OVERCOMING TRAUMATIC STRESS
CONTENTS:
Dealing with Intrusive Memories
Safety Behaviour – Response Prevention
Dealing with Emotional Numbness
Alcohol, Drugs and Comfort Eating
In a traumatic experience the normal capacity to cope is completely overcome by a terrible event the person may have experienced or witnessed that involved serious injury, threatened or actual death. It is likely the person feared they would suffer physical harm and been overwhelmed with fear. Occasionally, the after-effects of a trauma can be more traumatic than the initial trauma (e.g. serious injuries may have occurred).
Traumatic events are of three types:
Man-made disasters (e.g. fires and transport disasters).
Natural disasters (e.g. floods and earthquakes).
Acts of violence, crime and terrorism (e.g. domestic violence, rape, bomb explosions).
Some people may experience various life events as traumatic (e.g. redundancy, divorce, bereavement).
Vicarious traumatization occurs from working with trauma survivors in a caring and empathic way.
To learn to cope you need to examine the traumatic experience and understand your reactions and the distressing responses produced since the event. It is necessary to confront any deeply buried memories, thoughts and feelings connected to the trauma, which may be preventing you from moving forward. As you start to gain control again the trauma will loosen its hold.
While working through this advice should you feel distressed please try to distract yourself with a different activity.
There are three main symptom groups for reactions following trauma:
Re-experiencing the event (Intrusive reactions) – a feeling that you are experiencing the original event all over again, through memories intruding into your waking or sleeping life.
Arousal reactions – you feel persistently aroused in a nervous, agitated sense, anxious, tense, unable to settle or concentrate, over-reacting very sharply to small things and especially, have trouble sleeping.
Avoidance reactions – you make frantic efforts to avoid anything that could remind you of the trauma, or cause you to think or talk about it in any way. It may be you shut down your feelings about other people, things you normally care about and keep to yourself. You may feel unusually withdrawn and emotionally numb.
In most people the above responses subside after a few days or weeks following the traumatic incident. If instead they recur over and over again you could be suffering from Post-Traumatic Stress Disorder (PTSD) and need to consult your doctor for a diagnosis.
In PTSD arousal reactions are due to the ‘fight, flight, freeze or faint’ stress response failing to shut off so that the system is stuck on red alert that the environment is dangerous so that the traumatized individual is prone to overreacting to everything. Post-trauma sufferers often come to dread socializing due to the embarrassment caused by their unusual responses. They also go to great lengths to avoid anything that reminds them of the trauma (e.g. watching the news or reading newspapers). All these responses interact with each other to keep a vicious cycle going.
Re-experiencing the event (Intrusive reactions):
Flashbacks: These are memories through which you experience the original event as if it were happening all over again. They can occur during waking hours or when asleep in dreams and nightmares.
Intrusive recollections: Most people will find they continually recollect the traumatic event although not every vivid detail is experienced as a flashback. Your security of the world before trauma has been violated and almost anything can trigger traumatic associations in an instant.
Arousal reactions:
Sleep disturbance is the most common after-effect of trauma. Bad temper, lack of concentration, hyper-alertness and exaggerated concern for safety, exaggerated startle response and panic attacks are all arousal reactions.
Avoidance reactions:
Avoidance behaviour – you avoid any person, place or thing that reminds you of the trauma.
Emotional numbness – this is a form of avoidance behaviour where your capacity for experiencing feelings is shut down.
Perhaps you experience difficulty in communicating with others, feel disconnected from your surroundings and your ability to cope with intimacy is affected (e.g. unexpected physical contact may make you jump). Alcohol, drugs and comfort eating may be resorted to but such behaviours can only temporarily improve things. Depression can be associated with traumatic grief. Seek help from your doctor if you think you are suffering from depression.
See Program 12: Overcoming Depression.
Guilt, self-blame, decreased self-esteem and loss of confidence are common.
See Program 1: Coping Strategies Counselling Advice – Guilt.
Develop your confidence.
See Program 1: Coping Strategies Counselling Advice – Assertiveness Training, Neuro-Linguistic Programming (NLP), Building Confidence I, Building Confidence II, Building Confidence III, Building Confidence IV and Program 16: Overcoming Low Self-Esteem.
3. Reactions of Others Close to You
Many family members and loved ones find it difficult to cope with the changes from the emotional scars of the trauma, in the trauma victim. They may try to help but the recipients do not readily accept this help and it may not have any effect. It is not that the trauma victims stop loving others as before the trauma but that their normal response to people has been incapacitated, for the present.
In a well-functioning relationship there is openness and good communication. Trauma survivors find opening up difficult – this can be due to feelings like shame that they are losing control or because it stirs disturbing memories and emotions. Encourage them to share their internal distress and experiences with others.
See Program 1: Coping Strategies Counselling Advice – Shame.
Healthy relationships require trust, and trauma can shatter a person’s capacity to trust.
Form a good support network.
See Program 1: Coping Strategies Counselling Advice – Social Skills Training, Communication Training, Negotiation Training, Troublesome Emotions and Program 13: Overcoming Destructive Relationships.
There is a need for fun, relaxation and recreation in relationships and trauma victims lose interest in previously enjoyed activities. An activity schedule may be helpful.
See Program 1: Coping Strategies Counselling Advice – Planning an Activity Schedule.
Allow the traumatized person to heal in their own time – do not pressurize them to get better. Recognize that trauma affects each individual differently. Without pressurizing them, make the trauma victim aware that you are available to listen to them if they feel like recounting their story.
When the traumatized person tells their story they are likely to experience strong emotions and these need to be expressed as part of the normal healing process. Try to give the trauma victim a sense of stability and routine at this time. Major life decisions should be postponed for at least six months.
It is important to treat each other as equals. Write down what changes you would like to make to your relationship and how you are going to work together to achieve these goals. Support for partners is available from professional agencies or you might confide in someone outside the family. If your partner’s reactions are overwhelming you should protect yourself and withdraw.
In a notebook keep a record of your progress toward recovery and date all the entries. Allow yourself time to work through this advice, and time for relaxation and recreation. Be responsible for your own safety and control destructive impulses (e.g. suicidal thoughts) – seeking professional help if they persist. Do not abuse alcohol, drugs or keep anything potentially dangerous in the house.
Make a contract with yourself by:
Considering the obstacles to your recovery, both external (e.g. not enough time in the day), and internal obstacles (e.g. fear of change).
Writing down desired changes to remove as many of these obstacles as possible and how and when you intend to make these changes.
Making a list of things you promise yourself to do that will help in your recovery process (e.g. ‘I will persevere in my efforts and reward myself for every success no matter how small’).
It may be you felt that others did not want to know about how the trauma affected you emotionally – that they were only concerned with the physical aspects. Perhaps you found it too distressing to share your experience of trauma. It could be you have been ignored because your injuries were not as serious as that of other people. You may have been blamed for the trauma and no one was sympathetic to how the trauma affected you.
To understand the trauma you need to clarify what exactly occurred, your reactions to it and what it means to you. Talk about your experience of trauma to a friend you trust. Your feelings could get overwhelming so make sure you keep yourself safe.
Try writing about your trauma to understand your experience – do this only if your trauma is actually over. Spend a set regular time daily on this exercise then do a pleasurable activity afterwards. Give yourself as much time as you need to write a detailed account of your experience in the present tense using the first person (e.g. ‘I feel…’) Allow yourself to acknowledge any feelings that may arise.
If at any time you feel overwhelmed, distract yourself – if your distress continues seek professional help.
See Program 1: Coping Strategies Counselling Advice – Distraction Techniques.
If writing is difficult you could follow the same procedure by dictating your experience on tape. Painting, drawing, making a collage or sculpture, writing a poem or song to express your experience are also alternatives. When you have completed this exercise remember to reward yourself.
For further coping strategies:
See Program 1: Coping Strategies Counselling Advice – Competitiveness and Perfectionism, Frustration, Procrastination and Persistence.
5. Dealing with Your Intrusive Reactions
You need to familiarize yourself with your intrusive reactions so you have a baseline to measure your reactions before you start to make any changes. In this way:
After making changes another measure will tell if the changes you have made lessen your reactions.
You will be able to see your progress as the difference between the baseline and subsequent scores.
You will know when certain strategies are not working and should seek professional help.
In your notebook, for each of the following questions rate:
How frequently you have had each of the experiences over the past week using the scale 0 (not at all), 6 (almost always).
How upsetting each of the experiences has been in the past week using the scale 0 (not at all upsetting), 6 (extremely upsetting).
In the past week have you had intrusive thoughts, images, sounds or smells in your mind about your traumatic experience?
In the past week have you been disturbed by dreams or nightmares about your traumatic experience?
In the past week have you had flashbacks that the trauma is happening all over again?
In the past week have you felt emotional when you remember your traumatic experience?
In the past week have you felt physical discomfort when you remember your traumatic experience?
Record the total score for frequency and the total score for upset by adding the scores for each of the questions for the two categories. If your score is below 10, it is low; 10-20, it is mid-range; more than 20, it is high.
Also, rate how disabling these intrusive reactions have been in the past week using the scale 0 (not at all disabling), 10 (severely disabling).
If your scores have been high, professional help may be useful in addition to this advice.
Dealing with Intrusive Memories
From the following: [Exercise 1] you will find out how often you push intrusive memories away.
In your notebook record the date and make a table with columns for:
Time.
Intrusive memory.
Bodily sensations.
Level of distress 0 (no distress), 10 (severe distress).
Tolerable.
Dismissed it.
Intolerable.
Then note the time and for one hour continue with your activities as normal. In this time observe if any intrusive memories enter your mind and note each one in the table, rating your level of distress. Record also how you coped with the memory by ticking one of the last three columns.
Stop after an hour and check how often you tried to push your intrusive memories away. Be aware of the bodily sensations you experience and the level of distress at which you find the intrusions intolerable.
The next: [Exercise 2] will help you to integrate the intrusive memories into your life. You will need to allocate half an hour a day on a regular basis for this exercise:
In your notebook record at what level of distress you found the intrusions intolerable and what physical sensations did you notice?
Try to make yourself feel the bodily sensations you experience at that level of distress. Stay relaxed and aware as long as you can of these sensations you experience when intolerably distressed.
It may help to give your bodily sensations a shape or colour and explore changing its form or colour. By allowing yourself to experience your bodily feelings you will realize that tolerating them is feasible.
Repeat this [Exercise 2] for a week until you can tolerate your bodily feelings at that level of distress then repeat [Exercise 1] for finding out how often you push intrusive memories away, to measure the strength of your distress now.
When you no longer need to dismiss the intrusions that result in that highest level of distress (i.e. the intrusions are tolerable), try [Exercise 2] to expose yourself to your bodily intrusions, moving to the next higher level of distress.
Expose yourself to a hierarchy of problem situations to gain control of your distress.
See Program 1: Coping Strategies Counselling Advice – Controlled Breathing and Relaxation Techniques, Eye Movement Technique (EMT), Mood Induction Procedure, Rational Emotive Imagery (REI), Imago Graded Exposure and In Vivo Graded Exposure.
First you need to understand what occurs when you have a flashback. Answer the following questions in your notebook and record any observations:
Recognizing the triggers: When, at what time, in what circumstances and were you alone or with others when it happened? What are the similarities between your present situation with that of your flashback? Can you recollect feeling this way before and what are the similarities and differences? What do you think triggered it (e.g. thoughts, smells, media)?
Recognizing the traumatic memory: Can you recall your flashback? Write it down or draw it in as much detail as possible. What was the duration of the flashback? Were you conscious of your external environment?
Becoming aware of your bodily sensations: Note the sensations you experienced during the flashback in as much detail as possible. What was your level of distress at these sensations, 0 (no distress), 10 (severe distress)? What were your thoughts and reactions to these sensations? How did you make yourself feel better this time and in the past?
Flashbacks occur because your mind is trying to make sense of what happened.
There are three stages:
The trigger stage which tells you the initial cause of the flashback.
Upsetting memories make you feel as if the trauma is happening all over again.
Experiencing strong physical sensations.
Identify and record your most common triggers for your flashbacks. Monitor your flashbacks over a long period of time to gain understanding of them.
Draw a table with columns for:
Date/time.
Trigger.
Flashback (content).
Your reactions.
Level of distress 0 (no distress), 10 (severe distress).
How long did the flashback last?
After you can identify a flashback and are aware of your reactions you can try to control your flashbacks. Attempt to control flashbacks by avoiding known triggers to your flashbacks. This can be useful if you are experiencing very strong reactions that may be a danger to you and others.
Go through the common triggers you identified earlier and your flashback monitoring record to mark out the triggers it would be helpful to avoid. Make a list of triggers to avoid and a plan of how you will avoid each trigger.
Using your notes on common triggers and your flashback monitoring record categorize your triggers into four groups:
Triggers you feel you could deal with now.
Triggers you feel you could deal with soon.
Triggers you feel you cannot deal with now or soon but hopefully eventually.
Triggers you feel you will always need to avoid for everyone’s safety.
Next, choose a trigger you feel you can deal with now and try the following strategies: Write down in detail the flashback associated with this trigger. In what ways does the flashback distress you and why does this have such an effect on you? What feelings do you experience when you have the flashback? Now using these notes:
Rescript the flashback:
Consider if there is anything in the imagery of the flashback that you could alter to gain more control over the flashback.
Rewrite the flashback with this altered image. Visualize the flashback in this altered form.
Every time this trigger sets off this flashback you should rescript the flashback.
Resize your flashback:
Visualize your flashback as a film – try to fit the image onto a small television screen and practise viewing it as frequently as possible. Reduce the speed and colour, and pause frames as you wish.
Every time this trigger sets off this flashback you need to watch it in the above manner.
When you feel you can tolerate this trigger you can select a different trigger to work on.
You can use Grounding techniques to reduce the intensity of your flashback and reconnect with reality:
When a flashback is triggered immediately focus on any object in your surroundings and describe it in detail to yourself including its use and your feelings about it.
Grounding smell: Choose a pleasant scent that does not remind you of your trauma and carry an item that smells of this scent. As soon as a flashback is triggered, breathe in this scent and be calmed by it.
Grounding object: Carry a small object (e.g. a stone) that you can feel and study as soon as a flashback is triggered.
Grounding position: Find a bodily position which is comforting and use it as soon as a flashback is triggered.
You could also try reciting a poem or singing a song.
If you experience flashbacks related to sexual abuse, in a relationship: You should stop any further sexual contact until the flashback is over and focus on your immediate surroundings as soon as the flashback is triggered; note the differences between your partner and present environment to your abuser and environment in your flashback. Make sure your partner is aware you are having a flashback and let your partner comfort you in ways you have discussed beforehand. Use any of the grounding techniques mentioned above.
See Program 1: Coping Strategies Counselling Advice – Forgiveness, Program 6: Overcoming Anger and Program 10: Overcoming Childhood Abuse.
Re-score yourself:
See Dealing with Your Intrusive Reactions.
Compare the new score with the baseline score. Remember intrusive memories and flashbacks are the body’s way of making sense of your traumatic experience. Reward yourself on your successes.
6. Dealing with Your Arousal Reactions
You need to familiarize yourself with your arousal reactions so you have a baseline to measure your reactions before you start to make any changes. In this way:
After making any changes another measure will tell if the changes you have made lessen your reactions.
You will be able to see your progress as the difference between the baseline and subsequent scores.
You will know when certain strategies are not working and should seek professional help.
In your notebook, for each of the following questions rate:
How frequently you have had each of the experiences over the past week using the scale 0 (not at all), 6 (almost always).
How upsetting each of the experiences has been in the past week using the scale 0 (not at all upsetting), 6 (extremely upsetting).
In the past week have you suffered from sleep disturbance either initial insomnia, broken sleep or early morning awakening?
In the past week have you been aware of being angry or irritable?
In the past week has your concentration been poor?
In the past week have you been overly cautious and preoccupied with the safety of yourself or others?
In the past week have you felt more agitated than usual?
Record the total score for frequency and the total score for upset by adding the scores for each of the questions for the two categories. If your score is below 10, it is low; 10-20, it is mid-range; more than 20, it is high.
Also, rate how disabling these arousal reactions have been in the past week using the scale 0 (not at all disabling), 10 (severely disabling).
If your scores have been high, professional help may be useful in addition to this advice.
Ensure you have secure or new locks on your doors and windows so you feel protected. You may consider moving house if the trauma occurred in your home. While you are recovering it could be you need to sleep alone – discuss this with your partner and reassure them that this is only temporary.
Develop good time and sleep management with adequate time for relaxation and recreation. Ensure you have a healthy diet and regular exercise.
See Program 1: Coping Strategies Counselling Advice - Nutrition, Exercise, Managing Your Time and Sleep Management.
To deal with stress:
See Program 1: Coping Strategies Counselling Advice – Problem-Solving, Program 22: Overcoming Stress and Program 23: Overcoming Stress At Work.
For further coping strategies:
See Program 1: Coping Strategies Counselling Advice – Controlled Breathing and Relaxation Techniques, Meditation, Creative Visualization, Autogenics and Self-Hypnosis.
Re-score yourself:
See Dealing with Your Arousal Reactions.
Compare the new score with the base-line score.
7. Dealing with Your Avoidance and Emotional Numbing Reactions
You need to familiarize yourself with your avoidance and emotional numbing reactions so you have a baseline to measure your reactions before you start to make any changes. In this way:
After making changes another measure will tell if the changes you have made lessen your reactions.
You will be able to see your progress as the difference between the baseline and subsequent scores.
You will know when certain strategies are not working and should seek professional help.
In your notebook, for each of the following questions rate:
How frequently you have had each of the experiences over the past week using the scale 0 (not at all), 6 (almost always).
How upsetting each of the experiences has been in the past week using the scale 0 (not at all upsetting), 6 (extremely upsetting).
In the past week have you tried to dismiss any thoughts or feelings connected to your traumatic experience?
In the past week have you avoided situations, places and conversations that remind you of your traumatic experience?
In the past week have you tried and been unable to remember anything about your traumatic experience that is of importance?
In the past week have you not been able to enjoy yourself as much as usual?
In the past week have you felt distant from others around you?
In the past week have you felt emotionally numb?
In the past week have you been indecisive and pessimistic about the future?
Record the total score for frequency and the total score for upset by adding the scores for each of the questions for the two categories. If your score is below 14, it is low; 14-21, it is mid-range; more than 21, it is high.
Also, rate how disabling these avoidance and emotional numbing reactions have been in the past week using the scale 0 (not at all disabling), 10 (severely disabling).
If your scores have been high, professional help may be useful in addition to this advice.
Panic reactions can lead to a vicious cycle where anxiety results in avoidance and the anticipation of more anxiety hence, more avoidance. Handle panic by reminding yourself that there is no need to be frightened and use controlled breathing.
See Program 1: Coping Strategies Counselling Advice – Controlled Breathing and Relaxation Techniques, Program 8: Overcoming Anxiety and Program 20: Overcoming Panic Disorder.
Use coping statements (e.g. ‘I can deal with this’ ‘It will be over soon’). Continue in the situation slowly and calmly. When you are in a suitable place try using the Relaxed Breathing Method.
See Program 1: Coping Strategies Counselling Advice – Sleep Management.
Reward yourself for your progress with this advice.
For a fortnight keep detailed notes of the circumstances when you feel panic or anxiety. Make a list of things you avoid because of your panic attacks/anxiety in order of difficulty, and select the easiest for Imago and In Vivo Graded Exposure. Work through the list from the next easiest to the most difficult.
See Program 1: Coping Strategies Counselling Advice – Controlled Breathing and Relaxation Techniques, Eye Movement Technique (EMT), Mood Induction Procedure, Rational Emotive Imagery (REI), Imago Graded Exposure and In Vivo Graded Exposure.
Safety Behaviour – Response Prevention
If your trauma occurred while driving or in a similar activity you may find yourself being extra cautious in doing these activities again. Your body remembers the danger and is trying to protect itself. You need to understand that these situations are no longer dangerous.
List the sorts of safety behaviours you are using and deal with them one by one. It is necessary you realize that they are not required and use controlled breathing and relaxation techniques to help you cope.
Dealing with Emotional Numbness
You need to be able to acknowledge your traumatic experience in its entirety. Perhaps you feel that the trauma has prevented you from achieving your dreams or has caused the loss of your identity. Consider who you are, how you see yourself and how you compare yourself to others now, after the trauma. What do you fear others will see or are fearful of admitting to yourself? How have your personal expectations altered since the trauma?
Use the technique of graded exposure to deal with emotional numbness reactions.
See Program 1: Coping Strategies Counselling Advice – Imago Graded Exposure and In Vivo Graded Exposure.
Numbness is often associated with grief.
See Program 15: Overcoming Grief And Bereavement.
Alcohol, Drugs and Comfort Eating
The numbness reaction often extends to the overuse of alcohol, drugs or comfort foods. Anorexia Nervosa can also be triggered by a traumatic experience. If you feel you have a dependency, contact your doctor and seek the necessary help.
See Program 4: Overcoming Addiction.
Intimacy Problems
You may feel alienated and incapable of connecting with anyone intimately. As before use the techniques of Imago and In Vivo Graded Exposure to deal with this avoidance behaviour.
Re-score yourself:
See Dealing with Your Avoidance and Emotional Numbing Reactions.
Compare the new score with the baseline score.
8. Before and Beyond Your Trauma
Before the trauma people have had to cope with negative and positive experiences. Beyond the trauma people’s experiences whether negative or positive are affected by the trauma – their energy seems to be stuck at the time of the trauma in the negative life experiences.
Lifespan Exercise:
This exercise will enable you to see that life has been moving on and that you have survived. Ensure you have at least two hours to yourself and on a large piece of paper draw a vertical line down the centre. Starting from the bottom, plot your earliest recollections and work your way to the top and where you are now. Plot negative experiences on the left and positive experiences on the right.
If you become distressed, stop and write down your feelings till you feel calmer then resume the exercise or leave it for another time. Seek the help of a health professional if you feel you may harm yourself or others.
Connect the dots of your memories in chronological order to get a zigzag effect around the central line. Leave the chart until another time when you will have two hours to yourself.
Examine your chart and answer the following questions in your notebook:
How have I coped with positive and negative events in my life?
Do I acknowledge my successes?
How do I cope when under stress?
Which are the most successful ways of coping for me?
In what ways has my coping pattern altered since the trauma?
Do I know of any coping strategies that would be helpful but I have not attempted yet?
How do I cope with interpersonal relationships?
Can I cope when alone?
You may think of additional questions.
From these make two lists: One of positive coping strategies and the other of negative coping strategies. Decide which strategies you want to continue to use and which you no longer want to use. Focus on increasing the positives and shifting away from the negatives. Congratulate yourself on your successes.
Deal with negative thinking.
See Program 1: Coping Strategies Counselling Advice – Modifying Maladaptive Thinking.
Perhaps you have physical scars as well as emotional scars and need to adjust to these changes in your body.
Consider your life before trauma. Write down all the things you used to be able to do. Rate how your quality of life was in the past using a score of 0-10 (0 is very low and 10 is extremely high quality of life). Note what sorts of things you are able to do now and rate your current quality of life. Write down the difference, if any between the two scores.
Think of all the changes you could realistically make to improve your quality of life. Give your desired quality of life a score of 0-10 (where 10 is highest quality). List these changes in order of difficulty. Starting with the easiest, consider the steps you need to take to achieve your target. It may be helpful to ask a friend for support in making these changes.
Learn to accept your new body image.
See Program 1: Coping Strategies Counselling Advice – Criticism, Countering Self-Criticism, Improving Your Self-Image and Combating Self-Harm and Coping with the Need for Approval.
Every day for a week spend 5-10 minutes examining and familiarizing yourself with different parts of your body, starting with areas which have not altered much, to those parts which have greatly changed. Write a letter of appreciation to different parts of your body. Show acceptance of your body by buying the different parts inexpensive but pleasurable gifts such as cream or ribbon, for massage or decoration.
There may at present be no medical solution to your pain but you can learn to control it. Write down activities you no longer do because of the pain you experience. Choose one or two of the activities you would like to resume or a new activity you would like to start, and consider how you might achieve this objective. Plan toward your goal in small steps.
You could try transforming your pain in your imagination:
Consider the colour, shape, size and texture of your pain. How does it feel? Is it solid or liquid? Is it hot, warm or cold? Does it make a noise? Where in your body is it located? Now imagine altering this image to lessen your pain. You could make it smaller, smoother and more soothing in colour or allow the pain to flow out of your body as a liquid.
Rate the intensity of your pain before and after you do this exercise using a score of 0-10 (0 is no pain and 10 is extreme pain). Keep a record of these scores in a diary which will enable you to see your improvement. Practise this exercise as often as possible.
See Program 19: Overcoming Pain.
The path to recovery is a long one. You may find it difficult to forgive yourself or others. While premature forgiveness can be detrimental, forgiveness allows you to move on. Use visualization to enhance your recovery.
You could try the following method of visualization:
Ensure you have some time to yourself and push your worries to one side. Sit or lie comfortably and close your eyes with your arms by your side. Concentrate on breathing naturally.
Place your hands on your stomach and breathe in deeply and hold for a few seconds feeling your stomach rise. Breathe out and feel your stomach contract. Repeat and as you breathe out think of a relaxing image or sound. Continue doing this until you feel thoroughly relaxed.
Now visualize the future: How are you? Where are you? See clearly your surroundings. How do you feel? Feel acceptance of yourself and become aware of your strength and courage. Count back from ten, then open your eyes – slowly get up and resume normal activities with confidence in your ability to move forward.
If despite all your efforts you feel unable to cope, you need to seek professional help.
See Program 1: Coping Strategies Counselling Advice – Relapse Prevention.
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