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Symptom management techniques

Although symptom management techniques may not produce fundamental changes, they facilitate progress by reducing distressing feelings, such as anger, anxiety, fear and worry, and making them manageable to enable other behavioural techniques to take place. Three symptom-management techniques are mentioned here: controlled breathing, tension-release exercises and coping cards.

Controlled breathing

he aim of controlled breathing is to restore the oxygen–carbon dioxide balance and acid–alkali balance which can be disrupted because of changes in the breathing rate under conditions of fear or acute stress. The key in controlled breathing is to breathe in from the abdomen, keep the chest still, breathe out slowly and fully and keep a regular pace between breathing in and out with pauses in-between. A way to know that this is done properly is when the abdomen moves out when you breathe in and moves in when you breathe out. This could be difficult to get used to, because most people breathe in from their chest and their stomach tends to move in as they breathe in. It is better to practise abdominal breathing when calm and comfortable in order to master the technique so that it can be used with the first warning signals of psychological arousal.

Tension-release exercises

Tension-release exercises have been established as part of a comprehensive applied relaxation training programme for anxiety conditions. Tension-release exercises aim to control physiological arousal symptoms, such as muscle tension, sweating, pounding heart, light-headedness, ‘butterflies in the stomach’, etc. The person learns to recognize these symptoms early and control them before they reach their peak. This can be achieved by systematically tensing muscle groups in the body for 5 seconds and then releasing them for about 10 seconds. The exercises are first practised for 20–30 minutes in comfortable conditions and then could be done in distress-provoking situations. It is important that: •the muscles are only tensed until the person feels a sense of ‘pulling’; too much pressure may cause injuries or the muscles may not be able to relax after releasing the tension; •the release of the muscles should be immediate and NOT gradual.

Coping cards

The person uses small index cards or pieces of paper or a certain part of their diary to write a few sentences which are: •Encouraging: ‘I have dealt with worse before, this is just fear and I won’t let it get the best of me’, ‘I’m getting better at this all the time’. •Challenging: ‘Don’t jump into conclusions or take it personally’, ‘There is no need to prove myself, I am good enough as I am.’ •Self-instructions or reminders: ‘I must walk away now’, ‘Time to step back and take a breath’, ‘I’ll make a note of this so I can take it out of my mind now and talk about it with my friend later.’

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