relaxation techniques you are about to learn can become a part of your future lifestyle: helping your recovery and preventing relapse in the face of further stresses.

A few things people can do on a regular basis to help reduce stress and tension are as follows:

• walk briskly: this can be very beneficial even if only for 10 minutes or so at a time;
• have a warm bath; relax and focus on positive and nurturing images;
• treat themselves to a professional massage;
• practice more effective time management and problem solving skills; and also
• do some of the exercises outlined below.

Progressive muscle relaxation is a technique designed to reduce tension in the body. It requires the person to systematically work through each muscle group in the body, step by step, consciously and deliberately relaxing each muscle group in turn and not moving on to the next until relaxation has been achieved in the muscles that are the focus of attention. Thus tension in muscles is progressively removed. These states of tension occurring in both body muscles and especially in the muscles of the scalp and head and neck can result from a buildup of stress. Progressive muscle relaxation helps induce feelings of calm and reduces tension pain resulting from chronic muscular contraction.

Muscle tension is a necessary response when reacting to a stressful event because it mobilizes adrenaline, increases blood sugar and produces other physical and mental changes which, in the short term, enable the stressor to be dealt with more efficiently. However, when this tension builds up over time and where there is no opportunity for a return to a state of no tension, chronic tension can worsen distress, cause anxiety, worry and insomnia. Somatic pain symptoms can be induced, for example, the disturbance of automatic body processes like heart action (causing palpitations) and intestinal movement (causing nausea and possibly loose bowel action).

Relaxation training aims to teach people how to reduce the level of tension in the body and, through regular practice, to be able to relax deliberately and at will in the face of a stress build up. This can help a person achieve a state where levels of tension in stressful situations will be more under control, with less likelihood of the person developing unpleasant and irrational states of distress or anger.

In many cases when people have been tense for a long time, they fail to realize just how tense they really are. Progressive muscle relaxation gives people awareness of just how tense they have become. The muscles must be relaxed in a progressive manner, usually starting with the feet and leg muscles, then moving to thighs, abdomen, chest, shoulders, hands and arms, and ending up with the neck, face and scalp. It is a technique that requires practice. Progressive benefits are gained and it is vital to persist to gain the benefits.

How to do progressive muscle relaxation

Firstly, you will need to find a place free from interruptions and noise and you must then adopt a position - sitting or lying down - which you find to be comfortable. It is also recommended that you designate a regular time each day; this should not be directly after meals as you will feel sleepy and not after strenuous exercise. During the whole procedure you must try to focus mentally, commencing for a few quiet moments before you actually start the systematic muscle and breathing work. During this 'focusing' aim to keep out unwanted thoughts (as you would do in many meditation techniques).

As you then begin to relax each muscle group, focus on the muscles in question and try to let them go completely loose, heavy and relaxed. During this process it is important to breathe slowly and regularly. For each muscle group, try to hold your breath in for 3 seconds and then let it remain released for 3 seconds before taking the next breath. During this breathing sequence try to hold the tension in the muscle group concerned as you breathe in and hold, and then, as you breathe out and wait, let the muscle tension relax completely. Do this at least twice for each muscle group. Take a break between each muscle group, breathing in and out for two cycles (in and out, and then again, in and out) before continuing on to the next muscle group.

Hands: To tense your hands, make a fist with each hand. To relax them, release the fist.

Upper arms: Tense your upper arm by bending your arm up at the elbow and bringing it up towards your shoulder (like a bicep curl). Relax the upper arm by straightening it and letting it sink heavily into the bed or chair arm.

Shoulders: Tense by lifting your shoulders upwards, as high as you can. Relax by letting your shoulders return back to where they were.

Neck: Lean your head to the left until you feel the muscles tighten in the right side of your neck. Bring your head gently back to the middle. Then slowly move your head to the right side of your neck. It is important to do this exercise gently so as not to strain the neck.

Face: Tense the muscles by screwing up your face. Relax by releasing the tension and letting your face muscles return to normal.

Chest: Take a deep breath in to expand your lungs, which will tense your chest muscles. Hold the tension and then release by slowly expiring the air.

Stomach: Simply push your stomach out to tense your stomach muscles. Release by relaxing your stomach.

Upper back: Leave your arms by the side of your body and pull your shoulders forward. To relax let your shoulders return to their original position.

Lower back: While sitting, let your head drop forward, with your chin against your chest. Relax the muscles by returning to your original position.

Bottom: Tighten your buttocks. Then release the tension.

Upper legs: While sitting, push your feet firmly against the floor to tighten your upper leg muscles. Relax to release the tension.

Feet: You can choose to curl your toes up or down. Then relax your toes to release the tension.

Once you have finished the relaxation exercise, wait a while before getting up to avoid feeling dizzy and disoriented.

Relaxation is a skill that improves with practice. It requires patience and persistence and will almost certainly not be of much help without such patient and conscientious persistence. The more frequently relaxation is done, the deeper the relaxation, the longer lasting are the effects and the faster tensions can be reduced when required.

Breathing exercises

Breathing exercises are a technique to slow the breathing down and to bring it under control. They are particularly useful when a person feels stressed, anxious or on the verge of panic. In such circumstances the breathing rate usually increases so that the rate is out of step with the body - faster than the body requires for normal functioning. A number of unpleasant symptoms can result from over-breathing such as: dizziness; light-headedness; confusion; blurred vision; feelings of unreality; increased heart rate; numbness in fingers and toes; clammy hands; and stiff muscles.

Over-breathing (hyperventilating) is hard work and, as a result, can leave the person feeling flushed, sweaty and exhausted. It can also make the chest and the chest muscles feel tight and, in some cases, quite painful.

Breathing exercises can reverse these symptoms very quickly. Long-term use of breathing exercises can become an automatic response to anxiety or panic and these symptoms will occur less and less and, with persistence, may be controlled completely. The following is an example of the type of technique that can be done at the first sign of over-breathing.

1. Stop what you are doing and sit down or lean against something. Close your eyes and slow your breathing.
2. Breathe through the nose - breathe in and out slowly in a six-second cycle. Breathe in for 3 seconds and out for 3 seconds. This will produce a breathing rate of 10 breaths per minute.
3. Once you feel calm, focus on a positive set of words, or a phrase, repeating them to yourself in your mind. You might simply say the word 'relax' every time you breathe out, or you may like to have a set of words like a personal mantra that you use regularly and consistently in the future. Examples may be "I can achieve control," or "I can do this."
4. Continue breathing in this way for up to 10 minutes until all the symptoms of over-breathing have ceased.

If this is done as soon as the first signs of over-breathing are noticed, the symptoms will subside within a minute or two and there should be no ill effects. Like other relaxation techniques, practicing and applying this technique of slow, controlled breathing will bring benefits and ongoing relaxation.

Problem solving

Everyone comes across difficult and stressful times during their lives. Problems may arise at home, at work, with partners and friends, with finances or in many other facets of life. It can be easy to ignore problems when they arise but this may just allow the problems to get bigger and eventually even more difficult to solve than it might have been. The goals of problem solving are to:

• enable the person to identify, at an early stage, when a problem occurs;
• brainstorm a number of possible solutions to the problem;
• select an appropriate solution and plan how to put the solution into action; and
• evaluate how effective the solution was (for future modification).

Steps to successful problem solving

• Define the problem
• Clearly specify what the problem is
• Can the problem be broken down into a number of smaller problems?
• List possible solutions to deal with the problem
• Try to brainstorm as many solution-options as possible.
• Select the best solution from those listed
• Examine the advantages and disadvantages of each option
  

Which solution-option will work best?

• Prepare how to put your chosen solution into action
• Ask the questions 'when, where, how and whom' about the chosen solution
• Put your chosen solution into action
• Mentally rehearse the chosen solution
• Visualize carrying out the solution from beginning to end
• Clearly visualize the plan in action
• Write out a script of the chosen solution
• Write down a timetable for the steps in the solution to be implemented
• Practise the plan with a friend.

Additional actions

• Ask a friend or family member what they would do in your position
• Seek the expertise of a counselor about how to choose and carry out the best option
• Carry out the finally chosen solution

Evaluating how effective your solution was

Did the chosen solution work? If not, try evaluating the pros and cons of each brainstormed solution again.

Time management

Many of the stresses experienced on a day-to-day basis are due to poor time management. Poor time management can be the result of procrastination, poor ordering of priorities, poor planning and failure to obtain a healthy balance between work and pleasure.

Procrastination (putting things off till a later time) is a deadly time waster and frequently leads to stress. Procrastination usually involves time wasting on alternative unimportant activities. As the deadline approaches for important tasks, vital tasks are often rushed in at the last second. This requires a task which should take a good deal of time and effort to be squeezed into a much smaller timeslot and the result can be severe feelings of stress, exhaustion and inability to cope.

For better time management consider the following tips:

• Make a list of the tasks that need to be done for the week.
• Group them into priority order by giving tasks requiring to be done immediately a priority of 1, those of lesser urgency a priority of 2, and those that are least urgent a priority of 3.
• Start on the high priority tasks (those with a 1 priority) and ensure that all are completed before moving to priority 2 tasks. Then complete all tasks of priority 2 before moving to the priority 3 tasks.
  Re-order tasks each day in priority order. A task that was low in priority at the beginning of the week may become high in priority by the end of the week.
• Use a timetable and enter all the weekly activities and tasks that need to be done with their priority order number. It is important to remember to plan also for relaxation and pleasure time as well. Note that trying to get through too much work in a limited period may, in fact, reduce your productivity.
• Try to produce an environment that maximizes productivity by reducing all unnecessary distractions.
  

Exercise

There is some evidence that suggests that the greater the level of physical fitness the better a person is able to cope with stress without experiencing emotional difficulties. Anxiety and tension symptoms are reduced with exercise, particularly if it has been enjoyable. Listed below are some of the known benefits of regular exercise.

• Increased energy
• Reduced muscle tension
• Improved mood
• Better concentration
• Greater relaxation
• Improved sleep
• Weight loss
• Increase in flexibility
• Improved muscle tone
• Increases in muscle strength
• Reduced blood pressure
• Reduced cholesterol and improved cardiovascular fitness
• Improved overall sense of well-being and better general health
  

Exercise relieves tension that builds up from stress. Ideally, exercising and relaxation go together to reduce muscle and mental tension.

People, especially older people, new to exercise must take care to have a medical check-up prior to starting vigorous exercise. At the check-up your doctor will suggest suitable strategies to help ease you safely into exercise.

Exercise tips

• Start gradually and build up the exercise regime in small steps.
• Choose anaerobic exercise that strengthens the cardiovascular system, e.g. swimming, brisk walking, running, cycling or team sports such as football, basketball or netball.
• Exercise for 15-20 minutes at a steady pace. It may take some time to build up to this level, so start with a few minutes at a time and build up gradually over a week or two.
• Try to exercise 3-5 times a week. Regular exercise has many benefits and infrequent activity can sometimes do more harm than good.
• Warm up at the beginning and cool down at the end of exercise. Warming up stretches and prepares the muscles for the coming workout and helps to prevent injuries. Cooling down after vigorous exercise might typically involve a slow walk for about five minutes. Slowing down prevents too high a build up of lactic acid in the muscles and circulation. It also allows the body, and especially the heart, to return to normal in a smooth manner.
• Drink plenty of water while exercising to replace water that is lost through sweating.
  Wait at least 2 hours after eating before engaging in strenuous exercise.
• DO NOT exercise after drinking alcohol, or when you have an illness or an infection.
  

WARNING: Stop exercising if dizziness or pain is experienced and immediately seek medical advice.