Counselling Techniques to Reduce Stress

How do we cope with stress? There are literally thousands of books, articles and websites that cover stress and stress management. However, the ancient and natural ways are probably still the best ways towards peace and serenity. The old adage, ‘prevention is better than cure’ is certainly true for stress management. Below are three counselling techniques counsellors can utilise with clients:

Breathing Retraining

Breathing retraining is based on the rationale that over breathing is a contributing factor in the development of stress. The abnormal breathing often goes unnoticed by the person but the effects include hyperventilation that incorporates such things as dizziness, tingling sensations, palpitations and tightness in the chest. This is the result of depleted carbon dioxide in the blood. Hyperventilation is not dangerous, although it can feel very frightening for those experiencing it. It is a normal part of the fight or flight response, which consequently sends a message to the brain that there is danger present.

A slow-breathing technique is used to counteract the effects of hyperventilation. It should be done at the first possible sign that anxiety is occurring, as this strategy of slow-breathing sends a signal to the brain that there has been a false alarm. It is a very effective first step in the treatment of anxiety, but can also be used as a preventative measure to lower a person’s baseline levels of anxiety prior to any stressor occurring.

Breathing Retraining:

1. If possible, stop what you are doing and sit down or lean against something.  If driving, pull over and park in a safe place.
2. Hold your breath and count to 10 (don’t take a deep breath).
3. When you get to 10, breathe out and say the word “relax” to yourself in a calm, soothing manner.  Remember to breathe through your nose.
4. Breathe in and out slowly in a six-second cycle. Breathe in for three seconds and out for three seconds.  This will produce a breathing rate of 10 breaths per minute. Say the word “relax” to yourself every time you breathe out.
5. At the end of each minute (after 10 breaths), hold your breath again for 10 seconds and then continue breathing in the six-second cycle.
6. Continue breathing in this way until all symptoms of over breathing have gone.
7. If this is done at the first signs of over breathing, the symptoms will subside within a minute or two and an anxiety attack will not follow.

Source: Andrews et al., (1996)

Progressive Muscle Relaxation (PMR)

Muscle tension is commonly associated with stress, anxiety and fear. It is a part of the process that helps our bodies prepare for a perceived dangerous/threatening situation. Originally developed by Jacobson (Barlow, 1988), the PMR procedure teaches clients to relax their muscles in two steps. First, tension is deliberately applied to each muscle group, and then the tension is released while the client notices how the muscles feel when relaxed. With regular practice clients learn to distinguish between tensed and relaxed muscles. With this knowledge, they can then relax muscles at the first sign of the tension that accompanies the fight or flight response.

PMR- Procedure and Sequence:

Each tensing is for 10 seconds; each relaxing is for 10 or 15 seconds. Note that each step is really two steps–one cycle of tension-relaxation for each set of opposing muscles. Breathe slowly and evenly and think only about the tension-relaxation contrast. Do the entire sequence once a day if you can, until you feel you are able to control your muscle tensions. Be careful: If you have problems with pulled muscles, broken bones, or any medical contraindication for physical activities, consult your doctor first.

1. Hands. The fists are tensed; relaxed. The fingers are extended; relaxed.
2. Biceps and triceps. The biceps are tensed (make a muscle–but shake your hands to make sure not tensing them into a fist); relaxed (drop your arm to the chair–really drop them). The triceps are tensed (try to bend your arms the wrong way); relaxed (drop them).
3. Shoulders. Pull them back (careful with this one); relax them. Push the shoulders forward (hunch); relax.
4. Neck (lateral). With the shoulders straight and relaxed, the head is turned slowly to the right, as far as you can; relax. Turn to the left; relax.  (Bringing the head back is not recommended–you could break your neck).
5. Mouth. The mouth is opened as far as possible; then relax. The lips are brought together or pursed as tightly as possible; then relax.
6. Tongue (extended and retracted). With mouth open, extend the tongue as far as possible; relax (let it sit in the bottom of your mouth). Bring it back in your throat as far as possible; relax.
7. Eyes. Open them as wide as possible (crease your brow); relax. Close your eyes tightly (squint); relax. Make sure you completely relax the eyes, forehead, and nose after each of the tensing.
8. Forehead. Raise your eyebrows as high as they will go, as though you were surprised by something. Then relax.
9. Back. With shoulders resting on the back of the chair, push your body forward so that your back is arched; relax. Be very careful with this one, or don’t do it at all.
10. Thighs. Extend legs and raise them about 6″ off the floor or the foot rest–but don’t tense the stomach; relax. Dig your feet (heels) into the floor or foot rest; relax.
11. Stomach. Pull in the stomach as far as possible; then relax completely. Push out the stomach or tense it as if you were preparing for a punch in the gut; relax.
12. Calves and feet. Point the toes (without raising the legs); relax. Point the feet up as far as possible (beware of cramps-if you get them or feel them coming on, shake them loose); relax.
13. Toes. With legs relaxed, dig your toes into the floor; relax. Bend the toes up as far as possible; relax.

(Source: Adapted from Jacobson, 1938)

Cognitive Restructuring

Cognitive restructuring, straight thinking or logical reanalysis is based on the belief that the way we feel, behave and respond to situations is based on the way we think. This approach attempts to modify unhelpful thought patterns and beliefs. Cognitive restructuring, also known as cognitive reframing, is a technique drawn from cognitive therapy that can help people identify, challenge and alter anxiety provoking thought patterns and beliefs.

Thinking that is not straight or accurate is based on false assumptions about other people and the world in general and is often the basis of anxiety and other negative mood states. For example, a woman who suffers social anxiety may hate to stand in line in the grocery store because she is afraid that everyone is watching her.

Once a false assumption has been made, it will then often be used as a basis for prompting key behaviours that end up acting in response to the false assumption as if it were true. Irrational thoughts like this, and their accompanying behaviours, play a big part in the onset of anxiety.

For example; thoughts like; “What if I do something stupid?”, “What if something terrible happens to me or my family?”, “What if I can’t escape?”, “What if they end up hating me” or “What if I have another panic attack?”, can clearly evoke emotions of fear and anxiety through believing the thought and then reinforcing the thought through shaping behaviour in accord with it.

The first step in cognitive restructuring is to identify what the unhelpful thoughts or self talk are and when they are most likely to occur. For example, a person who notices they become anxious before meeting new people might be asked to write down their thoughts prior to such an event. They might end up recording such unhelpful thoughts and self talk like:

• What if it all goes wrong?
• I’m not good enough to do this.
• What will people think if I say the wrong thing?
• I couldn’t relax last time; I’ll be useless this time.

Once this self-talk has been identified, clients are assisted in modifying them into a more realistic assessment and belief. For example:

Worrying about something going wrong won’t stop it from happening; it just makes me more anxious. I can take positive steps to prepare for possible problems and that’s all anyone can do. Anyway what really is the worst thing that can happen if it does go wrong? When I think about it – there really isn’t that much that would happen if it did go wrong. The word keeps spinning and the sun stays in the sky…

I do things well most of the time but like everyone, I will occasionally make a mistake. I will feel bad about this but I can handle that and take constructive steps to do better next time.

I don’t know what other people will think, but if I say the wrong thing I can cope. I’ve coped with this before. Anyway – What is ‘the wrong thing’ anyway? If it’s what I think or feel… then why should that be considered wrong? I have thoughts and feelings like anyone else. Just because they might be different from someone else doesn’t mean it’s wrong.

I experienced symptoms of anxiety last time which made things harder. I’ll use my anxiety management skills this time because the more I use them, the more relaxed I will become as I get the hang of it. Anyway, it’s not about focusing on the anxiety; it’s about focusing on what I need to do. I mean why worry about getting anxious… it happens to everyone… and anyway if I get anxious it’s not like my head is going to explode or my vital organs are going to get ripped out. I’ve got to keep it in perspective.

In teaching the client to make more accurate appraisals of each situation, they will begin to identify the unrealistic thinking that has been contributing to their anxiety.

When clients first begin to make reappraisals of their irrational thoughts, they will often state the new reappraised thought back accurately and they will usually see the logic and sense in the newly appraised thought. However, deep down, they may still feel emotionally connected to the irrational thought and somehow still believe the irrational thought over the newly appraised one. This is fairly typical as beliefs and perceptions are not always that easy to change. One reason why irrational thoughts, beliefs and perceptions can stay fixed is because often the client’s behaviour will continue to reinforce the older more irrational thought rather than the newly appraised thoughts.

For example, if a client was trying to have the reappraised thought that closing the front door 30 times before going to work will not do anything by way of stopping a personal tragedy but continues to close the front door 30 times each morning, then the behaviour is continually reinforcing the irrational thought that closing the door 30 times will help stop the likelihood of a personal tragedy.

Therefore, to encourage a greater level of ownership or more deeply held belief in the newly appraised thought of; closing the door 30 times before work does not stop personal tragedies, the client will often need to be encouraged to act as if the new thought was true – even if deep down they still had their doubts and even when their emotional response was still anxiety laden in contradiction to the newly acquired thought. In the context of the example already mentioned, the client would need to choose not to close the front door 30 times before work and behave instead as if the newly appraised belief was true.

Even if they walked away feeling very anxious, worried and apprehensive over the strong likelihood of a personal tragedy occurring, by acting as if the new appraised thought was true, they reinforce the new appraised thought, thus encouraging a greater belief in it over time.

References:

1. Andrews, G., Crino R., Hunt, C., Lampe, L., & Page, A. (1996). The treatment of anxiety disorders. New York: Cambridge University Press.