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1 Relaxation Exercises Let s start with breathing! Your breathing is often the first thing to be affected by stress. When we are anxious we tend to hunch up the shoulders and breathe in a more rapid and shallow way. If we can consciously relax our breathing by pulling the shoulders down and back and taking a few (just two or three) deep breaths starting in the stomach (not the chest), we can help to reduce the anxiety. 1. Start by lying down or reclining in a comfortable position; take time to make sure you won t be disturbed and turn off the phone. 2. Put one hand on your chest, and one on your stomach. Focus on any tension you have in your neck and shoulders. 3. Imagine you have a balloon in your middle just below the belly button. As you breathe in you will inflate this imaginary balloon and then deflate it as you breathe out. 4. Breathe in slowly to the count of four; start to fill that balloon from your stomach and feel it rising up into your chest. This has the effect of pushing your stomach out first, then feel your chest rising and filling with air. If you find your chest rises first and your stomach is sucked in you are not using all your lung capacity. It s helpful to think about the balloon as it forces you to use more lung capacity. 5. Hold your breath for the count of four. While you hold your breath, become aware of the pressure building up in your lungs. Now you are at the top of your breath. 6. Breathe out slowly to the count of four. As you breathe out, notice how relaxed your body becomes. The air leaves your chest first then your abdomen. 7. When you reach the bottom of your breath just breathe normally for a minute or so. 8. Do this at least 10 times to bring your breathing into a more regular, helpful pattern. Important! Don t take too many of these deep breaths in a row or you may become dizzy. Take a few regular breaths in between the deep ones. Note the difference between the warm relaxed feel of deep breathing as opposed to the tense shallow anxious breathing. Some people like to link a word or colour they find relaxing to this feeling. No-one else needs to know about it; just say in your mind: calm, serene, warm, anything that fits with a pleasant feeling as you breathe in peace and breathe out stress.

2 Progressive Muscular Relaxation (PMR) Relaxation Exercises Contraction (squeezing) and then releasing the muscles trains the body and mind to recognise the difference between tension and relaxation. This is the basic way of switching off the anxious response. You can t be both anxious and relaxed at the same time. using 1 muscle group 1) Focus on a muscle group, for example your right hand and be aware of any tension in the hand and forearm. 2) Inhale and squeeze the muscles fairly tightly for between 3-6 seconds (this involves making a tight fist with your hand). 3) Release the tension, let all the tightness and pain flow out of the muscles as you exhale. Imagine any tightness or pain flowing out of your hand as you exhale. 4) Focus on and notice the difference between the pleasant feelings of relaxation and the feelings of tension you felt before. The full PMR technique takes about 15 minutes to do and is used on all muscle groups working from the head down to the feet. Important. Before practicing PMR on the whole body, you should consult with your GP if you have a history of serious injuries, muscle spasms, or back problems, because the deliberate muscle tensing of the PMR could exacerbate any of these problems. Hints for practicing PMR: 1 Practice full PMR in a quiet place, with few distractions. 2 Remove shoes and wear loose clothing. 3 Avoid eating, smoking or drinking just beforehand. 4 Never practice after drinking alcohol or caffeinated drinks. 5 Sit in a comfortable chair if possible. You may practice lying down, but this increases the likelihood of falling asleep. 6 Relaxation is a method for enabling you to feel good and in control of your mind and body while you are awake, it is not intended to put you to sleep. 7 If you fall asleep, give yourself credit for the work you did up to the point of sleep. 8 If you practice in bed at night, plan on falling asleep before you complete your cycle. 9 When you finish a session, relax with your eyes closed for a few seconds, and then get up slowly (a sudden drop in blood pressure due to standing up quickly-can cause you to faint). Some people like to count backwards from 5 to 1, and then say, Eyes open. Very calm. Alert. Build it into your daily routine, if you lead a very busy life all the more reason to take time to focus on yourself. It doesn t have to be more than about 15 minutes per day.

3 Using guided imagery You may find this is called a lot of different things such as meditation, self-hypnosis, visualization. What it s called matters less than how well it is explained, so read on. It may have a strange title but it just means training your mind to focus and being more in control. It sounds easy but some people find they really have to practice to stay focused. Guided Imagery research has shown that stimulating the brain through imagery may have a direct effect on both the hormone and nervous systems, which lead to changes in immune system function. It can boost your feeling of well-being. When practicing deep relaxation, your heart rate and breathing slows down, your blood pressure reduces, you use oxygen more efficiently, and you sweat less. Also, your adrenal glands produce less cortisol, and your ability to fight infection can improve. Once you have trained your body to know the difference between tension and relaxation you can train your mind to bring on this relaxation response with a few simple phrases or prompts. But like with the progressive relaxation techniques you have to practice making mental pictures. Try this to test how good you are at bringing images to mind Imagine a lemon, hold the picture in your minds eye. See the detail - the smell, the colour, the shape, the texture of the peel. Continue to imagine the smell of the lemon, and then see yourself taking a very sharp knife and cutting into the lemon. Take half of the lemon and squeeze into your mouth and feel the juice squirting into your mouth. Many people salivate when they do this. This exercise demonstrates how your body can respond to what you are imagining. Now you are ready.. Step 1. Find a quiet and comfortable place to sit or lie. Remove distractions such as phones, alarms or any time of the day you may be interrupted. Stick a post-it note on your door saying do not disturb. You can have soft music in the background if it helps. Start with deep breathing, just 5 or so deep breaths in between normal breaths.

4 Step 2. Think of a place or scene that you can picture in your mind s eye. Create the most relaxing environment you can imagine. For some, this would be floating in the cool, clear waters off a remote tropical island, where attractive people bring drinks and smooth music plays in the background. For others, this might be sitting by a fire in a secluded snow cabin, deep in the woods, sipping hot chocolate and tucked up in a fleece blanket. It can be anything that you make up but it needs to help to make you feel relaxed and happy. It can be anything at all.no one else will see it! Pay particular attention to the senses you are using: The sights, colours of the sky and other visual aspects of the scene such as the shape of the trees. Listen to the sounds that may be there clock ticking, birds outside the window. Notice any smells, tastes and textures that may be part of the picture. The details of the picture are important but only to train your mind to concentrate. Focus on each of those sensations in turn and if your mind wanders while you are doing this, don t worry, just bring yourself back to one sense image. Guided imagery keeps a person focused on the present moment but don t be too hard on yourself it doesn t happen instantly. You may have to do a lot of returning to a particular sensation (shape or colour) in the beginning but with practice you will find your mind wanders less. Step 3. Stay in the picture for as long as you like. Keep your mind on the details for at least 5 minutes. Let the feeling of warmth and calm wash over you from feet to head. Really take time to relish that feeling of safety and comfort. Focus on the pleasant sensation and find a word or sound that you can link with that feeling. Some people I know have used such phrases as brown velvet ; lush meadow, tropical and even some that are not for public consumption! You will use your personal word or sound to bring on that feeling later, after practice, when you can t go through the whole of the steps above. When you re ready to come back to reality, count back slowly from ten or twenty, and tell yourself that when you get to one, you ll feel serene and alert.

5 Summary Three types of exercises that can help you to relax and control arousal: 1. deep breathing exercises 2. muscular relaxation 3. guided imagery You can use all three together or choose to work on them individually. The sense of control over how your body and mind works is a helpful part of managing a condition such as psoriasis.

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