Additional Stress Management:

Breathing Relaxation, Imagery &

Mindfulness Meditation

Marla K. Ruhana LMSW

School of Social Work
Wayne State University
SW 8350

Relaxation Strategies (Cormier et al.,2013, chapter 12)

Breathing relaxation (Cormier et al., 444)
Diaphragmatic breathing
Slow and deep abdominal breathing.

Muscle relaxation
Progressive muscle relaxation (Cormier et al., p. 449)
Progressively tensing and relaxing major muscles in the body.

Rationale
Reestablish effective breathing and foster physical & mental
relaxation.
One cannot be tensed and relaxed at the same time.
A useful tool in the treatment of anxiety to counterbalance the
tendency to hyperventilate that accompanies anxiety disorders.

Diaphragmatic breathing
Steps for diaphragmatic breathing
Find a comfortable body position: sitting, reclining or lying on your
back.
Inhale: breathe in slow, deep breaths through your nose.
As you inhale your abdomen should expand (imagine that the air that
comes in through your nose goes and expands your abdomen).

Exhale: breathe out slowly through your mouth (as if blowing on a

spoonful of hot soup).
As you exhale feel your diaphragm pull up and inward (imagine your
diaphragm helping to expel the air).

As you exhale feel yourself relax.

Always check to make sure that there are no medical/

physical conditions that may contraindicate the use of
diaphragmatic breathing.

Use of diaphragmatic breathing in

therapy:
Particularly useful when incorporated in treatment of
anxiety.
In session: teach the client how to use diaphragmatic
breathing and practice.
Outside session: encourage the client to practice at home
and implement s routine of breathing exercise 2-3
times/day for 10 to 15 minutes at the time.

Imagery (J. Beck, 2011, chapter 16)

Why use imagery?
Therapeutic value of imagery:
Helps to elicit automatic thoughts & feelings associated with
certain events/memories
Some people experience automatic thoughts as images rather than
clear thoughts; imagery is a means to recall those thoughts.

Use of imagery in exposure therapy (i.e., imaginal exposure).

Helps to visualize problematic situations & develop and rehearse
possible solutions (i.e. covert modeling).
Create a peaceful and relaxing scene to help reduce tension and
anxiety
Relaxation & calmness anxiety & tension

Imagery
Automatic thoughts as images
Ask! (e.g., along with your thoughts did you have any images or
pictures in your head of ...).
Educate clients about imagery
Responding to spontaneous distressing images
Follow images to completion.
Imaging successful coping.
Change/reimagine/substitute an image.
Reality test a distressing image.

Spontaneous vs. Induced images

Spontaneous client initiated.
Induced therapist initiated.

Guided Imagery
Image could be
Chosen by the client or
Induced by the social worker

Steps for using guided imagery:

Explain the rationale and process (i.e. what is going to happen.)
Assess clients potential for imagery
Help client develop imagery scene
Help the client describe the scene as vividly as possible by
accessing, if possible, all five senses: hearing, vision, smell, touch,
and taste.
Practice the scene until the client can readily visualize the scene to
induce calmness.

Homework

Guided Imagery
Rationale for guided imagery:

Reduce anxiety and relieve discomfort associated with a particular

situation or event by learning to visualize a pleasant and relaxing scene.
One cannot be anxious and relaxed at the same time (i.e., reciprocal
inhibition)

Explanation of the process:

I am going to ask you to close your eyes, sit back and get
as relaxed as you possibly can, then I am going to help you
visualize, as vividly as you can a scene that is particularly
pleasant, peaceful, calm and relaxing to you.

Mindfulness (Cormier et al., pp. 455-462).

A form of meditation used to induced mental calmness and
physical relaxation.
What is meditation?
Any activity that keeps attention pleasantly anchored in the present
moment (Borenko as quoted in Cormier et al., 2013, p. 456)

Increased clinical and empirical evidence for the use of

mindfulness with anxiety, depression and other stressrelated disorders.
Consider the use of mindfulness within a stress reduction
framework to help engender a sense of safety and control.

Attitudes that Facilitate Mindfulness

Mindfulness is about non-doing, non-striving, watching
whatever comes up to ones mind from one moment to the
next.
There is no right or wrong way.
Focus on, and experience the moment...
...pay attention to this moment in this place.
...mindfulness has no goal.

Be non-striving, non-expecting, non-judgmental.

Striving anxiety

Patience
Trust
Acceptance
Letting go

Rationale for Using Mindfulness

Mindfulness is a form of meditation
Enhance focus and attention
Become an observer of your thoughts

To observe & accept their internal experiences without

judgment.
Slow down the mind
Induce calmness & reduce stress
Promote relaxation

Clinical Applications
Teach individuals to be observers of their thoughts.
As opposed to accepting their thoughts as truths.

Help individuals learn that they do not have to act on

their thoughts or urges.
Individuals learn that thoughts are just thoughts, not
facts.

Preparation for practicing mindfulness

Find a quiet, restful place

Set a regular time for meditation and meditate for 10 20
minutes daily.
Wear loose clothes.
Sit in a comfortable position and close your eyes.

Steps for Mindfulness

Engage in diaphragmatic breathing (as previously discussed)
Breathing slowly and naturally.

Focus on your breath going in and out.

After some time shift your attention to your body (i.e. body
scan) and notice:
Urges, soreness, sensations (i.e. hot or cold), sounds, etc.
Acknowledge these, avoid criticizing, judging or thinking about it

Always return your focus to your breathing to let go.

If intrusive thoughts/images/sensation happen observe them,
do not judge them and focus back on your breathing.
Open your eyes and shift your attention to an object
Observe it without saying anything about it in your mind.