Essentials of Relaxation Training for Children & Adolescents

Transcription

1 Essentials of Relaxation Training for Children & Adolescents Drs. Greg Schoepp & Jo Eustace Registered Psychologists Alberta Health Services - Capital Health University of Alberta & Stollery Children s Hospital Edmonton, AB Children s Mental Health Matters November 7, 2008 Objectives Understand rationale for using relaxation and mindfulness approaches Learn core components of progressive muscle relaxation, breathing methods, mental imagery or visualization, and mindfulness basics Discover specific guidelines for implementing relaxation techniques Overview 1. Greg introduction, progressive muscle relaxation, and breathing methods 2. Jo Imagery or visualization and mindfulness approaches 3. Greg & Jo Questions and discussion

2 Six Families of Deep Relaxation Smith (2005) Physical Yoga stretching Progressive Muscle Relaxation (PMR) Breathing exercises Mental Autogenic suggestion Imagery or visualization & relaxing selftalk Mindfulness The Stress and Relaxation Engines NERVOUS SYSTEM Central Nervous System Brain Spinal Cord Peripheral Nervous System Somatic Nervous System 1. Nerves to muscles 2. Nerves from sense organs Autonomic Nervous System 1. Sympathetic nervous System 2. Parasympathetic Nervous System 3. Enteric Nervous System (abdomen) Autonomic Stress Arousal Constellation of physical changes Automatic awakens & energizes body, Flight or fight response Adaptive, can be delayed and prolonged effect, automatically integrated Severe or prolonged stress primes body and brain for stress arousal

3 Relaxation Applications Acute & chronic pain Medical conditions Insomnia Stress management Anxiety Anger control Relaxation Benefits Reduce arousal Reduce susceptibility to illness Speed healing from non-chronic conditions (injury) Reduce complications from chronic conditions (diabetes, cardiac) Relieve destructive effect of chronic stress on functioning (attention, flexibility, memory, energy) Relaxation Benefits Simplified for Families Rapee et al. (2000) Relaxation techniques help you: Feel calmer and more relaxed Feel more in control Have less body tension Be less nervous Improve concentration Enjoy more peaceful sleep Have less stomach and headaches Enjoy activities more

4 Cognitive Behavioral Model Behavior My actions & body clues (physical) Cognition My thoughts and beliefs Affect My feelings Increasing Awareness of Physical Responses Body Clues (adapted from Barrett, 2001 & Lyneham et al., 2003) Rating Emotions or Arousal Child & Teen Versions Small Worry Medium Worry Big worry Calm Angry Super Angry Not relaxed at all Relaxed Very Relaxed

5 Muscle Groups for PMR 4 groups 4 groups 1. Arms 1. Stomach 2. Face 2. Chest 3. Stomach 3. Shoulders 4. Legs 4. Face Rapee et al., (2000) Craske & Barlow (2006) 8 groups 1. Arms 2. Legs 3. Abdomen 4. Chest 5. Shoulders 6. Neck 7. Eyes 8. Forehead Four Main Steps for Progressive Muscle Relaxation 1. Tense muscles 2. Isolate muscles 3. Concentrate on muscles 4. Relax or release tension Main message to family: a) You create changes in your mind and body b) Calm and relaxed are very different c) Recognizing changes and knowing you re scared are first steps in coping Developmental Adaptations Exercises short and simple, 15 minutes maximum Clear, step by step directions Directions sensitive to child s age and abilities Frequent repetition and monitoring, 2-3 session practice, daily home practice Start with awareness of tension vs. relaxation

6 Developmental Adaptations May not be necessary for all anxious kids & teens Useful when kids can t manage cognitive approaches Often helps when prominent somatic symptoms present Check for past adverse experiences with relaxation training Relaxation Training Progression Awareness exercises Quiet practice in therapy and at home Practice brief relaxation (eyes open and no tensing) in outside settings such as school, sports, bus Goal is child learns simple strategies to quickly relax themselves in emotional provoking situation (anxiety, anger) Stress Importance of Practice Parental involvement role depends on child s age, parents teach by example Skill based practice, no sleeping Build into daily routine Find quiet place, no interruptions Short and simple Use some form of monitoring forms, logs

7 My Relaxation Practice Rapee et al. (2000) Practice the exercises from the CD. Please try each exercise at least three times before going to the next one. Start with Exercise 1 and progress to Exercise 4. Please fill in your form every day. Circle your answer. Do the relaxation ratings. Did you do your relaxation? Relaxed rating? Before After Friday Yes No Saturday Yes No Sunday Yes No Monday Yes No Tuesday Yes No Wednesday Yes No Thursday Yes No Relaxation Thermometer Not relaxed at all Super relaxed PMR for Preschoolers Arms squeeze lemon in hand Shoulders stretching lazy cat Neck turtle hiding from danger Jaw Bubblegum in mouth Face/Nose pesky fly on face Stomach lying in grass, animal steps on your abdomen Legs/feet stuck in mud puddle Ollendick & Cenry, 1981 Troubleshooting Concentration problems incorporate imagery; relaxation may not work with ADHD symptoms Isolating muscles is child trying to isolate every muscle Falling asleep sit, do earlier in day, needs to be distinct practice session Parental interest & motivation education & session involvement

8 Deep, Calm, or Belly Breathing Increases depth or relaxation, portable tool Child focuses on breathing in a relaxed way Goal is to produce even, calm, relaxed breathing Can be paired with self-talk or coping statements ( Relax, I m worried, calm breathing will help. Calm Breathing Methods Slow deep breath in through nose for 3 seconds & out for 3 through the mouth Young children bubble blowing or balloon in stomach Lie on stomach or back to teach, keep shoulders down Practice rules twice daily, 10 calm breaths in a row Anxiety BC Recall-Relaxation Method Take a few deep breaths Use release-only relaxation to scan body for tension, letting it go Once relaxed, silently say your cue word or phrase (i.e. relax ) on each exhale Continue calm breathing for a few minutes, saying your cue word or phrase. Markway & Markway (2003)

9 How to Make an Audio Recording Record in session for take home or prepare ahead of time Speak slowly & softly Incorporate pauses and silences, which are essential to promote relaxation and provide client time to complete instructions and enjoy their effects Progressive Muscle Relaxation, Calm Breathing & Autogenic Training Practice Relax...

10 Imagery Exercises For Children How to use your imagination to relax Eliciting images from the 5 senses Using a theme relevant to the child Imagery Relaxation Themes For Children Lying on a beach Watching the sunset Floating on a cloud Watching the snow falling Walking through the autumn leaves Lying on the couch by a fire Breathing related images Mindfulness For Children

11 What Is Mindfulness? o Paying attention o Becoming aware of present moment realities o Acceptance. Not judging whatever is happening as good or bad Sitting with quiet stillness Accepting what is rather than changing thoughts feelings and actions What Is Mindfulness? o Jon Kabat-Zinn (1990) defines mindfulness as paying attention in a particular way; on purpose, in the present moment and nonjudgmentally. What Is Mindfulness is not Not a relaxation exercise Not a way to avoid difficulty Not a way to by-pass personality problems Not about achieving a different state of mind

12 Mindfulness Background The roots of mindfulness practice are in the contemplative practices common to both eastern and western spiritual disciplines but particularly within the Buddhist tradition. William James 1900 Ram Daas 1971 John Kabat-Zinn established Centre for Mindfulness 1979 Stephen Hayes ACT 1999 MBCT John Teasdale, Zindel Segal et al Mindfulness Processes Attention is focused on the present, not the future or past. Attention is focused most commonly on the breath, a universally available sensation. Focus is on observance and acceptance of feelings, thoughts, sensations without reacting. This re-conditions the stimulus response cycle. The process is reinforced through remaining absolutely still for an extended period of time and not responding to physical irritations and pain. Mindfulness Practice for Therapists a means of self-care in the therapist's personal life. Promotes non-judgmental acceptance of thoughts. more 'present', relaxed, and receptive with clients. learns to disentangle from our own conditioned patterns of thoughts that arise in the therapy relationship

13 Mindfulness in CBT Patients learn to disengage from the ruminative process that facilitates relapse ( I m sad, this must be the depression again. I ll never get better ). Thought is thus construed as a mental event, not a fact ( This is only a thought; let it be ). Mindfulness in CBT In contrast to traditional CBT, the strategy is not to strive to change the content of thoughts but to disengage from habitual dysfunctional cognitive routines This treatment is specifically designed for patients who have recovered and not for people in the acute phase of the depression. Teasdale et al. (2000) Practicing Mindfulness with Children. Pick the right time Make the time Create the habit Create a relaxing environment Use praise and make it fun Keep it simple and short Teach by example Rapee et al. (2000)

14 Practicing Mindfulness with Children. Provide a meaningful explanation for the exercise Best done with eyes closed Start with basic relaxing breathing Moderate your voice Use a script or make up your own with input from the child Give a few moments for the child to end the exercise Practicing Mindfulness with Children Case Examples and Questions References Anxiety BC. How to do progressive muscle relaxation & How to do calm breathing. Retrieved October 29, 2008 from complete_home_tool_kit.php. Markway, B. G. & Markway, G. P. (2003). Painfully shy: How to overcome social phobia and reclaim your life. New York: St. Martin s Press. Ollendick, T. T., & Cerny, J. A. (1981). Clinical behavior therapy with children. New York: Plenum Press.

15 References Rapee, R., Spence, S., Cobham, V., Wignall, A. (2000). Helping Your Anxious Child: A step by step guide for parents. Oakland, CA: New Harbinger. Rapee, R., Wignall, A., Hudson, J., & Schniering, C. A. (2000). Treating Anxious Children and Adolescents: An evidence-based approach. Oakland, CA: New Harbinger. Smith, J. C. (2005). Relaxation, meditation, & mindfulness. New York: Springer Publishing. References Kabat-Zinn, J. (1990). Full catastrophe living. New York: Delacorte Press. Thompson, M., Gauntlett-Gilbert, J. Mindfulness with Children and Adolescents: Effective Clinical Application. Clinical Child Psychology and Psychiatry, Vol. 13, No. 3, (2008). Teasdale J, Segal Z, Williams M, Ridgeway V, Soulsby J, Lau M. Prevention of relapse/recurrence in major depression by mindfulness- based cognitive therapy. J Consult Clin Psychol 2000;68: References M.Stewart Lawlor, N. Fischer, K Schonert- Reichl. (2006). Promoting Children s Academic and Social Success Through Mindfulness Education. Supporting Children s Social and Emotional Health: Assessment Tools, Research and Practice, U.B.C May 11, 2006

16 Additional Resources I Can Relax! A Relaxation CD for Children (2001). Order from Child Anxiety Network websit, Dr. Donna Pincus, Boston University at Appropriate for ages Ready, Set, Release CD & Healing Images for Children CD. Order from (Inner Coaching Books & CDs).