28. 促进放松

促进放松

有些非常紧张和焦虑的人发现仅靠咨询不足以减轻他们的症状，使他们感到舒适。有时建议将这些人转介给医生或精神科医生进行评估，以便必要时开具适当的药物。然而，对于许多患有紧张和焦虑的人来说，通过使用放松技巧可以获得相当大的益处。

引入放松练习

在介绍放松练习之前，重要的是，与其他所有干预措施一样，要与个人确认他们是否愿意参与这项练习。这可能涉及总结过程，以便个人了解预期的情况。

放松练习的特点

普遍适用：大多数人都能轻松学会放松，享受放松，并且可以被鼓励定期使用它。
潜在威胁：有少数人发现放松技巧相当具有威胁性。在进行放松练习时，他们反而会感到紧张和焦虑增加。对于一些人来说，这可能是严重的。要小心给予你希望帮助的人停止放松练习的许可，如果他们发现这是压力而非放松的。对于这样的人，如果这不是太具威胁性，探索这种压力体验可能是有用的，因为它可能与他们现在或过去的其他压力体验有关。

放松环境

安静的房间：用于放松的房间最好是安静的，灯光柔和而不是刺眼。尽可能保护房间不受外部噪音（如电话铃声）和其他人的干扰。当一个人试图放松时，有人开门走进来是不合适的。

放松练习的具体步骤

有许多不同的放松教学方法。以下是我们使用的一种放松练习。如果你希望使用它，请用平静、缓慢、单调的语调向寻求帮助的人读以下指示。每条陈述之间暂停几秒钟。

放松练习

躺在地板上，头枕在垫子上，双手放在身体两侧，双腿伸直。
移动身体直到感到舒适。
闭上眼睛。
你可能会喜欢这个练习并觉得它很愉快，但如果任何时候你感到不舒服并想停止，你可以选择静静地躺着不理我的声音，或者告诉我你想要终止这个练习。
注意你的身体哪些部位接触地面。
调整身体姿势使自己更舒适。
注意从头到脚的整个身体，伸展任何不舒服的部分。
让你的身体压在地面上。
注意地面支撑你的感觉。
这是一种很好的感觉。你与地面接触，地面也与你接触。
注意你的呼吸。
允许自己自然舒适地呼吸。
[长时间停顿]
我们将进行一系列练习，在此期间你将放松身体的不同部分，从脚尖开始，到头顶结束。
对于每组肌肉，我会建议你在深呼吸时收紧这些肌肉，然后在呼气时放松它们。
每当记得时，在呼气时对自己说“放松”。
在放松每组肌肉之间，再次专注于呼吸。自然呼吸，并在每次呼气时默默地对自己说“放松”。通过这样做，你会逐渐变得更加放松。如果任何杂念进入你的脑海，不要担心，只需重新专注于呼吸。
注意你的呼吸。
每次呼气时默默地对自己说“放松”。
[观察对方的身体，注意他们的呼吸。每次他们呼气时轻声说“放松”。这样做几次，使对方记住自己这样做]
注意你的身体。如果有任何部位不舒服，伸展或调整姿势使自己更舒适。
专注于呼吸。
当你准备好时，我会要求你在吸气时慢慢深呼吸，并在此过程中紧紧蜷缩脚趾，收紧脚部的肌肉。
[选择时机]
深呼吸并收紧脚部的肌肉。
屏住呼吸并保持脚部肌肉紧绷一两秒。
重重地呼气并释放脚部的紧张。
继续自然呼吸，并在每次呼气时对自己说“放松”。
[等待一段时间，让对方继续自然呼吸]
现在在深呼吸时收紧大腿和小腿的肌肉。
屏住呼吸并保持肌肉紧绷。
呼气时放松。
自然呼吸并感到放松。
[稍作停顿]
在深呼吸时收紧臀部肌肉。
屏住呼吸并保持肌肉紧绷。
现在呼气并放松。
自然呼吸并注意到从脚到臀部的放松感觉。
[稍作停顿]
在深呼吸时收紧腹部肌肉。
屏住呼吸。
放松。
注意呼吸。
[稍作停顿]
在吸气时握拳。
保持。
放松。
[稍作停顿]
现在在深呼吸时收紧手臂肌肉并伸展手指。
保持。
放松。
注意到从脚到小腿、大腿、腹部、手、手臂和胸部的放松感觉。
让你的身体沉入地面，感受地面的支撑。
自然呼吸。
[稍作停顿]
在吸气时收紧肩部和颈部肌肉。
保持。
放松。
[稍作停顿]
咬紧牙关，皱起脸，紧紧闭上眼睛，并在吸气时感受到头皮的紧绷。
保持。
放松。
[稍作停顿]
自然呼吸并注意到放松的感觉向上蔓延，覆盖全身。
注意呼吸。每次呼气时，感到自己越来越放松。
[长时间停顿]
很快就要开始重新接触周围环境了。当这样做时，允许自己感觉良好，保持清醒和警觉。
[稍作停顿]
注意地面。动动手指感受它。
稍微扭动一下身体，准备好了就睁开眼睛。
躺在原地环顾四周。允许自己吸收所见的一切，感觉良好，保持清醒和警觉。
准备好了就侧身翻滚，用一只手臂支撑自己呈半坐姿。
在合适的时间坐起来。

实践建议

上述放松练习可以在咨询过程中教授，然后鼓励个人在自己的时间里定期练习。然而，警告他们过度放松的危险。例如，不建议在非常放松的状态下开车。一定程度的紧张是有用的，以便快速应对危险。因此，不要在寻求帮助的人即将开车离开前立即进行放松练习！
一旦一个人学会了通过肌肉的紧张和放松来放松，他们就会发现在站立和紧张的情况下更容易放松。教他们深呼吸几次，每次吸气时收紧肌肉，然后在呼气时放松。通过练习，他们可能会发现自己在自然呼气时能够让自己放松。

学习总结

在教授放松时使用平静、缓慢、单调的语调。
放松练习对某些人来说可能具有威胁性。
确保寻求帮助的人明白他们可以在任何时候停止练习。
观察对方的身体，以确保指令的时机正确。
警告在需要集中注意力时过度放松的危险。

进一步阅读

Davis, M., Eshelman, E.K. & McKay, M. 2008, Relaxation and Stress Reduction Workbook, 6th edn, New Harbinger, Oakland, CA.
Payne, K.A. & Donaghy, M. 2010, Payne’s Handbook of Relaxation Techniques: A Practical Guide for the Health Care Professional, Elsevier, Edinburgh.

本章知识点阐述

进一步阐述知识点

促进放松的重要性

缓解紧张和焦虑

对于一些非常紧张和焦虑的人来说，仅靠心理咨询可能不足以减轻他们的症状。放松技巧可以帮助他们达到更舒适的状态。
放松技巧不仅可以减轻心理压力，还可以改善生理状态，如降低心率、血压等。

转介医疗

对于一些严重紧张和焦虑的人，可能需要转介给医生或精神科医生进行评估，以确定是否需要药物治疗。
医疗专业人员可以提供更专业的诊断和治疗方案。

引入放松练习的注意事项

确认意愿

在介绍放松练习之前，必须与个人确认他们是否愿意参与这项练习。这有助于建立信任关系，确保个人感到安全和舒适。
通过总结过程，让个人了解预期的情况，有助于减少不确定性和焦虑。

潜在威胁

尽管大多数人都能轻松学会放松，但有少数人可能发现放松技巧具有威胁性。在进行放松练习时，他们可能会感到紧张和焦虑增加。
咨询师应给予个人停止练习的许可，并在必要时探索这种压力体验，因为它可能与他们过去或现在的其他压力体验有关。

放松环境的设置

安静的房间

用于放松的房间应该是安静的，灯光柔和而不是刺眼。这有助于创造一个舒适的环境，减少外界干扰。
尽可能保护房间不受外部噪音（如电话铃声）和其他人的干扰，确保个人能够专注于放松练习。

避免干扰

当一个人试图放松时，有人开门走进来是不合适的。确保房间在放松练习期间不会受到干扰。

放松练习的具体步骤

身体姿势

躺在地板上，头枕在垫子上，双手放在身体两侧，双腿伸直。调整身体姿势使自己更舒适。
闭上眼睛，注意身体与地面的接触点，感受地面的支撑。

呼吸练习

允许自己自然舒适地呼吸。注意呼吸的感觉，每次呼气时默默地对自己说“放松”。
通过深呼吸和肌肉的紧张与放松，逐步放松身体的各个部分，从脚尖开始，到头顶结束。

逐步放松

每组肌肉的放松练习包括深呼吸时收紧肌肉，然后在呼气时放松。通过这种方式，逐步放松身体的不同部分。
在放松每组肌肉之间，再次专注于呼吸，自然呼吸并感到放松。

结束练习

重新接触周围环境，允许自己感觉良好，保持清醒和警觉。
动动手指，稍微扭动身体，准备好了就睁开眼睛。侧身翻滚，用一只手臂支撑自己呈半坐姿，然后在合适的时间坐起来。

实践建议

定期练习

一旦个人学会了放松技巧，应鼓励他们定期练习，以巩固效果。
定期练习有助于形成习惯，使个人在日常生活中更容易放松。

避免过度放松

警告个人过度放松的危险，特别是在需要集中注意力的场合，如开车。一定程度的紧张是有用的，以便快速应对危险。
不要在个人即将开车离开前立即进行放松练习。

肌肉紧张与放松

教会个人通过肌肉的紧张与放松来放松。深呼吸几次，每次吸气时收紧肌肉，然后在呼气时放松。
通过练习，个人可能会发现自己在自然呼气时能够让自己放松。

总结

放松技巧在帮助紧张和焦虑的人减轻症状、提高生活质量方面具有重要作用。通过具体的放松练习，个人可以在安全的环境中体验放松，减少心理和生理的压力。咨询师在这一过程中起着重要的引导和支持作用，通过观察、反馈和提问，帮助个人更好地掌握放松技巧。最终，这些方法不仅有助于解决当前的问题，还能帮助个人在未来更自信地面对生活中的挑战。

学习总结

促进放松的重要性
- 缓解紧张和焦虑：
  - 放松技巧可以帮助紧张和焦虑的人达到更舒适的状态。
  - 放松技巧可以减轻心理压力，改善生理状态。
- 转介医疗：
  - 对于严重紧张和焦虑的人，可能需要转介给医生或精神科医生。
  - 医疗专业人员可以提供更专业的诊断和治疗方案。
引入放松练习的注意事项
- 确认意愿：
  - 确认个人是否愿意参与放松练习，建立信任关系。
  - 通过总结过程，减少不确定性和焦虑。
- 潜在威胁：
  - 少数人可能发现放松技巧具有威胁性。
  - 咨询师应给予个人停止练习的许可，探索压力体验。
放松环境的设置
- 安静的房间：
  - 房间应安静，灯光柔和，减少外界干扰。
- 避免干扰：
  - 确保房间在放松练习期间不会受到干扰。
放松练习的具体步骤
- 身体姿势：
  - 躺在地板上，调整身体姿势。
- 呼吸练习：
  - 注意呼吸的感觉，每次呼气时说“放松”。
- 逐步放松：
  - 逐步放松身体的不同部分。
- 结束练习：
  - 重新接触周围环境，动动手指，准备好了再睁开眼睛。
实践建议
- 定期练习：
  - 鼓励个人定期练习，巩固效果。
- 避免过度放松：
  - 警告过度放松的危险，特别是在需要集中注意力的场合。
- 肌肉紧张与放松：
  - 教会个人通过肌肉的紧张与放松来放松。

参考文献和进一步阅读

de Shazer, S. 1985, Keys to Solution in Brief Therapy, W.W. Norton & Company, New York.
O'Connell, B. 1998, Solution Focused Therapy: Helping People with Problems to Succeed, Allen & Unwin, St Leonards, NSW.
Berg, I.K. & Miller, S.D. 1992, Working with the Problem Drinker: A Solution-Focused Approach, Norton, New York.

28 Facilitating relaxation Some people who are very tense and anxious find that counselling alone does not sufficiently reduce their symptoms to enable them to feel comfortable. Sometimes it’s advisable to refer such people to a medical practitioner or psychiatrist for assessment so that appropriate medication can be prescribed if necessary7. However, for many people who suffer from tension and anxiety» considerable benefit can be achieved through the use of relaxation techniques. Before introducing a relaxation exercise it is important, as with all other interventions, to check out with the person whether or not this is an exercise in which they would like to participate. This might involve summarising the process so that the person is aware of what to expect. Most people find it easy to learn relaxation, enjoy relaxing and can be encouraged to use it regularly. However, there are a minority of people who find relaxation techniques quite threatening. Instead of becoming relaxed during a relaxation exercise, they experience increased tension and anxiety. For some, this can be severe. Be careful to give the people you seek to help permission to stop a relaxation exercise if they find it is stressful rather than relaxing. For such people it may be useful to explore the stressful experience, if this is not too threatening, because it may well be related to other stressful experiences in their present or past. Preferably, a room used for relaxation should be quiet and have subdued rather than glaring lighting. It should be protected, as far as possible, from external noises such as phones ringing and also from the intrusion of others. It is not helpful to have someone open a door and walk in while a person is trying to relax. There are many different ways of teaching relaxation. The following relaxation exercise is one that we use. If you wish to use it, read the following instructions to the person seeking help using a quiet, slow, monotonous tone of voice. Pause between each statement for a few seconds. RELAXATION EXERCISE Lie on the floor with your head on a cushion, your hands beside you and your legs straight. Move around until you feel comfortable. Close your eyes. You will probably enjoy this exercise and find it pleasurable, but if at any time you are feeling uncomfortable and want to stop, you may either cchoose to lie quietly and ignore my voice, or you may speak up and tell me that you want to discontinue the exercise. Notice where your body touches the floor. Move yourself so that you are more comfortable. Be aware of your whole body from head to toe and stretch any part of you that is uncomfortable. Let your body press down on the floor. Notice the floor pressing up on you. It's a good feeling. You are in contact with the ground and the ground is in contact with you. Notice your breathing. Allow yourself to breathe comfortably and naturally. [Long pause] We are going to go through a series of exercises during which you will relax various parts of your body, starting from the tips of your toes and finishing at the top of your head. For each set of muscles, I will suggest that you tighten those muscles while breathing in deeply, and then relax them as you breathe out. Whenever you remember, say to yourself the word 'relax' as you breathe out. In between relaxing each set of muscles, focus on your breathing again. Breathe naturally and say 'relax' silently to yourself as you breathe out each time. By doing this you will gradually become more relaxed. If any intruding thoughts come into your mind, don't worry, just return to focusing on your breathing again. Notice your breathing now. Each time you breathe out say 'relax' silently to yourself. [Observe the person's body, and notice their breathing. When they breathe out each time say the word relax’ quietly. Do this a few times so that the person remembers to do it themselves] Notice your body. If any parts of it are uncomfortable, stretch or move so that you are more comfortable. Focus on your breathing. When you are ready, I will ask you, as you breathe in, to take a slow, deep breath and as you do this to clench your toes tightly and tighten up the muscles in your feet. [Choose the time] Breathe in deeply and tighten up the muscles in your feet. Hold your breath and keep the muscles in your feet tight for a second or two. Breathe out heavily and release the tension in your feet. Continue breathing naturally and say 'relax' to yourself each time you breathe out. [ Wait for a while as the person continues to breathe naturally] Now tense your thigh and calf muscles as you breathe in deeply. Hold your breath and keep your muscles tense. Relax as you breathe out. Breathe naturally and feel relaxed. [Pause for a while] Tense the muscles in your buttocks as you breathe in deeply. Hold your breath and keep your muscles tensed. Now breathe out and relax.. Breathe naturally and notice a feeling of relaxation flowing up your body from your feet to your buttocks. [Pause for a while] Tense the muscles in your stomach as you breathe in deeply. Hold your breath. Relax. Notice your breathing. [Pause for a while] Clench your fists as you breathe in. Hold. Relax. [Pause a while] Now tense the muscles in your arms and stretch your fingers out as you breathe in. Hold. Relax. Notice a relaxed feeling flow up from your feet through your calves, thighs, stomach, hands, arms and chest. Let your body sink into the floor and feel supported by the floor. Breathe naturally. [Pause] Tighten your shoulder and neck muscles as you breathe in. Hold. Relax. [Pause] Clench your teeth, screw up your face, close your eyes tightly and feel your scalp tighten as you breathe in. Hold. Relax. [Pause] Breathe naturally and notice the relaxed feeling moving up and encompassing your whole body. Be aware of your breathing. Each time you breathe out feel yourself becoming more relaxed. [Long pause] Soon it will be time to start getting in touch with your surroundings again. When you do this, allow yourself to feel good, to be wide awake and alert. [Pause] Notice the floor. Move your fingers and feel it. Wriggle slightly, and when you are ready, open your eyes. Lie where you are and look around. Allow yourself to take in what you see, to feel good, and to be awake and alert. When you are ready, roll over sideways and support yourself with one arm in a half-sitting position. Sit up when the time is right for you. 1 he above relaxation exercise can be taught in a counselling session, and the person can then be encouraged to practise it regularly in their own time. However, warn them about the dangers of being too relaxed. It is not advisable, for example, to drive a car in a very relaxed state. A certain amount of tension is useful so that the person’s reactions to danger are fast. 1 here fore, do not go through the relaxation exercise immediately before the person seeking your help is due to drive away! Once a person has learnt to relax by muscle tensing and relaxing they will find it easier to relax when standing up and in a tense situation. Teach them to take a few deep breaths and each time they breathe in to tighten up their muscles and then relax as they breathe out. With practice they will probably find that they are able to let themselves relax as they breathe out naturally. If teaching relaxation methods appeals to you, we suggest that you might like to learn more from the books listed as further reading below.

Learning summary Use a quiet, slow, monotonous tone of voice when teaching relaxation. Relaxation exercises can be threatening for some people. Make sure that the person seeking help understands that the exercise can be discontinued whenever they like. Observe the person's body so that your instructions are correctly timed. Warn of the danger of being too relaxed when attention is required. Further reading Davis, M., Eshelman, E.K. & McKay, M. 2008, Relaxation and Stress Reduction Workbook, 6th edn, Newharbinger, Oakland, CIA. Payne, K.A. & Donaghy, M. 2010, Payne’s Handbook oj Relaxation Techniques: A Practical Guide for the Health Cate Professional, Elsevier, Edinburgh.