Self-Nurture: Learning to Care for Yourself As Effectively As You Care for Everyone Elseby Alice D. Domar, Juliette Parker (Read by)
Think about how you feel at the end of a day when every waking minute has been filled with obligations to your mate, friends, colleagues or kids-when you found your first free moment so late in the evening that you were too exhausted even to seize it for yourself? If you've had too many days like this-and what woman hasn't?-you'll find in Self-Nurture the help you need to transform your life. Psychologist Alice D. Domar, Ph.D., acknowledged for her cutting-edge work in stress management for women, believes that learning to nurture ourselves is essential for women today whose lives often feel overwhelming. Most women, says Dr. Domar, have to juggle the roles of caregiver, breadwinner, and nurturer-and have been taught to put everyone else's needs ahead of our own. The result is a near-epidemic of physical, emotional, and spiritual fatigue.
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Recently, a good friend, a bright, resourceful woman, told me why she was at the end of her tether. She was having a rough pregnancy; her mother was repeatedly returning to the hospital for treatment of a mysterious infection associated with her sudden recurrence of cancer; she was afflicted with writer's block trying to complete her master's thesis; she and her husband were about to relocate from New York to Los Angeles so he could get work as an actor; they had two hundred dollars left in their bank account; and their tiny sports car, used mainly to shuttle her mother to and from the hospital, was impounded due to late payments. The only solace they could findno small comfort in the midst of this madnesswas that neither she nor her husband had a terminal disease. As she ran down the list of troubles, oddly enough we found ourselves doubled over. When so many stressful events converge so preposterously, laughter is often the only means of maintaining your sanity.
While laughing with a friend over major stressors is real medicine, we need more than laughter when the real world keeps intruding with the message that we must somehow cope. We need specific skills for relaxation, coping, and spiritual sustenance.
Why does stress get the better of us? Why do we seem to lack creativity and vitality? In my decade of experience working with womenwhether they have suffered from burnout, low self-esteem, marital conflict, loneliness, financial pressure,or chronic medical problemsthe fundamental problem is not that we lack coping skills or relaxation techniques. Most of us do lack knowledge of these methods, but, more fundamentally, we're missing a commitment to ourselves that is rooted in compassion.
We lack the energy and initiative to solve problems when we're so busy working and taking care of others that we neglect ourselves. We lose commitment to a relaxation practice when we don't feel entitled even to twenty minutes each day for our own well-being. We set aside creative pursuits because we internalize negative messages about our talents, or view artistic endeavors as one more drain on our crowded schedules. And we lose heart when our spiritual growth takes a backseat to duty and obligation. In other words, our inability to self-nurture becomes a roadblock to all our efforts to manage stress, enhance health and energy, develop creativity, and cultivate soul.
Each upcoming chapter offers methods for self-nurture organized by different themes, and each thematic focus is broken down into four steps, one each for nurturing, the body, mind, emotions, and self/spirit. Here's what you will find in the four steps within each chapter:
· Step 1: Nurture the Body. Includes relaxation approaches, such as meditations and guided imagery. For instance, women with tumultuous relationships with husbands or partners may benefit from quiet meditation with a prayerful focus word; this practice fosters a sense of stillness. Women with severe anxiety about their body image can practice "progressive muscle relaxation" to reacquaint themselves with their bodies and loosen chronic muscular tensions.
· Step 2: Nurture the Mind. Centers on the use of "cognitive restructuring," a technique to help challenge negative thought patternsthe inner voices that help fuel anxiety, despair, and self-loathing. Replacing these thoughts with kinder and more realistic assessments is a form of mind-nurture. Negative thoughts, such as "I'm fat and I'll never feel good about my body," "I'll never amount to anything," "My husband is no longer attracted to me," and "I'm a horrible mother," can hound us into full-blown depression. We can restructure these thoughts based on a relentless truth-seeking analysis. After using the stepwise process I teach, one woman turned the negative thought "I'm a horrible mother" into the more affirmative "I'm actually a very good mother who has tried to attain perfection and fallen short in my all-too-critical eyes."
· Step 3: Nurture the Emotions. Includes practices of emotional awareness, expression, and communication. I use a specific approach to journal writingexploring the depths of an issue or life event, past or presentas one way to practice awareness and expression. Communicating emotions also requires practice, and in many chapters I include methods for taking care of your emotional self in the context of your relationships, work, and creative activities.
· Step 4: Nurture the Self/Spirit. Involves making commitments to various parts of yourself (i.e., "I will take my creative self to a movie or museum every week," "I will honor my sexual self by letting my needs be known") or other ways to realize and enact kindnesses toward the self. You will also find imagery exercises and affirmationspositive statements or self-styled prayers said inwardlythat cultivate control, self-confidence, and inner peace.
Within each of the four steps, I offer a range of customized mind-body practices. To ground you in these techniques, and so I don't repeat basic instructions in each chapter, I will orient you to the basic mind-body practices here in this chapter. This will enable you to move easily through each chapter, to make these practices your own, to tailor them to each theme and to your individual needs.
Pathways to Relaxation
If self-nurturance is the soul of mind-body practice, relaxation is the heart. Relaxation techniques, ranging from meditation to progressive muscle relaxation to yoga, are all designed to elicit our inborn "relaxation response." While studying transcendental meditation (TM) in the 1970s, my colleague and mentor, Herbert Benson, M.D., discovered the physiologic changes associated with deep meditation: reduced heart rate, blood pressure, and oxygen consumption; slackened muscular tensions; raised skin temperature; and altered brain-wave patterns. He observed this set of changes not only when people practiced TM, but when they practiced virtually any established method of relaxation. Dr. Benson recognized that we all have the capacity to elicit these physiologic shifts, which occur in tandem with a calm mental state.
Benson named this becalmed mind-body state the "relaxation response." He viewed it as biology's answer to the fight-or-flight responsethe set of changes that occur when we experience threat, danger, or acute stress. We've all experienced "fight or flight"that adrenaline-driven state of anxiety or aggression characterized by a pounding heart, sweaty hands and brow, and the muscular readiness either to do battle or flee the scene. Indeed, fight or flight is part of our historical and genetic endowment, preserved through evolution as our psychobiological response to any threat to life and limb. Our prehistoric ancestors, the hunter-gatherers, were threatened by saber-toothed tigers, and through the course of history the threats have changed from wildlife to warrior nations to workaday pressures.
In today's world we respond to a mammogram or a boss's tirade much the way our predecessors reacted to tigers. Then and now, we "come down" from an acute state of high anxiety or aggression through a set of mind-body shifts. During fight or flight, our sympathetic nervous systems pump out stress hormones and our bodies are readied for action. Once the threat is gone, our sympathetic nervous systems decelerate: anxiety and aggression are eased, heart rate slows, blood pressure drops, and the brain waves move into a "calm" frequency rangethe relaxation response.
In the modern world, the problem for most of usmen and womenis chronic stress, in which accumulating pressures, role demands, strained relationships, and financial difficulties leave us in a perpetual state of fight or flight. It's as if we were constantly being pursued by dangerous animals. Chronic stress can trigger continually high levels of stress hormones (for example, adrenaline and cortisol) that produce elevated blood pressure or heart rate, increased oxygen consumption, weakened immune systems, and other physiologic imbalances that eventually lead to symptoms or even full-blown diseases.
Most of us have had one or another stress-related disorderthe migraines, tension headaches, low back pain, hypertension, or autoimmune conditions we can directly link to traumas or periods of overwhelming stress. Dr. Benson has shown that by deliberately and regularly eliciting the relaxation response, we can use this natural mechanism to counter the effects of chronic stress on mind and body.
In the short term, eliciting the relaxation response produces nearly instant resultsplummeting anxiety levels and the relief of physical tensions accompanied by a calmer physiology. When women practice relaxation on a daily basis, the long-term benefits are even more pronounced. They remain on an even keel for extended periods of time and are better able to cope with stress and fear, whether at work, behind the wheel of a car, or in a doctor's waiting room. In a matter of weeks, they also notice the alleviation of physical symptoms such as chronic headaches, back pain, and fatigue commonly caused by stress. In our research, we have demonstrated that regular relaxation results in a 57 percent reduction in the severe symptoms of PMS. We've also shown that menopausal women experience a significant decrease in depression and anxiety, not to mention a 28 percent reduction in the intensity of hot flashes.
There are numerous ways to elicit the relaxation response. The following section offers a short course on eight methods of relaxation. You will find these methods variously mentioned throughout the book, in some cases tailored for a particular need or issue regarding self-nurture. Refer back to this section whenever you need to remind yourself of these relaxation techniques; eventually, you won't need to.
First, a few simple guidelines when you practice any method for eliciting the relaxation response:
· Find a quiet place. Sitting in a comfortable chair is preferable, since you are less likely to fall asleep than when lying down. (If sitting is uncomfortable, lying down is fine; just monitor your tendency to drift into slumber.)
· Choose a regular time of day. For many women, the early morning is best, but there are no rules in this regard. It is best, however, to stick with one time; a sense of ritual keeps your commitment strong. Protect your relaxation timelet family or others know that you don't want to be interrupted for any nonemergency circumstances.
· There is no set time for relaxation, but most people take between 15 and 25 minutes; some sit for as long as 45 minutes to an hour. The average time, 20 to 25 minutes, is a good goal; it may also depend on the audiotape you may use as a guide. (See the appendix for a list of audiotapes.) Once-a-day practice is usually sufficient, though women who are particularly stressed surely may benefit from doing it twice a day.
I suggest that you sample all, or at least many, of the relaxation techniques that follow. Breath focus, the first method discussed, is a good place to start, and it is commonly used as an induction to other approaches. As you try out the different methods, you'll soon come to decide how you wish to spend the 15 to 25 minutes you set aside for relaxation. You may find you want to start with the breath focus for 5 minutes, then expend the rest of your time on, for example, the body scan or progressive muscle relaxation. Settle on a method that works best for you, but be flexible enough to mix, match, and change approaches when a particular technique no longer meets your needs.
The goal of breath-focus relaxation is to shift from tense, shallow chest breathing to deep, relaxed abdominal breathing. During times of high stress or anxiety, our natural tendency is to hold our breaths. When the tension is chronic, we become shallow breathers, barely filling our lungs. As women, many of us were taught from an early age to hold in our stomachs, since our culture's concept of beauty revolves around the proverbial flat tummy. If we continuously tighten our stomach muscles, we lose the capacity to let the diaphragm move downward when we breathe. It's the descending diaphragm, that sheath of muscle separating the chest cavity from the abdominal cavity, that makes ample room for our lungs to fill during inhalation. But we must let our abdomens expand so the diaphragm can drop down, allowing oxygen to fill the bottom of our lungs. Otherwise, our bodies remain in a state of alarm, robbed of optimal oxygen. In turn, our anxiety levels surge, our breathing becomes even more shallow, and we get trapped in a vicious cycle of mental and physiologic tension.
Breath focus breaks the vicious cycle. The practice is simple:
· Take a normal breath. Don't change any aspect of how you breathe; simply take note of your breathing.
· Now take a deep, slow breath. Let the air come through your nose and move deeply into your lower belly. Take note of how your belly expands when you take such a deep breath; make no effort to limit this expansion. Then breathe out through your mouth.
· Take one normal breath, then one slow, deep abdominal breath. Alternate normal and deep breaths several times. As you do so, let yourself become aware of how you feel on each inhalation and each exhalation. Compare and contrast the sensations associated with your normal breathing and your conscious deep breathing. Do you notice that your normal breathing is constricted? Does the deep breathing help you to relax?
· Now take time to practice deep breathing. Let the inhalations expand your belly. Now, on long, slow exhalations, allow yourself to sigh. Repeat this process for several minutes.
· For another 10 minutes or so, add another element to your practice. When you inhale, imagine that the air traveling in through your nose or mouth carries with it a sense of peace and calm. On the exhalation, imagine that the air traveling out of your nose or mouth carries out tension and anxiety. You may even wish to say these words silently to yourself on the inhalation: "Breathing in peace and calm." And, on the exhalation: "Breathing out tension and anxiety."
· Continue to focus on your deep breathing, letting in peace and calm, letting go of tension and anxiety. You may complete this entire process in about 20 minutes.
We all carry tension in different parts of our bodies, though often we are hardly aware of the muscle spasms present in the scalp, jaw, throat, chest, stomach, or pelvis. We hold stress, anxiety, or anger in varying muscular patterns, but the body scan relaxation practice can help anyone, regardless of where you carry tension or emotional distress. During the body scan, we close our eyes and "scan" our bodies with the mind's eye, becoming aware of muscular tensions. We then use breath awareness to focus on these tensions and to gradually let them go.
The body scan provides an opportunity to explore sensations in parts of your body you don't normally pay much attention to. You'll discover tensions and feelings you didn't know existed, and with practice you'll find yourself able to release the strain and pressure on different muscle groups with a simple awareness of your breath moving into and out of these areas.
The body scan practice involves several simple steps:
· Pay attention to your breathing. Allow your stomach to rise as you inhale, and to slowly fall back down as you exhale. Take some time to breath deeply before you begin the body scan.
· First concentrate on your forehead. As you breathe in, notice the muscles of your forehead. Become aware of any muscle tension in your forehead. As you breathe out, let go of any muscle tension you find there. Continue this practiceawareness of forehead tension on the in-breath, letting go of forehead tension on the outbreathfor several slow, deep breaths.
· For the remainder of the body scan exercise, repeat this process: Concentrate on any muscle tension in a particular body area as you inhale. Now, as you exhale, use your consciousness to loosen and release that tension. (Some people find it useful to imagine the breath traveling into the particular body part, then traveling out as they exhale. As the breath leaves the area, they visualize the muscles slackening, as if the departing breath carries the tension away with it.) Make certain to take slow, deep breaths, perhaps noticing how your stomach rises as you inhale and falls as you exhale. Now move down gradually and repeat the process in these bodily areas:
· Scan your eyes and the muscles around them.
· Scan your mouth and jaw. You may notice that your jaw drops a bit as you exhale, letting go of tension in that area.
· Scan your throat and neck.
· Scan your back, all the way from the top of your spine down to your tailbone.
· Scan your shoulders.
· Scan your upper arms, from where they meet your shoulders down to the elbows.
· Scan your lower arms, from the elbows down and including your hands and fingers.
· Scan your chest.
· Scan your stomach.
· Scan your pelvis and buttocks.
· Scan your upper legs.
· Scan your lower legs, ankles, and feet.
· As your body scan relaxation comes to a close, do a mental check on your entire body, from your head down to your toes. If you notice remaining areas of muscular tension, let yourself become aware of them as you breathe in. Let go of these muscle tensions as you breathe out.
Some people have difficulty with body scanning, finding it too abstract to try and "feel" body parts they are unaccustomed to feeling (eyes, for example). If this applies to you, progressive muscle relaxation may be more effective.
Progressive Muscle Relaxation
Progressive muscle relaxation (PMR) adds an important new element to the body scan practice. Instead of simply using mental focus and breathing to relax tense muscle groups, we consciously increase these tensions before letting go. This practice concretizes the effort to relax muscles, intensifying the sensations of both tension and release. For some people, this enhances the sense that they're able to slacken tight muscles and brings a refreshing feeling of relaxation to the entire body. Women with chronic pain might find that PMR increases discomfort by calling so much attention to the part of the body that causes suffering. But people who have trouble sensing or relaxing tense areas may find this highly active, concrete exercise to be most effective. (Some people prefer to practice PMR lying down.) The steps involved in PMR are similar to those of the body scan, with the key variation of actual tightening of muscles:
· Pay attention to your breathing. Allow your stomach to rise as you inhale and to come back down as you exhale. Take several deep breaths before you begin.
· Now concentrate on your forehead. Consciously tighten the muscles of your forehead while counting slowly from 1 to 5. Hold your forehead muscles as fight as you can for the duration of this count. Then let go of your tense forehead muscles while taking a slow, deep breath. Notice your stomach rise as you inhale, then come back down as you exhale. Now do this again: Tighten your forehead muscles for a count of 5; release those muscles as you take a slow, deep breath.
· For the remainder of the PMR exercise, repeat this process: Move down the body, and tighten the muscles in a particular body area for a count of 1 to 5; then release that tension as you take a slow, deep breath. Repeat this processtightening and releasing as you breathetwice for each bodily area. Now move gradually down the body and practice PMR in these bodily areas:
· Tighten and release the muscles around your eyes by squeezing your eyes tightly shut, then gently opening them.
· Tighten and release your jaw.
· Tighten and release your neck muscles by lowering your chin to your chest, then gently bringing it back up.
· Tighten your right shoulder, raising it as high as you can. Let go of the tension.
· Tighten your right upper arm, from the shoulder to the elbow, by flexing your arm as tightly as you can. Let go of the tension.
· Tighten and release your right forearm.
· Tighten your right hand into a fist; release.
· Take a moment now to notice if your right arm feels different from your left arm. Is your right arm more relaxed?
· Repeat this process on your left side: tightening and releasing your left shoulder, upper arm, forearm, and hand in the same manner you did on your right side.
· Tighten and release your back, all the way from the top of your spine down to your tailbone, by trying to get your shoulderblades to meet in back.
· Tighten and release your chest.
· Tighten and release your abdomen.
· Tighten and release your pelvis and buttocks.
· Tighten and release your right upper leg.
· Tighten and release your right lower leg.
· Tighten your right foot by flexing it; let go of the tension.
· Take a moment now to notice if your right leg and foot feels different from your left leg and foot. Is your right leg and foot more relaxed?
· Tighten and release your left upper leg.
· Tighten and release your left lower leg.
· Tighten your left foot by flexing it; let go of the tension.
· Once you finish tightening and releasing all the muscle groups, do a mental check on your entire body, from your head down to your toes. If you notice remaining areas of tension, tense those muscles for a count of 1 to 5; then let go of these muscles as you take slow, deep breaths.
The practice of meditation, at least twenty-five hundred years old, comes to us from both Eastern and Western spiritual traditions, from Hinduism to Buddhism to Judaism. Each tradition has its own singular philosophy and technique, though certain threads are common in virtually all meditative practices. Typically, meditation involves a turning inward of our attention, a repetitive focus on breathing and a simple word, phrase, or prayer. Many spiritual traditions also encourage the meditator to take a nonjudgmental attitude toward any thoughts or feelings that arise during practice.
It is not necessary to adopt a spiritual attitude or religious philosophy in order to practice meditation in a meaningful way. Of course, many meditators bring their beliefs into practice, and others who have no religious or spiritual affiliation still enjoy using a focus word or phrase that has special meaning or resonance. Indeed, you may choose a word or phrase to use in meditation that is secular (e.g., "Let it Be" or "Peace") or religious (i.e., "Hail Mary" for Christians, "Shalom" for Jews.) For the following simple instruction, I offer the old Sanskrit mantra, Ham Sah. (Ham means "I am"; Sah means "That.") Many patients use it because the sounds comfortably reflect the sensations of breathing and letting go. Feel free to substitute other words or phrases.
Take note: Many of us have racing or wandering minds. The purpose of meditation is not to control this tendency rigidly. Rather, meditation gives us a gentle way to shift from intrusive thoughts and feelings to a focus on our breath and the repetition of a simple phrase. When anxious fantasies, memories, or worries abound, we can accept their inevitability and recognize them for what they arejust the nagging mind. Then, we can return to our focus on breath and phrase, and return again and again when such thoughts arise. Remember, meditation is a process without a fixed goal, and it should not be your intention to do it perfectlyjust to do it. Begin by setting aside ten minutes for each session, then gradually work yourself up to twenty minutes or more.
Meditation practice is not complicated:
· Find a comfortable place to sit and close your eyes. Starting with the number 10, silently count down to zero, breathing in and out on each count. Notice that your breathing may slow as you count down.
· Now as you breath in, say the word Ham (pronounced Haam) silently to yourself. Imagine the sound reverberating in your mind, like the hmmm feeling you get when you sink into a hot bath. As you exhale, concentrate on the word Sah (pronounced Saah) in your mind, like a sigh. Do this for several moments. If your attention wanders, gently bring it back to Ham as you inhale, and Sah as you exhale.
· Continue to note your breathing. As you inhale, pause for a few seconds. As you exhale, pause for a few seconds. Let your breathing slow as you think Ham on the inhale, Sah on the exhale.
· If your mind starts to wander, return to Ham Sah. Stay as focused as you can on your breathing and these words. And don't judge yourself as you meditate. If thoughts or feelings intrude, neither encourage them nor push them away. Just quietly resume your breathing and repeating Ham Sah.
· As time for meditation comes to a close, continue to be aware of your breathing, but start to be aware of where you are, the sounds around you, where you are sitting. When ready, slowly open your eyes, look down for a few moments, and get up gradually.
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