A Practical Evidence-Based Self-Help Program for COVID-19-Related Worry and Anxiety
Session Five: On Calm
Prepared by Nicole Carter, MSW, RSW
Please do not copy or distribute this material without permission.
Consciously Calming the Body can Calm our Mind and Physiology
When we feel low, we often ruminate about the past, and when we feel anxious, we often generate worst-case scenarios about the future. This can leave little space to purposefully bring about a calmness in our body, or experience the pleasant things all around us in any given present moment.
Being mindful means to be aware of everything around us in any present moment with a sense of acceptance, without judging, striving, or resisting (wishing for things to be different). During COVID-19, it can be especially difficult to stay anchored in the present moment, as it is constantly evolving, and often filled with fear, uncertainty, and instability. However, practicing mindfulness techniques can help reduce our suffering in the face of these difficulties. Intentionally calming the body using breathing and other mind-body techniques can actually quiet the activation of our autonomic nervous system.
Suffering = Pain x Resistance
Painful and uncomfortable events are an inevitable part of life. Some argue that our own responses to these painful events are what causes our suffering, rather than the painful event itself. In other words, the more we wish for things to be different than as they are, the more we personally suffer. This idea comes from the equation, suffering = pain x resistance, which argues that suffering increases if we believe that the pain should not exist. Practicing the acceptance of painful events, like the current pandemic, can therefore help us suffer less. Since COVID-19 is not going anywhere fast, responding to it with resistance or a wishfulness for things to be different might actually increase the level of our suffering.
Common Relaxation Tools to Help Reduce Arousal and Calm the Mind
Diaphragmatic Breathing
When you look at a baby breathe, their stomachs typically rise and fall with each breath. As we get older, our breath tends to move up in the body into the chest, creating shallower breathing patterns. When we’re anxious, this is especially true - we tend to take shorter, quicker, shallower breaths, and shorter exhales. An extreme example of this can be hyperventilation. When you breathe diaphragmatically, filling the lower belly with air slowly upon your inhale, it stimulates the “vagus nerve,” a nerve that some argue helps stimulate our parasympathetic nervous system (the relaxation system at play all over our body).
Self-help Exercises
Choose one mind-body skill from this session to practice once per day for five minutes. Journal how you feel before, during, and after engaging in the technique, noting any reflections about your experience.
Gratitude can help cultivate a sense of mindfulness. Consider starting a gratitude journal where you write down three things you feel grateful for every day. Or, download the app Gratitude: Personal Growth and Affirmations Journal.
Consider dosing your media intake to once per day for 10-15 minutes to help reduce anxiety, stay grounded in the present, and maintain a sense of mindfulness.
How to breathe diaphragmatically:
To find your diaphragm, make a ‘hissing’ sound with your hand resting on your belly - you should be able to feel it contracting. To practice breathing diaphragmatically, breathe in deeply for four counts, expanding your diaphragm and lower belly as you inhale. Slowly exhale, releasing all of the air in your stomach, for four counts. For deeper relaxation, elongate your exhale beyond the length of your inhale. This sends your brain the message that there is no threat present and therefore no need for more oxygen to prepare for fight/flight.
Box Breathing
Box breathing is similar to diaphragmatic breathing, but it encourages two extra steps. It has been said that actors, singers, U.S. Navy Seals, and athletes utilize this technique as a quick, grounding method to reduce arousal.
How to box breathe:
To box breathe, breathe in for four counts, hold your breath for four counts, breathe out for four counts, and hold the state of depleted air for four counts.
Using Imagery: Taking a Vacation in Your Mind
If you were asked to bring to mind the experience of eating sour or tangy food, such as sucking on a juicy lemon or eating salt & vinegar chips, you would probably begin to notice sensations in your mouth developing. This illustrates the powerful effect of what we imagine and think about on our body and bodily sensations.
Guided imagery is a means to calm yourself, change your mood, or take a vacation in your mind. The most important part of imagery work is to use all of your senses when imagining so that you trick your brain into thinking you are really in the place you are imagining. Through brain scanning, researchers have found that this exercise can actually activate the visual cortex, tricking your body into believing that you are actually there and eliciting congruent feelings and sensations. Patient health outcomes are also higher when using guided imagery.
Taking yourself somewhere safe and pleasant in your mind can be especially suited for managing the stress around the global pandemic, since we can’t travel or visit many places that usually bring us joy, relaxation, and happiness.
How to Use Imagery:
The following script was borrowed from the developers of Koru Mindfulness, an evidence-based mindfulness meditation program for emerging adults, and changed slightly to fit this program.
Allow yourself to sit back and relax… see that your arms and legs are in a position that feels right for you. And… slowly and gently close your eyes. [Pause]. Allow your attention to move to your breathing. Let your breathing become even and comfortable. Breathing is one of the most powerful conscious influences you have on your nervous system. [Pause]. Now I invite you to see yourself in a very special place… it could be a real place – a place you may actually have been – a beautiful spot in nature or a comforting place in your own home. Your special place may be imaginary – a place in fairy tales – indoor or outdoor – it doesn’t matter where it is. Should more than one place come to mind, allow yourself to stay with one of them. [Pause]. The only thing that matters is that it is a place in which you are completely comfortable and safe… appreciate this scene with all of your senses…. hear the sounds….. smell the aromas… feel the air as it caresses your skin… experience the ground securely under you – touch and feel the whole environment that you are in. [Pause]. Notice what you are wearing. Notice what you have on your feet. What time of year is it? What time of day? How old are you? Are you alone or with another person or people? Notice the colours that surround you. What is the temperature? Is it warm? Is it cold? Notice the qualities of the place that make it safe and comfortable. [Pause]. Look around you to see if there is anything else that would make this place more safe for you… perhaps something that you need to remove from the place or something you need to bring in…. and then notice how your body feels in this place…. Take some time to enjoy this feeling of safety in your special place….[Pause]. Thank yourself for taking this time for yourself and perhaps promising yourself that you can visit this place or another place on your own whenever you need to. [Pause]. And when you are ready, at your own pace, let your breathing deepen… very gradually let the awareness of your body against the chair or mat return…. Bring yourself back slowly and comfortably… when you are ready, gently open your eyes.
Progressive Muscle Relaxation (PMR)
Some anxiety can create a feeling of being keyed up, on edge, or tense, and can even be associated with muscle tension and pain – specifically in our shoulders, neck, and head. PMR is a technique that moves through each of our body’s muscle groups, vacillating between tensing and relaxing as you move down (or up) your body. This technique rests on the assumption that we cannot feel tension and relaxation at the same time. If we learn how to relax the body, our tension will be eased.
How to Use PMR:
It is important to try to only tense and relax the muscle group you are focusing on, one at a time. Move through each of the following muscle groups, one at a time, tensing and relaxing only that muscle group for ten counts each (tense for 10 counts, relax for ten counts).
Foot (curl your toes downward)
Lower leg and foot (tighten your calf muscle by pulling toes towards you)
Entire leg (squeeze thigh muscles while doing above)
(Repeat on other side of body)Hand (clench your fist)
Entire right arm (tighten your biceps by drawing your forearm up towards your shoulder and “make a muscle”, while clenching fist)
(Repeat on other side of body)Buttocks (tighten by pulling your buttocks together)
Stomach (suck your stomach in)
Chest (tighten by taking a deep breath)
Neck and shoulders (raise your shoulders up to touch your ears)
Mouth (open your mouth wide enough to stretch the hinges of your jaw)
Eyes (clench your eyelids tightly shut)
Forehead (raise your eyebrows as far as you can)
Dosing your Media Intake
Coverage about COVID-19 is everywhere, and watching excessive amounts of media can change the way we think, feel, and behave. Sometimes this is helpful (for example, listening to expert advice) and sometimes it can unnecessarily increase our anxiety. What we watch influences how we feel in our body and the thoughts, assumptions and predictions we generate. It can be helpful to dose our intake so that we can maintain a balanced outlook, manage emotions skillfully, and think and behave realistically.
