Below are three relaxation exercises that can be practiced and called upon as nicotine cessation crave coping strategies: (1) slow deep breathing; (2) progressive muscle relaxation; and (3) guided imagery.
Before reviewing them, what if an intense craving begins with an argument, and every heated word exchanged is bringing the likelihood of relapse closer?
In order to save your recovery, step #1 is to abruptly end the argument. Let go. All you need to do is say these four words,"You are exactly right," without adding any ifs, ands or butts. [1]
Okay, now that things have stopped getting worse, let's focus on getting you relaxed. There will be plenty of time later to calmly address the root cause of the argument if necessary.
Slow deep breathing
It is not normal to breathe deeply. Most of us breathe from the chest. It's called shallow breathing. When you breathe deeply, your body takes in more oxygen and you exhale more carbon dioxide. The body "resets" itself to a more relaxed and calm state.[2]
Healthy adults normally breathe at a rate of 12 to 15 breaths per minute. Research shows that slow deep breathing at a rate near 6 breaths per minute - roughly one breath every ten seconds - promotes behavioral relaxation while maximizing heart rate variability and optimizing physiological function.[3]
The problem is that long-term smoking or vaping often damages normal lung function, requiring a greater number of breaths per minute. Thus, for you, the number of breaths per minute may need adjusting.
The use of slow deep breathing as a coping strategy isn't for everyone. Some of us have damaged our lungs more than others. Also, initial attempts at controlled breathing can lead to hyperventilation with lightheadedness. Multiple practice sessions may be needed before trusting deep breathing as a go-to coping strategy.
Allow at least 2 minutes to complete to this relaxation exercise:
1. Sit comfortably or lie down. Place one hand on your stomach and the other on your chest.
2. Breathe in slowly through your nose. Feel your stomach expand as you inhale. If you are breathing from the stomach, the hand on your chest shouldn’t move. Focus on filling up your lower lungs with air.
3. Slowly exhale, releasing all the air out through your mouth. Use your hand to feel your stomach fall as you exhale.
4. To begin, try breathing at or near six breaths per minute (about one full inhale and exhale every 10 seconds). Return to normal breathing if you begin feeling lightheaded.[2] If lightheadedness occurs, during your next practice session try adding 1-2 additional breaths per minute.
5. Repeat the above steps up to 10 times.
Allow 13 minutes to listen to this relaxation exercise:
- Short Relaxation Exercise by Sharon Morisis, LICSW, CEAP. [4]
Allow 9 minutes to listen to this relaxation exercise:
- Deep Breathing Session Relaxation by Kathleen Darchuk, Ph.D, ABPP. [5]
Progressive muscle relaxation
Progressive muscle relaxation is the intentional tensing and releasing of successive muscle groups. It's based on the premise that muscle tension is the body's physiological response to anxiety-provoking thoughts and that muscle relaxation blocks anxiety.[6]
A 2015 study found that "progressive muscle relaxation significantly reduces cigarette craving, withdrawal symptoms, and blood pressure in smokers undergoing acute abstinence."[7]
Before attempting the following exercise, stop if any movement causes you pain. Be cautious about stretching or tensing parts of your body that have caused you problems in the past. Consult your doctor first if unsure about safety due to an injury or condition.
Allow at least 10 minutes to complete this muscle relaxation exercise:
1. Take a few slow, deep breaths. Inhale deeply through your nose with your mouth closed to a count of four. Exhale slowly through your mouth - also to a count four. On the exhale, imagine tension leaving your body, flowing out with each exhale. Repeat this three to four times. If at any point you feel dizzy or light-headed, return to normal breathing.
2. Continue to breathe deeply as you move into the muscle tension and relaxation parts of this exercise. You will begin with your feet and work your way up. As you inhale, tense and hold each muscle for a count of four. Relax that muscle group as you breathe out. Take several breaths before you move to the next part of your body. Allow time to feel the relaxation.
3. Tense the muscles of your feet by pointing your toes and tightening your feet as you inhale. Hold this tension briefly, then relax your toes and feet as you breathe out. Imagine the tension flowing out with your breath. Notice the difference between tension and relaxation.
4. Press the balls of your feet into the floor and raise your heels, allowing your calf muscles to contract. Feel the tension in your calves for a moment. Then release and notice your muscles relax. Again, have the tension and relaxation match your breath.
5. Tighten your knees and allow your legs to straighten. Feel the tightness in the front of your legs. Notice the sense of tension as you inhale. And release on the exhale, allowing your legs to bend and relax back onto the floor.
6. Squeeze the muscles of your buttocks. Notice the feeling of tension as you inhale. Hold this for just a moment. And on your exhale, release and allow your muscles to relax, letting the tension melt away.
7. Continue up through your body. Concentrate now on your stomach. Contract your stomach and continue to breathe. Hold the tension for a count of four. Inhale deeply. As you exhale, let your stomach relax. Again, notice the difference the tension and relaxation.
8. Move your attention now to your hands. Curl your fingers into a tight fist in each hand. Hold your fists tight and notice the sense of tension as you continue to breathe. As you release your fists, let your hands relax back to a natural position. And notice the difference between the feeling of tension and relaxation in your hands.
9. Bend both arms now at the elbow (like Popeye). Flex both of your arms by making fists and pulling your fists up tightly to your shoulders. Notice the feeling in the tensed muscles of your upper arms. Take another inhale and as you exhale and relax your arms down to your sides. Take notice of any change in what you feel as you go from a state of tension to relaxation.
10. Push your shoulders up to your ears now. Hold this “shrugging” position for just a moment. Feel the tension in your neck and shoulder muscles. Feel the tension melt away as you relax your shoulders back down. Continue to breathe in and out.
11. Finish by tensing the muscles in your face. Scrunch your face as if you just bit into something sour. Feel your eyebrows pull together, your eyes pinch tightly shut, and your lips purse together. Notice the sensation of tenseness in your face for just a moment. Then allow your face to relax. Notice the release of tension from your forehead, eyes, cheeks, mouth and jaw.
12. Now, conduct a body scan. Try to find any other spot of tension in your body. Notice it and let it go. Let yourself be still for a few moments. Just experience your relaxed muscles. Continue to breathe slowly and deeply. Feel any tension flow out. Feel your relaxation grow deeper with each breath.[8]
Allow 21 minutes to complete the following progressive muscle relaxation audio exercise:
- Progressive Muscle Relaxation Exercise by Kathleen Darchuk, Ph.D., ABPP [5].
Allow 17 minutes to complete this passive muscle relaxation exercise:
- Passive Muscle Relaxation Exercise by Kathleen Darchuk, Ph.D., ABPP [5].
Allow 31 minutes to complete this muscle relaxation exercise:
- Progressive Muscle Relaxation Exercise by Dartmouth [9].
Guided imagery
Guided imagery or visualization is "a mind–body technique involving the deliberate prompting of mental images to induce a relaxed, focused state with the goal of achieving such varied purposes as managing stress or pain, promoting healing, or enhancing performance."[10]
"As guided relaxation imagery is learned and practiced, effectiveness of imagery is increased, perceived stress is reduced, and smoking abstinence is maintained." [11] How effective?
A 2005 study divided 71 smokers into two groups. While both groups received educational and counseling sessions in their homes, the intervention group was provided with additional instruction in the use of guided imagery and was encouraged to practice guided imagery at least once per day using an audio-taped exercise for reinforcement.
Smoking abstinence rates at 24-months were significantly higher for the guided health imagery intervention group (26%) than in the control group (12%). [12]
While 26% after two years may not sound inspiring, remember, the only difference between the groups was a single new skill. What if armed with hundreds of recovery insights and dozens of skills? It's my hope and dream that you'll read and sleep upon more than a single topic in a single chapter.
Allow at least 2 to 3 minutes to complete the following guided imagery exercise:
1. Position your body in a way that feels comfortable for you (either sitting in a chair or laying on a comfortable surface) and close your eyes.
2. Take a few deep breaths using the deep breathing technique described above.
3. Take a moment to imagine yourself in a scene where you feel relaxed. It can be a place you have been to in your past or a relaxing scene you imagine. It can be indoors or out in nature. Choose something that is calming for you.
4. Although normal to have doubts this will work, give yourself permission to visualize it. Put yourself in the scene.
5. Use your senses to experience the relaxing sights, sounds, smells, textures, and physical sensations in your scene. Fill in as many details as possible.
6. Allow yourself to relax into this scene. Focus your attention on the peaceful calm of this place.
7. Continue to focus your attention on the details of the scene and the feelings of calm that flow from it. See if you can stay with the image for at least 60 seconds.
8. If you find your attention being pulled away by distractions, gently bring your awareness back to the scene. With practice, it will become natural and relaxing. If prone to falling asleep you might want to set a timer to alert you after a few minutes. [13]
Allow 8 minutes to listen to this relaxation exercise:
- Mountain Meditation by Peter Morgan, Clinical Psychologist [14]
Allow 14 minutes to listen to this relaxation exercise:
- Visualization Relaxation by Kathleen Darchuk, Ph.D, ABPP [5]
Laughter
Let's close relaxation with laughter. First, try to laugh without smiling. Can you do it? Notice something missing?
Research shows that laughter activates various muscle groups for a few seconds each, which immediately after the laugh leads to general muscle relaxation which may last up to 45 minutes.[15]
Laughter also induces sporadic deep breathing.[16] There's also evidence suggesting that among those with a sense of humor, that laughter and smiling can result in diminished anxiety and stress.[17]
Baby steps. With each passing day, the challenges will grow fewer, shorter in duration, and generally less intense. It won't be long before you look back and feel a warm smile taking shape as you reflect upon the amazing journey you've made.
Still, just one guiding principle - none today!
References:
2. U.S. Department of Veterans Affairs, Relaxation exercise: deep breathing, https://www.va.gov/vetsinworkplace/docs/em_eap_exercise_breathing.asp Accessed 06/29/20.
3. Noble DJ and Hochman S, Hypothesis: pulmonary afferent activity patterns during slow, deep breathing contribute to the neural induction of physiological relaxation, Frontiers in Physiology, Sept. 2019, 13;10:1176.
4. Morisis S, Short Relaxation, Dartmouth Student Wellness Center, https://students.dartmouth.edu/wellness-center/wellness-mindfulness/mindfulness-meditation/guided-audio-recordings/deep-breathing-guided-relaxation - Accessed 07/08/20.
5. U.S. Department of Veterans Affairs, Harry S. Truman Memorial Veterans' Hospital, Relaxation Recordings by Kathleen Darchuk, Ph.D, ABPP, https://www.columbiamo.va.gov/services/Relaxation_Recordings.asp - Accessed 07/04/20.
6. Wikipedia, "progressive muscle relaxation," https://en.wikipedia.org/wiki/Progressive_muscle_relaxation - Accessed 06/29/20.
7. Limsanon T and Kalayasiri R, Preliminary effects of progressive muscle relaxation on cigarette craving and withdrawal wymptoms in experienced smokers in acute cigarette abstinence: a randomized controlled trial, Behavioral Therapy, March 2015, Volume 46(2), Pages 166-176.
8. U.S. Department of Veterans Affairs, Relaxation exercise: progressive muscle relaxation, https://www.va.gov/vetsinworkplace/docs/em_eap_exercise_PMR.asp Accessed 06/29/20.
9. Dartmouth, Student Wellness Center, Progressive Muscle Relaxation Exercise, https://students.dartmouth.edu/wellness-center/wellness-mindfulness/mindfulness-meditation/guided-audio-recordings/progressive-muscle-relaxation - Accessed 07/08/20.
10. American Psychological Association, APA Dictionary of Psychology, "guided imagery," https://dictionary.apa.org/guided-imagery, retrieved 06/29/20.
11 Wynd CA, Relaxation imagery used for stress reduction in the prevention of smoking relapse, Journal of Advanced Nursing, March 1992, Volume 17(3), Pages 294-302.
12. Wynd CA, Guided health imagery for smoking cessation and long-term abstinence, Journal of Nursing Scholarship, 2005, Volume 37(3), Pages 245-250.
13. U.S. Department of Veterans Affairs, Relaxation exercise: visualization, https://www.va.gov/VETSINWORKPLACE/docs/em_eap_exercise_visualizing.asp Accessed 06/30/20.
14. Morgan P, Mountain Meditation, Free Mindfulness, Adapted from Jon Kabat-Zinn, freemindfulness.org - Accessed 07/08/20.
15. Paskind J, Effects of laughter on muscle tone, Archives of Neurology & Psychiatry, 1932, Volume 28, Pages 623-628; as cited in Bennett MP, et al, Humor and Laughter May Influence Health: III. Laughter and Health Outcomes, Evidence-Based Complementary and Alternative Medicine, March 2008, Volume 5(1), Pages 37-40.
16. Fry W, The respiratory components of mirthful laughter, Journal of Biological Psychology, 1977, Volume 19, Pages 39-50; as cited in Bennett MP, et al, Humor and Laughter May Influence Health: III. Laughter and Health Outcomes, Evidence-Based Complementary and Alternative Medicine, March 2008, Volume 5(1), Pages 37-40.
17. Yovetich NA, et al, Benefits of humor in reduction of threat-induced anxiety, Psychological Reports, February 1990, Volume 66(1), Pages 51-58.
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