Brain Relaxation Techniques
One further modification to PMR is known as conditioned relaxation. The goal of this technique is to enable you to achieve relaxation in response to a self-produced cue (e.g., saying the word relax). To use this technique we recommend that you use PMR or relaxation via recall to become deeply relaxed. Once relaxed, focus all your attention on your breathing and then subvocalize a cue word (i.e., say a "relaxing" word of your choice) on each breath out.
Some examples of cue words that you might think to yourself include calm, control, and relax. Continue this process, repeating the cue word in synchrony with each breath out for 15 to 20 pairings (e.g., "calm 1," "calm 2,"… "calm 20"). We suggest that you practice this procedure at the end of your daily formal PMR practice. With regular practice, an association is built up between the subvocalized word and the relaxed state, whereby the word alone becomes capable of creating a state of relaxation. The subvocalized word has therefore become a "cue" for relaxation. Once you have learned the association between the deeply relaxed state and a self-produced cue word, and have learned to use such cues to produce relaxation, you can apply this technique to reduce tension in everyday situations. You may find that you can use an image of a favorite place or a piece of music in a similar fashion.
Slow Breathing Exercise
Slow (diaphragmatic) breathing is another portable and effective means of achieving a calm and relaxed state. This exercise involve regular practice. To begin, place your hands on your abdomen (stomach). Take a deep breath in and notice that as you breathe in your abdomen moves out toward your hands. As you breathe in think to yourself the words "in, 2, 3." Then breathe out while thinking to yourself "relax, 2, 3" and notice that your abdomen lowers. Repeat this process 10 times.
In previous few posts, we described several methods of relaxation. We suggest that you schedule regular daily practice of the formal four muscle group PMR procedure, which consists of the tension-release phase. As you begin to make progress in developing skill in relaxation we recommend that you gradually move from relaxing in quiet, comfortable places to increasingly more difficult locations.
For example, from a reclining position, you might move relaxation practice to an upright chair in the living room, or while typing in a study, eating in a cafeteria, standing in your bedroom, waiting in a ticket line or for a train, and walking outside. You should also begin to employ the relaxation via recall, counting or conditioned methods as mini-practice throughout the day. Given that these abbreviated procedures do not involve the tension cycle, they are more portable relaxation techniques that can be easily applied in everyday situations. Try to engage in mini-relaxation practice in a variety of situations, such as when you are waiting for a bus, stopped at a traffic light, standing in a line, and so on.
Another way of ensuring that you are applying relaxation in everyday situations is to become more aware of your particular "Tension areas" – those muscle groups in which you are prone to experience tension. Common areas include the neck and shoulders, the stomach, the jaw, and the forehead. During the day do a "spot check" of your tension areas and deliberately relax them as soon as you notice any increase in tension.
We recommend that you begin to use the relaxation training techniques to deal with the tinnitus when it is especially bothersome or when you are experiencing difficulty with sleeping. Try to identify situations in which you would like to become more relaxed. Maximum benefit is likely to be obtained when you use relaxation techniques to deal both with the stress associated with tinnitus and with other more general everyday stress, such as family or work problems.
Attention Control Techniques
"One really big problem that I have with tinnitus is that it just seems to consume me! It is everywhere I go. When I have a bad day I just can't seem to focus on anything else. I can't get my mind off the noise. It becomes my whole world! Nothing makes a difference. I find I worry about it more and it gets louder and louder. The louder it gets, the more impossible it becomes trying to ignore it. My family tells me to just forget about it. What do they know, none of them has tinnitus. They tell me to just read the paper or something. They think it is so simple. But once the tinnitus has caught my attention, I cannot concentrate on anything else – no way!"
Previously we described methods by which you can learn to change the way you think about your tinnitus. By learning to think about the tinnitus in a more constructive and helpful way, you can alter your emotional response. This approach may be helpful in reducing feelings of depression, anxiety, anger, and other troublesome emotions. The ability to identify problematic thoughts, to challenge your thinking, and to develop more constructive and helpful thoughts are very important skills in adapting to tinnitus or any other difficulty. Sometimes the tinnitus may be very intrusive, occupying your attention far more than you would like. Perhaps these times are those when you perceive the tinnitus to be particularly loud or when you are trying to fall asleep. In such situations you may wish that you could control the focus of your attention.
In next few posts we will instruct you in some methods that can help you achieve this goal. These methods include attention control, imagery training, and distraction techniques. These self-control strategies can be combined with the relaxation techniques that we described in the previously. The main aim of these techniques is to assist you in learning how to switch the focus of your attention from one thing to another, and to teach you that this process can be brought under voluntary control.
One common complaint about tinnitus is the extent to which it seizes a person's attention, making it difficult to focus on anything else. This can lead to heightened distress and a feeling of helplessness. The techniques described are designed to help you develop skills in refocusing your attention from your tinnitus to other internal or external sensations. These techniques can give you a greater sense of self-control over the tinnitus at times when it might be particularly troublesome as well as provide a further means of reducing tinnitus-related distress. We'll talk about it during our next post. Before that, you can check out Brain Relaxation Techniques for more details.