Relaxation Breathing, strongly influences mind, body, and moods. By simply putting your attention on your breathing, without even doing anything to change it, you move in the direction of relaxation. There are many worse places to have your attention on your thoughts, for one, since thoughts are the source of much of our anxiety, guilt, and unhappiness. Get in the habit of shifting your awareness to your breath whenever you find yourself dwelling on upsetting thoughts.

The single most effective relaxation technique I know is conscious regulation of breath. Iwill teach you a yogic breathing exercise I give to most of my patients. It is utterly simple, takes almost no time, requires no equipment, and can be done anywhere.

Although you can do the exercise in any position, to learn it Isuggest you do it seated with your back straight. Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and"keep it there through the entire exercise. You will be exhaling through your mouth around your tongue; try pursing your lips slightly if this seems awkward.

First exhale completely through your mouth, making a whoosh sound.

Next close your mouth and inhale quietly through your nose to a mental count of four.

Next hold your breath for a count of seven.

Then exhale completely through your mouth, making a whoosh sound to a count of eight.

This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

Note that you always inhale quietly through your nose and exhale audibly through your mouth. The tip of your tongue stays in position the whole time. Exhalation takes twice as long as inhalation. The absolute time you spend on each phase is not important; the ratio of 4:7:8 is important. If you have trouble holding your breath, speed the exercise up but keep to the ratio of 4:7:8 for the three phases. With practice you can slow it all down and get used to inhaling and exhaling more and more deeply.

This exercise is a natural tranquilizer for the nervous system. Unlike tranquilizing drugs, which are often effective when you first take them but lose their power over time, this exercise is subtle when you first try it but gains in power with repetition and practice. I would like you to do it at least twice a day. You cannot do it too frequently. Do not do more than four breaths at one time for the first month of practice. Later, if you wish, you can extend it to eight breaths. If you feel a little lightheaded when you first breathe this way, do not be concerned; it will pass.

You may also notice an immediate shift in consciousness after four of these breaths, a feeling of detachment or lightness or dreaminess, for example. That shift is desirable and will increase with repetition. It is a sign that you are affecting your involuntary nervous system and neutralizing stress. Once you develop this technique by practicing it every day, it will be a very useful tool that you will always have with you. Use it whenever anything upsetting happens, before you react. Use it whenever you are aware of internal tension. Use it to help you fall asleep. I cannot recommend this exercise too highly. Everyone can benefit from it.

People often ask me the reason for keeping the tongue in that position. Yoga philosophy describes two "nerve currents" in the human body, one positive, electric, and solar, the other negative, magnetic, and lunar. These begin and end at the tip of the tongue and the ridge behind the upper front teeth. Putting those structures in contact is supposed to complete a circuit, keeping the energyof the breath within instead of letting it dissipate. I don't knowif there is any correlation between these ideas and Western con-cepts of physiology, but since yogis have been doing this exercisefor thousands of years, it seems worth following their instructionsexactly.

Progressive relaxation is a way of releasing tension in muscles. It is often taught in yoga and exercise classes, on self-help tapes, and by various instructors, from massage therapists to psychologists. There are many variations of it. Most begin by having you lie on your back in a comfortable position. Take a series of deep slow breaths and then focus your awareness on different parts of the body in turn, becoming aware of any muscular tension and releasing it. One way to do this is to first tense a muscle deliberately and then relax it. You can start with the front of the body, tensing and relaxing the muscles of the upper face, then moving on to the jaw, neck, chest, front of the arms, abdomen, thighs, lower legs, feet, and toes. Then do the same down the back of the body. Finally, lie still with the eyes closed, concentrating on your breath and enjoying the feeling of peace and freedom from tension. You can easily learn to do this on your own, but it is pleasant to follow spoken instructions from someone with a soothing voice. You can incorporate progressive relaxation into your daily routine and find ways to make it more portable. For instance, you can modify it for a sitting position and do it at your place of work.

Exercise can be relaxing, and many people tell me it is their main method of reducing stress. One of the reasons I recommend regular aerobic exercise is for its moderating effects on emotions. This is a long-term benefit, but exercise, both aerobic and nonaerobic, can also work in acute situations. If you feel angry or upset at other people, yourself, or the world in general, a brisk walk or run or a half hour of lifting weights will often put you back in a good mood. In this case exercise is a symptomatic treatment. It burns up excess energy but does not teach you how to process stress differently. For that reason I do not recommend it as the sole method of relaxa-tion. Whenever someone answers my question "What do you doto relax?" by saying "Exercise," I always urge the person to learnsome other technique as well: breathing, visualization, or yoga, for instance.

Yoga, as mentioned earlier, is an excellent promoter of relaxation as well as a good form of nonaerobic body conditioning. It perfectly complements aerobic exercise. Yoga requires commitment to a formal practice and is best done with an instructor, at least at the start.

Massage and body work can be wonderfully relaxing. In order to gain full benefit, you need to be totally passive and surrender to the touch of a skilled therapist. There is a great deal of evidence that the state of the mind and nervous system is direcflected in the state of the musculature, also that body work is one route into the unconscious mind. Some kinds of massage are more relaxing than others. One of the best for this purpose is Trager work, a system that uses rocking and bouncing movements to lull the recipient into a very dreamy altered state (see Appendix A).

Like exercise, massage is more a symptomatic treatment than a lasting change. It is also limited in its application, since few of us are able to go to a massage therapist on a daily basis, and most of us need to practice relaxation skills every day.

Visualization and guided imagery have you concentrate on images held in the mind's eye. We all look at our internal images from time to time, especially when we daydream or have sexual fantasies, but few of us have learned how to develop our imaging capacity and take advantage of its ability to affect our minds and bodies. Visualization and guided imagery work with the connection between the visual brain and the involuntary nervous system. When this portion of the brain (the visual cortex at the back of the head) is not occupied with input from the eyes, it seems to be able to influence physical and emotional states. Moreover, a great many people in different parts of the world believe that images held in the mind's eye shape our experience of reality, and that learning to sharpen these images puts us more in control of our destiny. Whether you find that to be true or not, you can experiment with images to promote relaxation.

You can learn the technique from books, from self-help tapes, or from an instructor, especially psychologists and hypnotherapists who specialize in it (see Appendix A). You may have read of the use of visualization as an adjunctive treatment for cancer and other serious diseases. In some people with some kinds of diseases it can trigger healing, possibly through effects on the nervous, endocrine, and immune systems. For this purpose the images should be the patient's own, and one of the functions of the therapist is to help patients find the images that are right for them.

For relaxation and stress reduction it is all right to start with images you get from books or tapes, as long as they feel right for you. Or simply recall a scene from the past when you were supremely content, secure, and centered. Close your eyes, take a few deep breaths, and picture yourself back there. Try to make the image bright and clear and try to hear, feel, and smell the surroundings too. How long you focus on it is less important than how regularly you do it. If you spend a few minutes every day practicing your visualization, you will reap greater benefits than if you spend an hour at it every so often.

The best times for practice are the transition states between sleeping and waking. Just before falling asleep and just after waking up, try to concentrate on your peaceful image. At these times it passes more easily into your unconscious mind, where it can relax your nervous system and body. Of course, try it during the day, too, especially if external stress gets you down and you become aware of internal tension.

Biofeedback uses technology to help you learn relaxation faster. The idea of biofeedback is clever and simple: if you can develop sensory awareness of an involuntary function, you can learn to change it. In a common biofeedback setup, temperature sensors are connected to your fingers, and skin temperature is converted to an audible signal, perhaps a beep tone: the faster the beeps, the higher the temperature. Your job is to make the beeps go faster by raising your skin temperature. The tone gives your ears and brain feedback from a body function that is ordinarily unconscious and beyond the reach of your will. Skin temperature is a measure of blood flow into the hands, and that is determined by the size of little arteries. The autonomic nervous system regulates this flow by causing arteries to constrict (sympathetic influence) or dilate (parasympathetic influence). In order to raise your skin temperature you have to relax your sympathetic nervous system.

If I were to tell you to relax your sympathetic nerves or let more blood flow into your hands, you would not have a clue where to begin, because your conscious mind has no way of perceiving these functions, but in the biofeedback arrangement just described, you will quickly discover that you can influence the rate of the beeps and make them go faster. You will not know exactly what you are doing. Instead you will learn what it feels like when you relax the right area, and the reinforcement of faster beeps will soon have you doing it better and better. Learning in this way is interesting and fun.

The rewards of mastering the relaxation response are much greater than warm fingers (although that might be reward enough for people with cold hands and disorders like Raynaud's disease, in which excess sympathetic tone causes severe spasm in the arteries when hands are exposed to cold). Changing the balance of the autonomic nervous system away from dominance by its sympathetic division has a large spillover effect throughout the body, leading often to lowered heart rate and blood pressure and better digestive function, for example.

You can use other modes of biofeedback to work on muscle tension (as in cases of tension headache or of bruxism involuntary grinding of the teeth at night) or on brain waves. The applications of this method are many, limited mostly by the imagination of therapists and the willingness of trainees to practice. Once you get the feel of the state you want to create, your work has just begun. Now you have to go home and recreate it on your own without the machine. Unless you do this on a regular basis, you will have wasted your time and money, because the point is to incorporate what you learn into daily life. Ideally you should spend fifteen to twenty minutes a day at this practice, preferably after a few minutes of progressive relaxation, visualization, or meditation to set the stage.

Biofeedback works best for people whose tension is expressed in bodily complaints and who like machines with dials, lights, and beeps. I recommend it often to people with migraine, hypertension, cardiac arrhythmias, ulcers, chronic intestinal problems, Raynaud's disease, and bruxism. I also recommend it to people who feel they need outside help in learning to reduce anxiety and internal stress, who doubt they can do it on their own. Of course, when you do biofeedback youare doing it on your own, and much of the fun comes from realizing that fact. Brain-wave biofeedback, now becoming available to the public at specialized centers, can be a powerful technique to change your state of consciousness, advance a meditation practice, and overcome psychosomatic problems.

A typical biofeedback training program consists of ten hourlong sessions, often spaced a week apart. You can find biofeedback therapists in the yellow pages of the telephone directory or on the staffs of hospitals and spas. Shop around and do not get involved with anyone who does not seem interested in you. Some therapists do the training mechanically with little attention to individual needs. Medical insurance may pay for biofeedback, especially if a medical doctor prescribes it. I do not recommend using home biofeedback devices on your own without first training with a therapist.

Meditation is directed concentration. Meditators learn to focus their awareness and direct it onto an object: the breath, a phrase or word repeated silently, a memorized inspirational passage, an image in the mind's eye. Researchers have documented immediate benefits in terms of lowered blood pressure, decreased heart and respiratory rate, increased blood flow, and other measurable signs of the relaxation response.

Teachers of meditation usually recommend it for greater goals than mere relaxation. They promise that it can calm an agitated mind, creating optimal physical and mental health; that it can undo our sense of separateness, which is the common root of fear and misery; and that it can unify consciousness, putting us in touch with our higher self and connecting us to higher consciousness. They say meditation restructures the mind, allowing us to achieve our full potential as human beings. They admit that this is hard, long work. Buddhists say the untrained mind is like a drunken monkey stung by a bee a wild, unruly force, the source of all our unhappiness.

I believe in these potentials of meditation and practice it myself, but I do not recommend it to everyone looking for a way to relax. In the first place many people are not ready to meditate. They must first work to improve their diets, develop good exercise habits, and learn how to breathe properly. Some people need simpler techniques for relaxation that give immediate results with less effort, like the breathing exercise I described earlier. Others harbor negative associations to meditation as an aspect of religion, especially of Eastern religion, with images of yogis on beds of nails and greedy gurus come to the West to fleece devotees.

In fact, there are as many varieties of meditation as there are of exercise. Some are religious practices, some are not. Some are complicated, some are not. If you want to give meditation a try, shop around for a form of it that seems comfortable, that suits you and does not conflict with your belief system. All forms of meditation require regular, daily practice over a long period of time before they deliver the big rewards.

You can learn to meditate in a number of ways. I know a few good books and instructional tapes on meditation, which are listed at the end of this chapter. You can sign up for meditation classes at some schools and yoga centers or go on group meditation retreats. However you learn a method, you then have to practice it.

You can meditate in any position, but most systems recommend a seated posture with the spine straight. It is perfectly all right to sit in a chair if you cannot find a workable position on the floor. All sorts of meditation aids are available, too, from firm cushions to benches, stools, and pads. Try to meditate every day without fail, twenty to thirty minutes being a reasonable length of time. The best time for me is first thing in the morning. If I miss that opportunity and get caught up in the day's activities, I am unlikely to do it. Usually I am too sleepy at the end of the day to sit, but if I force myself to do even a little meditation before going to bed, that feels good too.

Many newcomers to meditation think the goal is to stop all thoughts. That is not possible. What you want to learn is to withdraw attention from the endless chains of associated thoughts that stream through the mind, putting attention instead on the object of meditation. Whenever you become aware that your attention has strayed to images, sensations, thoughts of dinner, or whatever gently bring it back to your chosen object. The tedious work of meditation is just this constant running after your attention and bringing it back.

If you want to get a feel for this challenging work, I suggest you try your hand at breath counting, a deceptively simple technique much used in Zen practice. Sit in a comfortable position with the spine straight and head inclined slightly forward. Gently close your eyes and take a few deep breaths. Then let the breath come naturally without trying to influence it. Ideally it will be quiet and slow, but depth and rhythm may vary. To begin the exercise, count "one" to yourself as you exhale. The next time you exhale, count "two," and so on up to "five." Then begin a new cycle, counting "one" on the next exhalation. Never count higher than "five," and count only when you exhale. You will know your attention has wandered when you find yourself up to "eight," "twelve," even "nineteen." Try to do ten minutes of this form of meditation.

It may not be a good idea for people who are mentally ill to meditate without supervision. Otherwise, meditation is for anyone willing to commit to a discipline that makes training the body look like child's play. By the way, Buddhist teachers would say that we are all mentally ill, and that meditation is the one and only cure for our dis-ease.

Mantram is the practice of repeating over and over in the mind certain syllables, words, or phrases that help unify consciousness and counteract negative mental states.Mantramis a Sanskrit word, and the technique is especially prominent in Hinduism, yoga, and Buddhism, although it occurs in many Western traditions as well. Repetition of a verbal formula is a way of focusing the thinking mind and counteracting the damage done to both mind and body by thoughts that produce anxiety, agitation, and unhappiness. You can get some of this benefit by repeating anything: "Peace, peace, peace, peace..." or "The sky is blue, the sky is blue..." or "Day by day in every way I am getting better and better." If you choose a holy name or spiritual formula from a religious tradition, you may get added benefit from the special power of those words and the field of consciousness created by millions of persons repeating them.

In India a guru will often give a disciple an individual mantram to be used by that person alone and not revealed to anyone else, but some very well-known mantrams are believed to have great transformative power on consciousness. Here are a few:

Rama, Rama, Rama, Rama (a Hindu name of God) Om mani padme hum (the Buddhist formula, referring to the "jewel in the lotus of the heart," a symbol of enlightenment)

Lord Jesus Christ, son of God, have mercy on us...(the Jesus prayer from the Eastern Orthodox tradition)

Hail Mary, full of grace...(the Roman Catholic prayer) Allah, Allah, Allah, Allah (the Muslim name of God)

Shema Yisroel, adonai elohenu, adonai ehod...(Jewish: Hear, O Israel, the Lord our God, the Lord is One!)

Repetition of a mantram provides a comforting focus for the mind. It is a totally portable technique, requires no training or equipment, and can be used in any circumstance, though you should be cautious about doing it while driving, operating machinery, or engaging in other hazardous activities that require undivided attention. Mantram is especially helpful for people with restless minds, whose turbulent thoughts keep them from relaxing, concentrating, and falling asleep. I recommend experimenting with it.

Hypnotherapy, the contemporary name for hypnosis, has fallen in and out of favor over the past few hundred years. Currently it is accepted as a useful method of relaxation, pain control, and management of habits like smoking and overeating. In fact, the use of trance and suggestion to affect the unconscious mind and through it the regulatory systems of the body has many more potential applications in the treatment of disease, but few hypnotherapists are willing to tackle interesting physical ailments. Most limit themselves to control of pain, stress, and habits.

Hypnotherapists do not put you into a trance. They just arrange circumstances to increase the likelihood of your shifting into a trance state, which is part of the normal repertory of human consciousness. About 20 percent of the population has a high capacity for trance; these people may go very deep under hypnosis and not remember the experience afterward. Another 20 percent has a very slight capacity for trance and may not respond to hypnotherapy at all. The rest of us fall somewhere in between these extremes.

I emphasize that the hypnotic state is one of your own potentials, because many people fear losing control to a hypnotist and being made to do things they would never do in a normal state. In a similar expression of this fear, yoga philosophy says that hypnosis is dangerous because it weakens the will. I often send patients to hypnotherapists, but I always sound them out first to make sure they do not have fears of loss of control that will get in the way of successful therapy. Also Iurge people not to enter into this work unless they feel totally comfortable with the therapist. Finally I tell them, as with biofeedback, that it is up to them to implement the program by committing to regular practice on their own. That may mean taking fifteen or twenty minutes a day to reproduce the feeling and concentrate on the images you learn in sessions with the therapist. At its best hypnotherapy gives you a sense of what it feels like to be relaxed and open, along with the tools to re-create that state on your own.

Hypnotherapy is a good choice for people who think they have no idea what it feels like to relax and for those with stress-related health problems. A few sessions of hypnotherapy can also teach you how to use visualization for self-improvement and can help you begin a meditation practice.