Encourage acceptance of a diversity of perspective

Lots of people have visual images either instead of or along with their other automatic thoughts. But usually we don't realize it. Sometimes images seem pretty strange, but actually it's common to have all kinds of images--sad, scary, even violent ones. Moreover, when our inner life is solely intellectual and we don't pause to attend to emotional communication, we may experience a loss of purpose and meaning, as the following story exemplifies. Frank: The Doctor Who Learned That He Had More to Offer than Just Medical Skill Frank graduated at the top of his class from one of the most prestigious medical schools in the country. Intent on creating the best medical practice for cancer treatment, he brought together a distinguished group of specialists dedicated to saving lives through an aggressive assault on the disease. Frank did this when chemotherapy and radiation were still in their infancy, over twenty-five years ago. Single-minded and confident of his skills as a physician, he took it as a personal failure (though he knew better) when patients nonetheless died. After only twelve years--as many years as he had spent in train-ing--and despite the fact that his practice had become the most popular oncology office connected to a major metropolitan hospital, Frank was ready to walk away from medicine. Then he met Sybil. By the time Sybil's cancer was diagnosed, it had spread throughout her body and there was little hope for her recovery. You might think you know how, but you might be surprised: Count to four as you breathe out. You can do this sitting, standing or lying down. When you breathe out, do it with a `whoosh' sound though your mouth. If your hand on the chest moves too fast, or in too many directions, or in uneven rhythmic movements, you're not doing it right. No need to panic. Just keep in mind that breathing is not about how much air you can hold in your lungs or for how long.

Let it be natural, slow, and steady. YAWNING IS GOOD FOR YOU A yawn is nothing more than your body demanding more oxygen. Here we use simple self-talk to acknowledge the feeling is present. We silently say to ourselves something like: `I'm noticing fear', or `Here's a feeling of fear', or `Here's fear. Note the difference between `Here's fear' and `I'm afraid', or `I'm noticing fear' versus `I'm scared'. If we use a phrase such as `I'm noticing . Our feelings are transient events, continually passing through us and changing like the weather. They do not define who we are or dictate what we do. Step 3: Make room Here we `breathe into' the feeling, psychologically `open up' and `make room' for it. When we breathe deeply, it helps to anchor us in the present, and when we `direct' our breath into and around the feeling, it helps us to drop the struggle with it. The fear is still present, but the more space we give it, the less impact and influence it has on our behaviour. The only problem is if you think you're strange for having an image. MODIFYING SPONTANEOUS NEGATIVE IMAGES There are two kinds of spontaneous negative images you'll address in treatment. The first kind occurs repeatedly and is experienced as intrusive. You can view them as an unhelpful thought process and use mindfulness techniques (article 16). When images aren't part of a thought process, there are several strategies you can teach clients: changing the movie, following the image to completion, and reality testing the image. Advise clients that they'll need to practice the techniques in and out of session to use them effectively when their distressing images spontaneously arise.

Changing the Movie LENNY reported a spontaneous image he had recently. He saw himself sitting alone in his apartment during the upcoming weekend, feeling sad and lonely. Frank saw her several times in the office before she needed to be hospitalized. During the holidays, Frank's visits to patients in the hospital were always quick. Vital signs would be checked, he would ask patients if they were comfortable, and he might order pain medication before hurrying on. On Christmas Eve the hospital was empty, the staff greatly reduced, and the corridors quiet. Nonetheless, Frank was in his usual hurry. But before he could dash out of Sybil's room, she asked him why he was in such a rush to leave. Dumbstruck by her question, Frank turned around and blinked. Sybil continued, I have the distinct impression that you can't bear the fact that I am dying. Shocked by her statement, all Frank could do was stare at Sybil and mutely nod. Thus began the closest friendship Frank had ever known. So next time you feel your mouth widening, take a huge gulp of air to satisfy your lungs. Get acquainted with your diaphragm The diaphragm, placed under the lungs, is a muscle. It separates the abdominal cavity from the chest cavity and supports the lungs. Once you inhale, the diaphragm flattens as the lungs put pressure on it so there's maximum space and the chest cavity expands. Lungs fill up with oxygen, and on exhaling the diaphragm returns to its normal shape. Since the diaphragm is a dome-shaped muscle, it is very important to learn diaphragmic breathing.

It's the most effective way to get oxygen in and carbon dioxide out and increase your lung capacity. All this helps to tide over stressful situations in our lives. People think forceful breathing or deep breathing is enough. Step 4: Expand awareness Having created space for this feeling, we need to re-engage with the world around us. This last stage draws on our engagement skills: we continue to notice the feeling and simultaneously connect with the world around us. Okay, so that's the summary. Now I'll take you through it in detail. Before we commence, you'll need to dredge up some fear so you've got something to work with. So look back on your values-guided goals from article 13, and find one that brings up fear. Now imagine yourself taking some sort of action towards this goal: sitting down to write that article, attending that interview, asking that person for a date, taking out that business loan, enrolling in that course, entering that tournament, going for that audition. Imagine it as vividly as you can: as you take this action, what are you doing with your arms and legs? What can you see, hear, touch, taste and smell? I educate him about images and help him create a new movie. PAULINE: LENNY, you don't have to be at the mercy of your images. You can change them, if you want. It's as if you're a movie director. You can decide how you want them to be instead. LENNY: I'm not sure I understand how to do that. PAULINE: Well, okay, you said you saw yourself sitting on the couch, feeling really sad.

What do you wish would happen next? LENNY: Umm, maybe that my daughter calls and invites me over for dinner. PAULINE: Can you imagine picking up the phone? He asked Sybil why she had no visitors and was alone at a time like this. She told him, It's OK. I've sent my daughter and husband away because they get on my nerves. I think they probably love me, but their heads are so full of relentless chatter that they can't make space between the words to pay attention to me. Intrigued, Frank sat in a chair by Sybil's bedside and asked what she needed from him. I want to you to stay with me while I die. I don't know that I know how to do that, Frank blurted out. I'll teach you, she said. And so she did. During the next ten days, Frank spent as much time as he could with Sybil before she died, and he learned to communicate in an entirely new way. Your diaphragm needs to be strengthened. Your heart rate and BP go up when you breathe incorrectly. Sometimes, you feel light-headed or giddy and then stressed because your body isn't getting enough air. Here's how you can exercise your diaphragm. Inhale slowly till your lungs are full of air. Note that only your upper abdomen should move, while the lower abdomen and upper chest should remain still. Practise it regularly and at least for one day before you start on the breathing exercises.