Hope, when all hope seems lost: practice makes perfect. (Cont’d from previous blog).

Having established – on the basis of empirical evidence where available – that those approaches briefly reviewed, i.e. autogenic training, visualization, meditation, progressive relaxation, auto-suggestion, are viable and potentially productive, we are now nearing the challenge posed by key questions such as (i) Is there a feasible and practical self-help approach which is therefore applicable in circumstances (as may be the case with you) where a clinician/therapeutic instructor is not readily available? (ii)What kind of daily time periods in training is it likely to realistically entail? (iii)What about the use of tapes/CDs and other recordings, where one might enlist the help and support of a trusted “other” in this regard? and (iv) How long is it likely to take before one can expect to experience real and ongoing benefit?You will have noted that I used the word “almost” in the final sentence of the penultimate paragraph of my last blog to you. This is because there are still one or two basic but nevertheless crucial points about strategy design and the prevailing circumstances /environment etc. to be created needing to be made. Strategy design, or method, is of course in this case in my hands, it is my hope and intention to include a short sample script for trial in the near future.

In general terms, I would expect any approach of this kind to meet need on a fairly broad front and provide the necessary motivation for regular and systematic use in application. In other words, it should be simple to follow, interesting and enjoyable in practice and able to facilitate the flow of fairly immediate positive feedback to the user. My own script should demonstrate that given a modicum of imagination, the use of a tape recorder· and possibly the help of a friend possessing good and clear diction, such an auditory aid to relaxation therapeutic strategy can be readily and successfully ‘assembled’ by someone of your own choosing and managed to a very acceptable degree of success. This also of course, assumes willingness to persevere and the necessary motivation and determination to succeed on your (or the users) part. Nevertheless, the point requires also to be made that there are limits as to how much one might ‘pare away’ (time wise that is) and regular practice will continue to be necessary, if satisfactory and a sustained level of progress is to be achieved.

Let me employ an appropriate analogy here, which hopefully, will clarify the point. I have already made brief reference to the fact that I was, as a child, introduced to the cornet and trumpet. Now, over 75 years on,· I did, until s0me ten years ago, still manage around 30 minutes practice daily. Even reasonably competent brass players will tell you that actual playing can only be satisfactorily and reliably based on a sufficiently robust ‘platform’ of for instance, embouchure·· maintenance and control, diaphragmatic breathing in aid of musical phrasing and satisfactory interpretation of the music being attempted; techniques of tonguing – single, double and triple; fingering and finger dexterity etc. and all of this and more beside, before the music – whether in tutti, i.e. all together or solo performance – is ever played out. What I can assure you of is that whether it is in the playing of a musical instrument, pursuit of proficiency in a chosen sport or applying a proven strategy in pursuit of relaxation, all must ‘bow’ to the old maxim, “if you don’t use it, you’ll lose it” for as the old saying goes: “even Paderewski needed the odd lesson and a little practice”.

As we have seen previously, consideration of the ‘backcloth’ against which any self-applied method of relaxation training is to be set, is similarly important. This of course encompasses (as well as much else besides) the amount of fresh air and gentle exercise that one is able to take in during the course of an average day and which is likely to vary. If you are well enough to get out of the house for a spell, a short walk (and preferably two well spaced walks) taken at a comfortable pace, should certainly be part of your daily itinerary. If, for whatever reason this should not prove possible, a walk around the house at intervals (making appropriate use of steps and stairs where present) will certainly contribute. Simple ‘do-able’ and permissible exercises of bending and stretching will also help. There is a good deal of dietary advice around and once again, you simply cannot go wrong with literature from, for instance CancerMacmillan.

Also, bear in mind that few of us take enough fluid (of the right kind, e.g. water) on board. And in this regard, remember too that injudicious intake of alcohol especially, can increase tension and induce irritability. From time to time, alcohol – in the form of a small brandy or whatever – is taken as a ‘nightcap’. As we shall see in my blog to you concerning preparation for night sleep, there are sound reasons for avoiding or abandoning such a practice altogether, which you might at least like to take a look at. Moreover, whilst relaxation techniques are certainly likely to aid sleep, it is important from the outset to teach the body and brain to clearly distinguish between relaxation training designed and intended to arouse and motivate into daytime wakefulness and activity intended to be a prelude to and precursor of night sleep. Let me explain.

Sometimes in discussion, a patient will mention that the relaxation approach must be working, because although he/she hadn’t of late been sleeping too well, he/she is now actually falling asleep during daytime sessions. This does in fact raise an important preliminary but quite basic issue about relaxation, which I will attempt to deal with here. In my view and experience, it is important to train the self (which, as it happens is relatively easily achieved) to clearly and unerringly make the following distinction. I refer to that between, on the one hand relaxation training which has been designed to optimize daytime interest and activity, i.e. ability to concentrate and to respond with appropriate alertness to all internal and external stimuli; and on the other, relaxational persuits and procedures, which are a prelude to night sleep. The former – again in my opinion – requires a formula of words, which make it both implicit and explicit that daytime interests, pursuits etc. are what are being envisaged. Moreover, this should be undertaken wherever possible, when one is in daytime attire and well away from the ‘sleeping quarters’. This allows for the latter to quickly condition in a paired association with night attire and should also contain clear and unambiguous reference throughout to what is to follow, i.e. night sleep.

My advice to the patient, who finds him/herself being drawn into sleep when undergoing daytime relaxation training, is to resist and never succumb to it. If you think about it, when you have been tense and ‘wound up’ for days on end and then, in a comfortable and reclined position are able to relax somewhat, the obvious will happen, i.e. you will sleep. It is better therefore – at least until some degree of equilibrium is restored – to employ appropriate relaxational exercises and pursuits only at night time, when sleep should come, as determined by and in keeping with your “biological clock”. Following a night or so of improved quality sleep, it should thereafter be possible to re-focus your attention on your intended programme of daytime progressive relaxation training, once you are washed and dressed and breakfast is behind you, that is. Remember too, what I stated in a previous blog, concerning the need for and support that we receive from the “old coat hanger”, i.e. routine. Make a mental note of priorities for the day, not late in the evening when you are tired and preparing for rest and sleep, nor at the very moment of waking from sleep. Bear in mind that the ordering of all such activities are best perceived to fall under the rubric of “daily routine” and that getting out of your nightclothes and into daytime attire, sends important messages to both body and brain. Once dressed, then “line up” (as it were) the day’s activities and as far as is possible, stick with your plan.

When in your daily dealings with others (including family members and close friends) try not to commit yourself to be bound, or indeed, to attempt to bind others, to unrealistic promises or commitments. Also, remember that dependability and reliability are just as important to you, i.e. internally, as they are to others, whosoever they may be. Once again, I can heartily recommend my father’s old and well-worn maxims of, “Let life unfold” and “Be guided by events” and to which I have alresdy referred at length in earlier blogs concerning the management of serious and life threatening illnesses.

  •  Cassette tape recorders as, such,  are now, However, there are a variety of similar up-to-date and readily available voice-recording devices available for purchase giving very satisfactory results. Internal or “integral” microphones are not a good idea, as any recordings made in this way will almost invariably pick up a hum/buzz from the machine.
  • Written in 2005
  • · The musculature of the lips and face which are trained to meet the demands of playing a brass  instrument.
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