session4.pdf

Mindfulness Based Stress Reduction

Homework

Week 4

• Practice mindfulness formally for 45 minutes every day for at least 6 days this

week using the Guided Meditation CD. You may also choose to alternate a couple

of days with one of the Yoga CDs.

• Read and reflect upon “Chaos or Calm” article

• Reflect upon the “Reacting vs. Responding to Stress” figure

• Read and reflect upon “ Working with Resistance” article

• Complete “Pleasant Events Calendar”

• Continue to cultivate your intention to increase your level of awareness during

daily activities such as: eating, showering, brushing your teeth, washing dishes,

taking out the garbage, reading to the kids. . .

Reflections

Worrying about the future is like trying to eat the hole in a doughnut. It’s munching on what

isn’t. - Barry Nail Kaufman

Unlike achieving things worth having, to achieve a thing worth being usually requires long

periods of solitude. - Meyer Friedman and Ray Rosenman

Man is disturbed not by things, but by his opinion of things.

- Epictetus, First-Century Roman Philosopher

In the beginner’s mind, there are many possibilities, but in the expert’s there are few.

- Shunryu Suzuki

To live without mindfulness is to live as if we were dead already.

- Sharon Salzburg

www.BeMindful.org Steve Shealy, PhD 813-980-2700

Chaos or Calm: Rewiring the Stress Response

By Carrie Demers, MD

Remember the tale "The Lady or the Tiger?" As it ends, the hero is standing before two identical

doors: one conceals a beautiful maiden; the other, a ferocious tiger. The hero must open one of

these doors—the choice is his—but he has no way of knowing which will bring forth the lady and

which will release the tiger.

I'm sometimes reminded of this story when a patient is describing one of the symptoms of chronic

stress: headaches, indigestion, ulcers, tight muscles, high blood pressure or some combination of

these. When I point out that the symptom is stress-related, the patient seems resigned—stress is

such a constant in most people's lives that all the doors seem to have tigers lurking behind them.

Most of the people who find their way to my office know the fight-or-flight response is hardwired

into our nervous system and many have come to accept a constant feeling of tension as normal,

even inevitable.

It isn't. Like the hero in the story, we have a choice. There is another door, another response to

the challenges of everyday living that is also hardwired into our nervous system. And unlike the

hero, whose destiny rests with chance, we can discover which door is which. A general

understanding of the nervous system and how it responds to stress, coupled with training in

three fundamental yoga techniques, make it possible for us to distinguish one door fron1 the

other. Practicing these techniques gives us the power to choose the lady while leaving the door

that unleashes the tiger firmly closed.

Releasing the Tiger

The autonomic nervous system controls all the body's involuntary processes: respiratory rate,

heart rate, blood pressure, gastric juice secretion, peristalsis, body temperature, and so on. It has

two main components or branches—the sympathetic and the parasympathetic. When we feel

stressed, our brain activates the sympathetic nervous system, which has come to be known as

the fight-or-flight response. This causes the adrenal medulla to secrete adrenaline (also called

epinephrine), a hormone that circulates through the bloodstream, affecting almost every organ.

Adrenaline revs up the body to survive a threat to life and limb: The heart pumps faster and

harder, causing a spike in blood pressure; respiration increases in rate and moves primarily into

the chest; airways dilate to bring more oxygen into the body; blood sugar rises to provide a ready

supply of fuel; some blood vessels constrict to shunt blood away from the skin and the core of the

body, while others dilate to bring more blood to the brain and limbs. The result? A body pumped

up to fight or run, and a mind that is hyper alert.

This response is a crucial reaction to a life-threatening event: when we find ourselves face-to-face

with a mountain lion, the stress response dramatically increases our chances of surviving. And

we’ve all heard stories of fantastic feats: the mom lifting a car off her trapped child, the

firsfighter carrying a man twice his size from a burning building. These are the benefits of the

sympathetic nervous system. Any time we respond quickly and decisively when a life is at stake,

this is the system to thank.

The fight-or-flight response is meant to be triggered sporadically, in those rare moments when

we are actually in peril. Ideally, it remains dormant until the next close call (weeks, months, or

even years later!). But in many of us this response is triggered daily, even hourly. Some people—

soldiers, tightrope walkers, members of a SWAT team, for example—do find themselves in life-

www.BeMindful.org Steve Shealy, PhD 813-980-2700

or-death situations frequently. But for most of us, such situations are rare: a mugging, a traffic

accident, a close-up with a bear in the backcountry. Once the threatening event is over, hormonal

signals switch off the stress response, and homeostasis is reestablished.

The problem is that for many of us the fight-or-flight response rarely switches off, and stress

hormones wash through the body almost continuously. The source of our stress is psychological

rather than physical—a perception that something crucial to us is threatened. Fear of the

unknown, major changes in our circumstances, uncertainty about the future, our negative

attitudes—all these are sources of stress. Today we worry more about our jobs, our relationships

or getting stuck in traffic than we do about fighting off a wild animal, but even though the

perceived threat is psychological, it still triggers the archaic survival response.

The upshot is that our bodies are in a constant state of tension, ready to fight or flee, and this

causes a host of physical problems. You can see what some of these are if you look again at what

happens when adrenaline courses through the body: elevated blood pressure, rapid shallow

breathing, high blood sugar and indigestion. What is more, adrenaline makes our platelets

stickier, so our blood will clot quickly if we are wounded. This increases our chances of surviving

a physical injury—but chronically sticky platelets are more apt to clot and create blockages in

our arteries. And this sets the stage for a heart attack or a stroke.

The damage doesn’t end there. When we are constantly in fight-or-flight mode, the adrenal

cortex begins to secrete cortisol, a steroid whose job it is to help us adapt to a prolonged

emergency by ensuring that we have enough fuel. Cortisol acts on the liver and muscle tissues,

causing them to synthesize sugars (glucose) and fats and release them into the bloodstream.

From the body's viewpoint, this is a reasonable response— dumping fat and sugar into the blood

will help us survive a shipwreck, for example. But when this fuel is not metabolized in response

to prolonged physical duress, disease results. Excess sugar in the bloodstream leads to diabetes,

and excess fat to high cholesterol/high triglycerides. Both conditions boost our chances of

developing heart disease.

The steroids cortisol and cortisone quell inflammation in autoimmune diseases and asthma, and

so are useful when used infrequently and for brief periods, but their constant presence in the

bloodstream suppresses immune function. This causes the white blood cells—those hardy

defenders against bacteria, viruses, cancer cells, fungi, and other harmful microorganisms— to

become sluggish. And this makes us more prone to disease, especially cancer and chronic

infections like Lyme disease, hepatitis, and the Epstein-Barr virus.

Sounds grim, doesn’t it? It is. It's a tiger A chronically activated sympathetic nervous system

keeps the body under constant pressure. If we ignore early warning symptoms—tight shoulders,

digestive upset, recurring headaches, an increasing tendency to lose our temper or become easily

upset—sooner or later the tiger will tear us up. But we can make another choice. The autonomic

nervous system has another component, the parasympathetic nervous system. Rather than

living under the tyranny of a ramped-up sympathetic nervous system, we can learn to trigger the

parasympathetic system, the rest-and-digest response, instead.

Just as the fight-or-flight response automatically kicks in at the threat of danger, the rest-and-

digest response automatically responds to our sense of equilibrium. When it is activated, the

heart rate drops, I blood pressure falls, and respiration slows and deepens. Blood flow to the core

of the body is reestablished— this promotes good digestion, supports the immune system and

infuses us with a sense of well-being.

www.BeMindful.org Steve Shealy, PhD 813-980-2700

We unconsciously achieve this state on vacation, in the throes of a hearty laugh, or in deep sleep.

1t feels good, and it offers a much needed respite from the hectic pace we set for ourselves. But

we have come to accept stress as the norm and to expect the feeling of relaxed well-being to come

about only sporadically—and so it does. We release the tiger a dozen times a day, even though

the other door is also there in every moment. Once we learn to open it at will, we can override

the harmful habit of triggering our stress response by activating the rest-and-digest component

of our nervous system instead.

Greeting the Lady

I use a variety of natural therapies in my medical practice, but the basic treatments are drawn

from yoga— stretching, breathing, relaxation and meditation—and these techniques are

especially effective when it comes to managing stress. You already know from personal

experience that aerobic exercise is excellent for dissipating stress-created tension, and that

sugar, caffeine and spicy food contribute to jangling your nervous system and shortening your

temper. You are probably also familiar with the relaxing effects of practicing yoga postures - they

teach us to move and stretch our tense, strained bodies and to focus on the breath. But do you

know that breathing slowly and deeply is the easiest way to activate the rest-and-digest system?

That is one reason yoga classes are so popular—they soothe frazzled nerves and quiet anxious

minds. But yoga also works at an even deeper level: it reestablishes healthy breathing patterns,

teaches us to relax consciously and systematically, and gives us the opportunity to explore the

inner workings of our minds through meditation. These techniques, both separately and in

combination, nourish and strengthen the parasympathetic nervous system so that the relax-and-

digest response becomes our normal mode. The fight-or-flight response is then reserved for

emergencies, as nature intended. So let's take a look at some ways we can open Door Number

Two.

Diaphragmatic Breathing • Babies and young children breathe deeply and fully, using the

dome shaped diaphragm that separates the chest and abdominal cavities to move air in and out

of their lungs. Their bellies are relaxed and move in concert with their breath. This is the

natural, healthy way to breathe. But as we grow up we are taught to constrict the abdomen (Pull

your stomach in and stand up straight!), and that training, coupled with an unconscious

tendency to tighten the belly when we experience stress, disrupts the natural flow of our breath.

With the abdomen pulled in, the breath is confined to the upper portion of the lungs (from about

the nipple line up). And because this breathing pattern is perceived by the body to be a stress

response, it reinforces the fight-or-flight reaction.

Diaphragmatic breathing, on the other hand, activates the relax-and-digest response by

stimulating the primary mediator of the parasympathetic nervous system, the vagus nerve. This

nerve travels from the brain to nearly all the thoracic and abdominal organs ("vagus" comes from

the same root as "vagabond"), and triggers a cascade of calming effects. Most of the time we wait

for it to be activated by something pleasant and hope for a trickle-down effect, not realizing that

the nerve (and hence the entire parasympathetic nervous system) can be turned on from the

bottom up by diaphragmatic breathing.

The fight-or-flight response is meant to be triggered sporadically, in those rare moments when

we are actually in peril.

Of all the processes regulated by the autonomic nervous system (heart rate, blood pressure,

secretion of gastric juices, peristalsis, body temperature, etc.), only breathing can be controlled

consciously. And in doing so, we stimulate the branch of the vagus nerve that innervates the

diaphragm (which carries a message to the other vagus branches and the brain) to activate the

www.BeMindful.org Steve Shealy, PhD 813-980-2700

entire rest-and-digest response. This is why the first step in reversing our chronic stress

response is to learn to breathe again the way we were born to breathe.

If you haven't been trained in diaphragmatic breathing, find an experienced teacher and practice

every day until it once again becomes a habit. Then, as you develop the skill of breathing from

the diaphragm in the course of your daily activities, you will begin to experience your breath as a

barometer for the nervous system. As long as you are breathing deeply and from the diaphragm,

you will find that you can access a feeling of calm and balance even when you are confronted

with an unpleasant situation. And you will also notice that if you allow your breath to become

shallow by breathing from your chest, anxiety creeps in, your muscles tighten, and your mind

begins to race and spin. When this agitated breathing is prolonged, it creates an unsettled and

defensive outlook on life. Once you know this from your own experience, you can make a different

choice.

Systematic Relaxation • to activate the parasympathetic nervous system, diaphragmatic

breathing makes an excellent beginning. But we need to do more, particularly when we have

spent years unconsciously flinging open the door to the tiger's cage. Daily periods of relaxation

are a must. When I tell my patients this, many of them say they relax while they watch TV or

read or knit or socialize. The problem is that while these activities distract the mind from its

usual worries (and so provide some relief), they do little to relieve the stress we hold in the form

of muscular contraction and tension.

To reverse well-established habits of holding tension in our bodies, we need to work with what

the yogis call the energy body (pranamaya kosha). Systematic relaxation practices offer a precise,

orderly technique for releasing tension from head to toe. There are a number of these techniques,

and like all yoga practices, they are best learned from an experienced teacher, and then honed

through patient practice. They range in complexity from simple tension/relaxation exercises and

point-to-point breathing practices to techniques that require making fine distinctions among

various points in the energy body. But all involve moving our attention through the body in a

methodical fashion, usually while resting in shavasana (corpse pose). And all require that we

withdraw our attention -from the drama of our lives. For the duration of the practice, we let go of

our memories, plans, worries, and fantasies, and focus on what we are doing here and now as we

move our awareness calmly and quietly from one part of the body to another.

Breathing from the diaphragm, while systematically bringing our full attention to one point in

the body after another, not only releases tension and fatigue in the places where we rest our

attention, it also augments the energy flow among those points. This promotes both healing and

cleansing. Further, because full engagement with a systematic relaxation practice requires that

we clear our minds and attend fully to the present moment, we are also refining a skill that

opens the door to meditation.

Meditation • Since stress begins with the perception that our lives (or at least our sense of

wellbeing) are in danger, working with the mind to alter our perceptions is the most powerful

technique for quieting our stress response. Most of what activates our fight-or-flight response is

not a matter of life or death. We may feel pressured to accomplish a certain task or worried about

what will happen at tomorrow's meeting—but our lives don't depend upon the outcome. With

rare exceptions, the habitual thought patterns that create the experience of stress for us are

overreactions to events in our lives. Instead of responding in a way that floods the body with

adrenaline, however, we can reframe the experience to make it not only less stressful, but also

more accurate in reflecting what is really happening ("I'm only in a traffic jam, I'm not at death's

door.' 'I want to please this person, but if I don't, I'm not going to be fired.") This goes a long way

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