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Mindfulness-Based Stress Reduction (MBSR)

A Neurobiological Approach

Mindfulness & Neurobiological

Tools for Healing - A Training Resource

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T

Mindfulness-Based Stress Reduction (MBSR)

8-Week Program

Mindfulness-Based Stress Reduction (MBSR) Train the Trainer Certificate Program

8 CEU's in an 8 weekly session awarded by COPING.US Training Programs (CE Broker Tracking #: 20-680150). This Program is approved by Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling for: LMHC's,LMFT's, LCSW's & CMSW's and Florida Board of Nursing for: RN's, ARNP's, LPN's & Clinical Nurse Specialists

Resource for Course on

1. Mindfulness-Based Stress Reduction - A Neurobiological Approach at:

2. Pain Management - A Neurobiological Approach at:

Program Description:

This program is geared to train mental health professionals who want to present the 8 Week Mindfulness-Based Stress Reduction program known as MBSR in their respective offices, agencies, hospitals or community. The MBSR program is an evidence based program to alleviate clients’ unhealthy stress in their lives as well as an effective tool used in an interdisciplinary setting for Non-Medication Management of Pain. The program will review the research in both stress and pain management as well as put the participants through an 8 week MBSR course with daily follow-up which includes practicing the specific meditation exercise presented in each weekly session along with daily logs on the formal and informal practice of these exercises and reviewing relevant Literature, Videos, Reading and Apps which the trainees can include in their own future MBSR programs they will conduct.


Learning Objectives: 

After participating in the program the participants will:

1. Learn about the underlying methodology, philosophy and intentionality of the MBSR program by reviewing all the relevant literature and research made available in this training program

2. Learn about each of the key components of the 8 weekly sessions which include overview of the psychology behind the meditation exercise to be presented that week along with supportive documentation which expands the theoretical underpinnings of the therapeutic model presented.

3. Learn about the daily exercises they will put their clients through when they present their own MBSR training programs including how to assist clients to keep a daily log as they practice the specific meditation presented in their weekly class.

4. Learn about the various assessment which can be utilized to assess if their clients first need the MBSR program to address their stress and/or pain and then to do follow up assessments once their clients complete their MBSR program.

Mindfulness-Based Stress Reduction (MBSR)

Train the Trainer Certificate Program

Location: Troy University Tampa Bay Site 5201 W. Kennedy, Suite 110, Tampa, FL 33609

Time: Fridays 5:30 to 7:30 pm

Term 2, 2019 (Cohort #5)

8 CEU's in an 8-weekly session Program (CE Broker Tracking #: 20-680150)

RSVP to save your seat for this program, by emailing your name, regular email and your License or Registered Intern # (if you have one) to:

(NOTE: Enrollment for this program is 12 students only for each term)

Term 2/2019, Fridays October 11- Dec 6, 2019

Weekly Schedule

Week 1: Oct 11  

Week 2: Oct 18

Week 3: Oct 25        

Week 4: Nov 1

Week 5: Nov 8

Week 6: Nov 15

Week 7: Nov 22

Week 8: Dec 6

On this Web's page you will find all of the PowerPoints, links to online video’s and Handouts for this 8 week program.


What you need to have before the first week session: Please download on your phone, tablet or computer the JKS Series #1, #2 & #3 which are the Mindfulness Meditations by Dr Jon Kabat Zinn which will be used in this program.

Outline of 8 Week MBSR Program

Week 1:

In class: Cover the specifics of conducting the 8-week program and introduce the participants Meditations beginning with the Body Scan Meditation (45 min) - JKZ Series #1 and

Introduce Mindfulness with the Raisin Exercise and the 9-Dot Puzzle.

Video for in class:

1. Shel Silverstein's The Missing Piece Click Here to Watch Video

2. Mindful Chair Yoga Click here for: A Brief 15 Minute Beginner's Practice


Week 1 Handout: The Missing Piece Click here to download Handout

Alternative PowerPoints for in class:

1. What is Stress & Its Impact on Health Click Here to Download the PowerPoint

2. Neurobiology of Improving One’s Mental Health Click Here to Download the PowerPoint

3. Low Self-Esteem: The Hidden Roadblock to a Full Healthy Self-Rolling Life Click Here to Download the PowerPoint

Post In-person Class Practice: Read The Body Scan Meditation. Do the Body Scan at least six times this week. Just let your experience be your experience. Record your experiences this week on your daily chart form.

Week 1 Practice Log Click Here to Download

Week 1: Handout Body Scan Click Here to Download

Week 1 Handout: 9 Dot Puzzle Click Here to Download

Week 1 Handout: Raisin Exercise Click Here to Download

Additional Homework after Session 1

In providing this training It has been found that many of the participants found it difficult to close their eyes during the JKZ meditations. For this reason we now are opting to provide the following two documents to participants to do as homework. They are an explanation of the use of Mandellas in meditations and the second are three sample Mandellas to fill in. We also give a box of 8 crayonts to the participants so that they can color in the Mandellas offered:

Week 1 Homework Mandala Meditation Instructions Click Here to Download

Week 1 Homework 3 sample Mandalas for Meditation Practice Click Here to Download 

Reading Homework:

Mindfulness & NeurobiologicalTools for Healing A Training Resource at:

Week 2:

In class: Use the Sitting Meditation (40 min) JKZ Series 1 #3

along with assorted readings and videos


1. The Little Engine That Could Click Here to View Video

2. Mindful Chair Yoga Click here for: A Complete Beginners Practice (40 min)

PowerPoint in class: You can Do It! Lessons from the Little Engine that Could Click Here to Download

Handout: What Percentages of Each Engine are You in Your Self-Care Click Here to Download

Post In-person Class Practice: Read the description of the Sitting Meditation. Between now and next week, practice at least six times, alternating the Sitting Meditation with the Body Scan. Just let your experience be your experience. Record your experiences this week on your daily chart form.

Week 2 Practice Log Click Here to Download

Week 2: Handout Sitting Meditation Click Here to Download

Reading Homework:
Self-Esteem Seekers Anonymous-The SEA's Program Manual at:

Laying the Foundation:Presonality Traits of Low Self-Esteem at:

Week 3:

In class:


1. The Actual '73 Giving Tree Movie Spoken By Shel Silverstein Click here to View Video

2. Mindfulness Chair Yoga Click here for: A 45 minute Practice

3. Sitting Meditation (10 minute) JKZ Series 2 #1

and with assorted reading and videos

Handout:The Giving Tree Keeps Giving Click Here to Download

Post In-person Class Practice: Read the description of Mindful Yoga. Practice at least six times this week, alternating Mindful Yoga 1 with the Sitting Meditation (e.g., three of each). At least one of the days, do a Body Scan. Just let your experience be your experience. Record your experiences this week on your daily chart form.

Week 3 Practice Log Click Here to Download

Week 3:Handout Mindful Yoga Click Here to Download

  • We will be using Mindful Chair Yoga: A 30 Minute Beginner Practice for Week 3 and 40 Minute Beginner Practice for Week 4 so as to learn how to help folks with physical impairments to perform Yoga Stretches in a safe manner. Click Here to View Video: Mindful Chair Yoga: A 30 Minute Beginner Practice
  • Additional Mindfulness Chair Yoga exercises are available at: MindfulChairYoga
  • There is also an additional video emphasing use of chair for Yoga 1 to use in Week 3 It is called MBSR Yoga 1 with emphasis on chair poses Click here to view.

Reading Homework:

Tools for Personal Growth at:

Tools for Handling Loss at:

Week 4

In class: Use the Mindful Chair Yoga and One-Minute Breathing Space with assorted readings 


1. Precious Present Click Here to View Video or Alternate Video Precious Present Click Here to View VIdeo

2. Mindful Chair Yoga Click here for:  Cultivating a Healthy Relationship with Thoughts and Feelings (30 min)

3. Sitting Meditation (20 min) JKZ Series 2 #2


Handout: Reflectons on "The Precious Present" Click Here to Download

Handout: What Can We Learn from “The Precious Present?” Click Here to Download

Post In-person Class Practice: Practice at least six times this week, alternating Mindful Yoga 1 with the Sitting Meditation. Also practice One-Minute Breathing Space during the week.  Just let your experience be your experience. Record your experiences this week on your daily chart form.

Week 4 Practice Log  Click Here to Download

Week 4 Handout STOP one-minute breathing Click Here to Download

  • We will be using Mindful Chair Yoga: 30 Minute and 40 minute Beginner Practice for Week 3 and Week 4 so as to learn how to help folks with physical impairments to perform Yoga Stretches in a safe manner. Click Here to View Video: Mindful Chair Yoga: A 40 Minute Beginner Practice
  • Additional Mindfulness Chair Yoga exercises are available at: MindfulChairYoga
  • There is also an additional video emphasing use of chair for Yoga 2 to use in Week 4 It is called MBSR Yoga 2 with emphasis on chair poses Click here to view.

Reading Homework:

Tools for Handling Control Issues at:

Tools for Anger Work-Out at:

Week 5

In class: Use any Sitting Meditation and Mindful Chair Yoga and introduce Soften, Soothe, Allow- with assorted readings and videos Note: Week 5 has two options. Option1: Difficult Emotions or Option 2 Dealing with Physical Pain


1. Shel Silverstein's The Missing Piece Meets the Big O Click Here to Watch Video

2. Mindful Chair Yoga Click here for: A Practice for Legs (30 min)

3. Sitting Meditation (30 min) JKZ Series 2 #3 and Breathscape (20 min) onJKZ Series 3

4. Need to relax? Take a break for meditation from Mayo Clinic Click Here to View Video


Week 5 Handout: Are You a Missing Piece? Click Here to Download Handout

Week 5 Handout for both options: Five-Step Model of Mindfulness Click Here to Download
Week 5 Handout for both options: Soften, Soothe. Allow Click Here to Download

Post In-person Class Practice: Practice at least six times this week, alternating Sitting Meditation (guided or unguided) with either the Body Scan or Chair Yoga. On the first day, though, try the Soften, Soothe, Allow Meditation. The Soften, Soothe, Allow Meditation is 15 minutes long, so on that day, you will have a shorter practice session (if you’d like a full 30 minutes, you can add silent meditation on your own that day). Record your experiences this week on your daily chart form.

Week 5 Practice Log with Physical Pain  Click Here to Download
Week 5 Practice Log with Difficult Emotions Click Here to Download

Week 5 Option 1 Handout: Turning Toward Difficult Emotions Click Here to Download

Week 5 Option 2 Handout: Turning Toward Physical Pain Click Here to Download

Reading Homework:

Growing Down - Tools for Healing Your Inner Child at:

Week 6:

In class: Use the Mountain Meditation from Series 2 with a discussion of Dealing with Change along with assorted readings and videos


1. Who Moved My Cheese Click Here to View Video

2. Mindful Chair Yoga Click here for: Cultivating a Healthy Relationship wiith Thoughts and Feelings (45 min)

3..Mountain Meditation (20 Min) on JKZ Series 2 and Bodyscape (20 min) JKZ Series 3

Powerpoint: The “Who Moved My Cheese” Personal Change Agent Model Click Here to Download

Handouts: Self-Assessment of Beliefs about Change Click Here to Download

The Handwriting on the Wall Self-Assessment  Click Here to Download

Post In-person Class Practice: Practice at least six times this week, doing either a Body Scan, Chair Yoga or Sitting Meditation (guided or unguided). Also, do either the Mountain Meditation or the Lake Meditation at least once. As before, don’t expect anything in particular. Just let your experience be your experience. Record your experiences this week on your daily chart form.
Week 6 Practice Log  Click Here to Download
Week 6 Handout Conflict Management Styles Click Here to Download
Reading Homework:

Tools for Relationships at:

Marriage Work-Out Team Building Manual at:

Marriage Work-Out A Marital Enrichment Online Workbook at:

Week 7

In class: Use Lake Meditation from Series 2 with a discussion of The Three Elements of Self-Compassion along with assorted readings and powerpoints.


1. Mindful Chair Yoga Click here for: A Playful Practice (20 min)

2. Lake Meditation JKZ (20 min) Series 2  and Soundscape (27 min) JKZ Series 3

PowerPoint: Creating the NOW Attitude “Our Iceberg is Melting” Model Click Here to Download

Handout: Overcoming Complacency in Quest of Improved Physical & Emotional Health Click Here to Download

Post in-person Class Practice: Practice at least six times this week, doing anything you’ve learned up until now (Body Scan, Sitting Meditation, Chair Yoga), with or without guidance. As before, don’t expect anything in particular. Just let your experience be your experience. Record your experiences this week on your daily chart form.

Week 7 Practice Log Click Here to Download
Week 7 Handout Three Elements of Self-Compassion Click Here to Download
Reading Homework:

PATHFINDER Parenting:Tools for Raising Responsible Children at:

Week 8:

In Class: Use any of the Mindscape meditation and review Cultivating Mindfulness: Beginning or Deepening a Personal Meditation Practice and Suggestions for Daily Practice


1. Mindful Chair Yoga Click here for: A 45 minute Practice through Playfulness

2. Mindscape (20 min) JKZ Series 2 & Lovingkindness/Heartscape (47 min) JKZ Series 3


Clinical Assessment Tools Click Here to Download


Week 8: Clinical Assessment Tools Available on Click Here to Download

Week 8: Mandala Meditation Instructions Click Here to Download

Week 8: RELAPSE System Click Here to Download

Week 8: Handout Developing a Practice of Your Own Click Here to Download

Reading Homework:

Tools for a Balanced Lifestyle: A Manual for a Guilt Free System of Healthy Living at:

NOTE: on Reading Homework in the following MBSR Training 8 Week outline
Each week Trainees will be given selections from to review. It is suggested that trainees go over the table of contents and select relevant topics which they believe their protential audiences in their MBSR training sessions they will conduct would be most interested in reviewing to lessen the stress, anxiety, tension and depression in their lives. These reading homework assignments are not intended to be the only sources of outside documents which trainees would like to consider to bring to their potential audiences.
NOTE: To help to enhance each of the weekly sessions be sure to utilize the tools available on listed at the beginning of this Stress Management section BELOW.

Resources on Related to Stress Management

Tools for Mindfulness, Meditation, Stress Management and Sleep Enhancement at:

Pain Management - A Neurobiological Approach at:

Improving Your Sleep Using Mindfulness and Other Neurobiological Tools at:

Introduction to Neuroscience For Mental Health Professionals at:

Dealing with the Opioid and Heroin Epidemic A Training Resource at:

Suicide Intervention and Prevention Strategies A Training Resource at:

Behavioral Medicine for Mental Health Professionals  A Training Resource at:

Motivational Interviewing - A Training Resource at:

Tools for Coping Series at:

How to Proceed to Assist Clients Cope

with Unhealthy Stress in Their Lives

If clients come to you saying they want help with dealing with the stress in their lives here are four steps to take prior to enrolling them in your MBSR Program.:

First: It is important that you ask for a release of information so that you can read their medical records and understand better what are the sources of stress and if such stress is based on some existing medical condition if and if there is a medical condition what has been attempted previously to help them to relieve their stress due to their medical condition.

Second: If the clients have been to other professionals to address their stress-related issues then you need releases of information so that you can get reports on their treatment and progress of these clients in working with them.

Third: Before developing a plan for your clients you must be sure to do a complete Initial Clinical Assessment ( which includes exploration of ACE Factors ( and history of any other major medical, social or interpersonal traumatic events which might account for the severity and duration of their stress.

You might also want to use the Social Readjustment Rating Scale (SRRS) - The Holmes and Rahe Stress Scale. More information on this scale is available at:

Fourth: It is important once the initial assessment is completed that you then utilize Motivational Interviewing Strategies ( to determine if the clients are actually ready to do the work necessary to deal with their stress as a reality of life, to work seriously at following through with the steps being outlined for them to pursue to lessen the impact of stress in their lives.

Fifth:Introduce your clients to an already existing program in your setting in which you would hope they would  be willing to become a part of. In your setting set up a modified SEA's 12-Step Program which is modified to meet the needs of your client populations which is conducted on a weekly basis with no time limits. This program's manual and supportive document is available at:Self-Esteem Seekers Anonymous-The SEA's Program Manual at:

 Tools Use in Mindfulness-Based Stress Reduction (MBSR)

8-Week Program

Resources Used to Develop this 8 week modified MBSR program for use in a variety of mental health settings.

  1. Santorelli, S.F., Meleo,-Meyer, F. & Koerbel, L. (2017). Mindfulness-Based Stress Reduction (MBSR) Authorized Curriculum Guide. Center for Mindfulness in Medicine, Health Care and Society at University of Massachusetts Medical School. Downloadable at:
  2. Palouse Mindfulness -  Online Mindfulness-Based Stress Reduction (MBSR) Course Manual. Downloadable at:
Tools Needed for the 8 week MBSR Program:
Audio Programs of Jon Kabet-Zinn's Meditations to be used in the 8 Week Course are in the first series of programs in the availabe two sets of programs which can be aquired through Better Listen: To purchase these 3 series of MBSR Meditations go to:
JKZ Apps Each of the three volumes of Jon Kabet-Zinn's Meditations are also available at the Apple Apps store. Each volume can be downloaded to your devices for easier availability. Each App costs $10.00.

Use of the Guided Mindfulness Meditation Audio Programs

Series 1 – Which are used in the 8 Week MBSR Course

Track 1: Body Scan Meditation

Track 2: Mindful Yoga 1

Track 3: Sitting Meditation

Track 4: Mindful Yoga 2


Dr Jon Kabat Zinn suggests the following:

I suggest you start by doing the body scan meditation (track # 1) for two weeks straight before going on to alternate with the guided mindful yoga 1 (track # 2) for another two weeks, one program per day. If the yoga is too strenuous for you (it is quite gentle actually, and you are encouraged to do it to your own capacity and visualize yourself doing whatever parts of it you are not yet ready to try), you can just alternate between the body scan and the guided sitting meditation (track # 3). The postures for both yoga tracks are outlined in Full Catastrophe Living.


The volume of my voice on the yoga tracks drops in certain places because I am speaking as I am doing the postures myself. This is not a defect in the program. Just follow along as best you can. The volume comes back up as the posture releases.


After four weeks with tracks 1 and 2, you can introduce the guided sitting meditation practice (track # 3) and alternate it for the next two weeks with mindful yoga 2 (track # 4), or with the body scan or mindful yoga 1, depending on your inclination. In week seven, you are encouraged to try to keep up the practice for a week without the tracks, using whatever combination of practices you care to.


In week eight, you are encouraged to return to the tracks, and use whichever ones make the most sense to you as you develop your own unique meditation practice, hopefully for the rest of your life. Of course, you can always combine the various practices in any way that you care to, at any time.


After practicing these guided meditations, you are likely to find that you are more mindful in your life at other times as well. This is a natural benefit of mindfulness practice. You can deepen this process by intentionally bringing awareness of your breathing and of your body as a whole into as many moments as you can in your everyday life. Practicing in this way can help you to see stressful situations with greater clarity

Book by John Kabat-Zinn related to Series 1 of JKZ series is:  Kabat-Zinn, J. (2013). Full catastrophe living- Using the wisdom of your body and mind to face stress. Bantam Books: New York 

Click here for Link for Book on Amazon


Series 2

Tracks 1, 2, 3 Sitting Meditations

Tracks 4, 5, 6 Lying Down Meditations

Track 7 Mountain Meditation

Track 8 Lake Meditation

Track 9 Silence with bells at set times: 5, 10, 20, and 30 minutes

Track 10 Silence with bells at random times


Dr Jon Kabat Zinn describes the Series 2 set of mediations:

The first three guided sitting meditations introduce you to the basic elements of formal mindfulness meditation practice, including both the inner and outer attitude reflected in your posture and in the quality of your attention. You can work up progressively from the ten-minute version to the twenty-minute one to the thirty-minute one as your concentration and awareness deepen over time.


The guided meditations on track 4-6 are aimed at cultivating mindfulness while lying down, preferably on your back. This may require that you learn how to “fall awake,” which is, after all, what mindfulness is about, instead of falling asleep, which is easy to do when lying down and becoming more and more relaxed.


The mountain meditation and the lake meditation evoke two powerful images that may help you to deepen your concentration, broaden the field of your awareness, and expand your feeling for the inward gesture involved in mindfulness practice. Ideally, the mountain meditation should be done sitting, and the lake meditation lying on your back.


Silence with bells provides an opportunity to practice on your own, without my guidance, once you have the feel for it from the other programs. This involves just hearing whatever is here to be heard in any moment, whether it is silence or sound.

Book by John Kabat-Zinn related to Series 2 of JKZ series is: Kabat-Zinn, J. (2005). Wherever you go, there you are: Mindfulness Meditation in every day life. Tenth Anniversary Edition. Hyperion Books: New York

Click here for Link for book on Amazon

Series 3
1. Breathscape (20 min)
2. Bodyscape (20 min)
3. Breathscape and Bodyscape – More Silence (20 min)
4. Soundscape (27 min)
5. Mindscape (20 min)
6. Dying Before You Die (30 min)
7. Nowscape (30 min)
8. Walking Meditation (10 min)
9. Heartscape (47 min)
10. Lifescape (12 min)

In his own words, Jon Kabat-Zinn introduced this series as: these Series 3 guided meditations are tools that invite and reward something more than a casual listening. They are designed to be used on a regular basis to help you develop and deepen a daily meditation practice and thus to strengthen the qualities of mindfulness (moment to moment non-judgmental awareness), compassion, including self-compassion, and lovingkindness in every aspect of your life.

Book by John Kabat-Zinn related to Series 3 of JKZ series is: Kabat-Zinn, J. (2006). Coming to Our Senses – Healing ourselves and the world through mindfulness. Hyperion Books: New York
Use of Mindful Chair Yoga in the 8 Week MBSR Program

NOTE: give that the majority of the treinees in this MBSR Train the Trainer Program, will be working with people who have some limitations physically. For this reason we strongly recommend that each week one of the following Mindful Chair Yoga Videos be utilized:

Mindful Chair Yoga Practices for MBSR Program (Your choice of which to use each week)


Mindful Chair Yoga: A Brief 15 Minute Beginner's Practice:

Mindful Chair Yoga: A Complete Beginner's Practice (40 minutes):

Mindful Chair Yoga: A 45 Minute Practice:

Mindful Chair Yoga: A Practice for the Legs (30 min):

Mindful Chair Yoga (30 min) Cultivating a Healthy Relationship with Thoughts and Feelings:

Mindful Chair Yoga (45 min) Cultivating a Healthy Relationship with Thoughts and Feelings:

Mindful Chair Yoga: A Playful Practice (20 min):

Mindful Chair Yoga: A 45 Minute Practice:Through Playfulness

Mindfulness-Based Stress Reduction (MBSR):

An Evidence Based Treatment of Stress

Forward, From his own words

Dr Jon Kabat-Zinn in 2013 revised his original work on MBSR called: Full Catastrophe Living, nine years after he found the Stress Reduction Clinic at the University of Massachusetts. From the beginning of MBSR, he states that he bent over backward to structure it and find ways to speak about it that avoided as much as possible the risk of it being seen as Buddhist, ‘New Age,’ ‘Eastern Mysticism’ or just plain ‘flakey.’ To his mind this was a constant and serious risk that would have undermined his attempts to present it as commonsensical, evidence-based, and ordinary, and ultimately a legitimate element of mainstream medical care. This was a challenge given the entire curriculum he created was based on intensive training and practice of meditation and yoga which at the time pretty much defined one element of the “New Age.” He admits he was too shy and worried how his MBSR model would be accepted but then in 2011 he pointed out that: “We can observe an accelerating confluence of dharma with mainstream medicine, healthcare, cognitive science, affective neuroscience, neuroeconomics, business, leadership, primary and secondary education, higher education, the law, indeed, in society as a whole, in this now very rapidly changing world”(Kabat-Zinn, 2011, p.284). He later in this same article stated that: “The challenge for the participants was to just do the work from week to week, in other words, to practice the curriculum as it was being unfolded, and see what would happen. The emphasis was always on awareness of the present moment and acceptance of things as they are, however they are in actuality, rather than a preoccupation with attaining a particular desired outcome at some future time, no matter how desirable it might be. One major principle that we committed to was, and still is, never asking more of our patients in terms of daily practice than we as instructors were prepared to

commit to in our own lives on a daily basis” (Kabat-Zinn, 2011, p.290).


In his book Full Catastrophe Living (Revised Edition) 2013, Jon Kabat-Zinn reports: “By the end of eight weeks, when the program comes to an end, their smiles and more relaxed bodies are evident to even the most casual observer. Although they were originally referred to the clinic to learn how to relax and to cope better with their stress, it is apparent that they have learned a lot more than that. Our outcome studies over many years, as well as participants’ anecdotal reports, show that they often leave with fewer and less severe physical symptoms and with greater self-confidence, optimism, and assertiveness. They are more patient with and more accepting of themselves and their limitations and disabilities. They are more confident about their ability to handle physical and emotional pain, as well as the other forces in their lives. They are also less anxious, less depressed, and less angry. They feel more in control, even in very stressful situations that previously would have sent them spinning out of control. In a word, they are handling “the full catastrophe” of their lives, the entire range of life experience, including impending death in some cases, much more skillfully (Kabat-Zinn, 1990. 2013).”

Sources of Material to be used in MBSR programs:

You can get a better look at Jon Kabat-Zinn at this website: however you will need to use another site to purchase the recorded meditations used in the 8 week MBSR Program. To purchase the three series of MBSR Meditations for the 8-week program go to:

Mindfulness-Base Stress Reduction Review of the Literature

There has been in recent year significant research to support the use of Mindfulness-Based Stress Reduction (MSBR) with patients with various conditions in and out of medical settings. However, in 2002 the findings were that the available evidence at the time did not support a strong endorsement of this approach, but it did encourage and recommended serious investigation in the future (Bishop, 2002). In 2004 a meta-analysis of 64 studies in the previous two decades with only 20 studies meeting the criteria for acceptable quality or relevance results being that MBSR may help a broad range of individuals to cope with their clinical and nonclinical problems (Grossman, Niemann, Schmidt & Walach, 2004). MSBR was found to help clients increase their mindfulness, and wellbeing and decrease their stress and symptoms (Carmody & Baerm 2007). MBSR was found to reduce ruminative thinking and trait anxiety, as well as to increase empathy and self-compassion for individuals who came for help to address handling stress in their lives (Chisea & Serretti, 2009). MBSR was found to assist clients with social anxiety disorder to have improvement in anxiety and depression symptoms and self-esteem as well as reducing emotional reactivity while enhancing emotional regulation (Golden & Gross, 2010). MBSR assisted clients to experience reduction of symptoms of stress and mood disturbance as well as in mindfulness, spirituality and self-compassion (Birnie, Speca & Carlson, 2010). Fifteen studies were evaluated and found that MBSR has the potential for improving overall well-being, quality of life and enhanced health outcomes for its participants in it group therapy format (Merkes, 2010). MBSR was found to be the most popular of all interventions utilizing mindfulness and that it shows substantial benefit for patients who suffer with chronic health conditions (Carlson, 2012). MBSR was found to result in positive signs of healthy signs of measures of growth in greater emotional regulation (Haslam, Wirth & Robb, 2017). Perceived stress, distress tolerance, and mood states showed favorable changes from pre- to post-MBSR meaning the people who had lower stress tolerance before participating in MBSR groups were more likely to experience greater benefits than those who had higher tolerance of stress before participation in such groups (Gawrysiak, et al., 2016). Participants in MBSR groups were found to have significant improvements in the four components of Psychological Capital (Hope, Self-Efficacy, Resilience and Optimism) and a reduction in depression and anxiety (Jain & Singh, 2016). MBSR was found to have stress-reducing effects due to improvements in perseverative cognition and emotion regulation, two “transdiagnostic” mental processes that cut across stress-related disorders (Greeson, et al., 2018).


A number of studies focused on the impact of MBSR on social anxiety. Use of MBSR was associated with reductions in social anxiety and depression and increases in subjective well-being (Jazaieri, Goldin, Werner, Ziv & Gross, 2012).  It was found that with MBSR mindful attitude and disputing anxious thoughts/feelings predicted subsequent decreases in weekly social anxiety during MBSR (Goldin et al, 2017). MBSR used in groups with student ages 17-40 were found to have a decrease in anxiety and avoidance symptoms during social situations (Ye, 2017).


A preliminary Systematic review of the literature in 2011 found that studies up to that date showed that Mindfulness Based Interventions (mBIs) could have nonspecific effects for the reduction of pain symptoms and the improvement of depressive symptoms in patients with chronic pain as well as some improvements in psychologic measures related to chronic pain such as coping with pain following MBIs (Chiesa & Serretti, 2011). In 2017 another meta-analysis of 38 studies found that mindfulness meditation was associated with decrease in pain, reduction of depressive symptoms and increase in quality of life (Hilton, et al., 2017). An analysis of the mechanisms impacted by Mindfulness meditation demonstrated its effectiveness in reducing pain through multiple unique physiological mechanisms (Zeiden & Vago, 2016) including reduction of emotional reactivity, depression and stress (Brown & Becerra, 2017) and improve general mental health in patients with tension headached (Omidi & Zarger, 2015).

Strong encouragement has been made to utilize Mindfulness-Based Stress Reduction (MBSR) with patients with chronic pain because it focuses not only on the mind but also the body (Merkes, 2010). MBSR has the potential to address some of the psychosocial factors that are important predictors of poor outcomes (Cherkin, et al., 2014). A study of use of a brief 5 week format of MBSR found that participants demonstrated improvements of increased acceptance through decreased judgment; enhanced observational skills and decreased social isolation resulting in improve psychological health (Bergen-Cico, Possemento & Cheon, 2013). MBSR was found to contribute positively to pain management by lowering anxiety and depression, feelings of controlling pain and acceptance of higher pain which are important dimensions in patients with long-lasting chronic pain (la Cour & Petersen, 2015). Using MBSR resulted in patients revealing significant and clinically relevant improvements in level of pain disability, psychological distress, engagement in life activities, willingness to experience pain and subjective ratings of their current pain (Beaulac & Bailly, 2015). Use of MBSR with women with chronic pelvic pain has shown promise in pain reduction (Crisp, Hastings-Tolsma & Jonscher, 2016). Use of MBSR with chronic low pain demonstrated through the measurement of increase in quality of life and decrease in pain severity (Ardito, et al., 2017). MBSR was used with patients with painful diabetic peripheral neuropathy resulting in reduced pain intensity, pain catastrophizing, depression, perceived stress and improved health related quality of life (Nathan, et al., 2017). Clinical MBSR therapy program intervention improved affective pain, sensory pain and evaluative pain for individual detoxifying from substance abuse (Hosseni, 2017). MBSR was found to improve the quality of life for veterans who suffered psychoimmunological factors of lungs damaged from the toxic chemical in the war zone (Arefuasab, et al., 2016).


In a systematic review of 23 studies using MBSR and MBCT There was found improved depressive symptoms, anxiety, stress, quality of life and physical functioning. The evidence supports the use of MBSR and MBCT to alleviate symptoms, both mental and physical, in the adjunct treatment of cancer, cardiovascular disease, chronic pain, depression, anxiety disorders and in prevention in healthy adults and children (Gotink, et al., 2015). Measures of catastrophizing, self-efficacy, acceptance, and mindfulness, and similar effects showed improvement on these measures among individuals with chronic low back pain once they received either MBSR or Cognitive Behavior Therapy (Turner, et al., 2016). Pain catastrophizing and psychological distress were identified as individual mediators of the relationship between mindfulness and depressive symptoms for people with chronic pain thus supporting the inclusion of the use of mindfulness based cognitive interventions with these individual (Brooks, et al., 2018).


Mindfulness-Based Stress Reduction programming has been successful in work with a number of different populations. Academic health care workers were found to have sustained improved stress management, wellbeing and daily spiritual experiences for 1 year post participation in MBSR groups (Geary & Rosenthal, 2011). In looking how participants relate to their experience in MBSR groups participants were found to develop an “observing self” with improvement of emotional health (Kerr, Josyula & Littenberg, 2011). Research demonstrated that residents living in a large urban community experienced significant reduction of distress as well as increase in awareness of everyday life (Evans, Ferrando, Carr & Haglin, 2011). Decreases in symptoms of PTSD and depressive symptoms and reduction of anxious attachment was found using MBSR with female survivors of interpersonal violence (Kelly & Garland, 2016). MBSR used with partners resulted in improved relational health among romantic partners (Khaddouma, Gordon & Strand, 2017).  MBSR was found  to help improve levels of anxiety, depression, emotional reactivity and impulsivity with homeless participants (Maddock, Hevey & Eidemeuller, 2017). Providing MBSR to college students reduced depression, anxiety, stress and anxiety sensitivity through use of a MBSR Bibliotherapy model (Hazlett-Stevens & Oren, 2017). In 2018 Mindfulness-Based Cognitive Therapy was found to be successful with college students suffering from perfectionism by reducing their self-compassion, and reducing impairment caused by perfectionism and increase in mindfulness practices by the students (James & Rimes, 2018)


When compared to a second internet-based intervention (Health Action Process Approach) online Mindfulness training was found to improve the mental health of its participants (Mak, et. al., 2015).  A Web-based Mindfulness 8-week training program on pain intensity, pain acceptance and life satisfaction was demonstrated as being reasonably successful and open for future research and replication (Henriksson, Wasara & Ronnlund, 2016). A meta-analysis of 15 controlled studies found that online mindfulness-based interventions do have a positive impact on improving mental health of its participants (Spijkerman, Pots & Bohlmeijer, 2016). Internet Based Mindfulness Training and Cognitive-Behavioral Training were found to improve the mental health of college students in a randomized trial (Mak et al., 2017). In 2018 a systematic review of 15 studies on the usefulness of web-based mindfulness training programs found it successful in reducing depression and anxiety and in enhancing quality of life and mindfulness skills, particularly in those with clinical anxiety (Sevilla-Llewellyn-Jones, Santesteban-Echarri, Pryor, McGorry, & Alvarez-Jimenez, 2018). There were 3 APPs compared: mindfulness-based program; cognitive behavioral psychoeducation and self-compassion program and all three were found to be efficacious in improving mental well-being and reducing psychological distress (Mak, 2018).

Summary of Findings on MBSR

It is clear that MBSR has been shown to be an effective intervention to use with clients and patients who are dealing with stress not only from medical and psychological conditions but also from natural environmental factors. It would serve mental health professionals well to utilize the MBSR model in treating their clients who have come in seeking help to alleviate their current levels of stress.

References MBSR

Ardito, R.B., Pirro, P.S., Re, T.S., Bonapace, I., Bruno, E. & Gianotti, L. (2017). Mindfulness-based stress reduction program on chronic low-back pain: A study investigating the impact on endocrine, physical, and psychologic functioning. The Journal of Alternative and Complementary Medicine, 23(8), 615-623. DOI: 10.1089/acm.2016.0423


Arefnasab, Z., Babamahmoodi, A.,  Babamahmoodi, F., Noorbala, A.A.,  Alipour, A.,  Panahi, Y,,  Shams, J., Rad, F.R,m  Khaze, V, and Ghanei, M. (2016). Mindfulness-based stress reduction (MBSR) and its effects on psychoimmunological factors of chemically pulmonary injured veterans. Iranian Journal of Allergy, Asthma and Immunology, 15(6), 476-486.


Beaulac, J. & Bailly, M. (2015). Mindfulness-based stress reduction: Pilot study of a treatment group for patients with chronic pain in a primary care setting. Primary Health Care Research & Development, 16(4), 424-428. DOI: 10.1017/S1463423614000346


Bergen-Cico, D., Possemento, K. & Cheon, S. (2013). Examining the efficacy of a brief mindfulness-based stress reduction (Brief MBSR) program on general health. Journal of American College Health 41(6), 348-360.


Birnie, K., Speca, M. & Carlson, L.E. (2010). Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress and Health 2010. DOI: 10.1002/smi.1305


Bishop, S.R. (2002). What do we really know about Mindfulness-Based Stress Reduction? Psychosomatic Medicine 6,:71–84.  0033-3174/02/6401-0071


Brooks, J.M. Blake, J., Iwanaga, K., Chin, C., Colton, B.P., Morrison, B., Deiches, J. & Chan, F. (2018). Perceived mindfulness and depressive symptoms among people with chronic pain. Journal of Rehabilitation 84 (2), 33-39.


Brown, A. & Becerra, R, (2017), Mindfulness for neuropathic pain: A case study. International Journal of Psychology and Psychological Therapy, 17(1),19-37


Carlson, L.E. (2012). Mindfulness-based interventions for physical conditions: A narrative review evaluating levels of evidence. International Scholarly Research Network, 2012, ID 651583, 21 pps. doi:10.5402/2012/651583


Carmody, J. & Baer, R.A. (2007). Relationships between mindfulness practices and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31,


Chiesa, A. & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people. The Journal of Alternative and Complementary Medicine, 15(5), 593-600. DOI: 10.1089=acm.2008.0495


Chiesa, A. & Serretti, A. (2011). Mindfulness-based interventions for chronic pain: A systematic review of the evidence. The Journal of Alternative and Complementary Medicine, 17(1), 83-89.


Crisp, C.D., Hastings-Tolsma, M. & Jonscher, K.R. (2016). Mindfulness-based stress reduction for military women with chronic pelvic pain: A feasibility study. Military Medicine, 181(9), 982-989.


Evans, S., Ferrando, S., Carr, C. & Haglin, D. (2011). Mindfulness-based stress reduction (MBSR) and distress in a community-based sample. Clinical Psychology and Psychotherapy, 18, 553-558. DOI: 10.1002/cpp.727


Gawrysiak, M.J., Leong, S.H., Grassetti, S.N., Wai, m., Shorey, R.C. & Baime, M.J. (2016). Dimensions of distress tolerance and the moderating effects on mindfulness-based stress reduction, Anxiety, Stress & Coping, 29(5), 552-560.


Geary, C. & Rosenthal, S.L. (2011). Sustained impact of MBSR on stress, well-being and daily spiritual experiences for 1 year in academic health care employees. The Journal of Alternative and Complementary Medicine, 17(10), 939-944, DOI: 10.1089/acm.2010.0335


Golden, P.R. & Gross, J.J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion,10(1), 83-91. DOI: 10.1037/a0018441


Golden, P.R., Morrison, A.S. Jazaieri, H., Heimberg, R.G. & Gross, J.J. (2017). Trajectories of social anxiety, cognitive appraisal and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder. Behaviour Research and Therapy 97 1e13.


Gotink, R.A., Chu, P., Busschbach, J.J.V., Benson, H., Fricchione, L. & Hunink, M.G.M. (2015). Standardized mindfulness-based interventions in healthcare: An overview of

systematic reviews and meta-analyses of RCTs. PLoS ONE,10(4), 1-17. DOI:10.1371/journal.pone.0124344


Greeson, J.M., Zarrin, H., Smoski, M.J., Brantley, J.G., Lynch, T.R., Webber, D.M., Hall, M.H., Suarez, E.C. & Wolever, R. Q. (2018). Mindfulness meditation targets transdiagnostic symptoms implicated in stress-related disorders: Understanding relationships between changes in mindfulness, sleep quality and physical symptoms. Evidence-Based Complementary and Alternative Medicine, 2018, ID 4505191, 10 pps.


Grossman, P., Niemann, L., Schmidt, S. & Walach, H. (2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research 57, 35–43.


Haslam, A., Wirth, M.D. & Robb, S.W., (2017). Relationship between meditation depth and waking salivary alpha-amylase secretion among long term MBSR instructors. Stress and Health 33, 298–306.


Hazlett-Stevens, H. & Oren, Y. (2017). Effectiveness of mindfulness-based stress reduction bibliotherapy: A preliminary randomized controlled trial. Journal of Clinical Psychology, 73(6),626-637. DOI: 10.1002/jclp.22370


Hilton, L., Hempel, S., Ewing, B.A., Apaydin, E., Xenakis, L., Newberry, S., Colaiaco, B., Maher, A.R., Shanman, R. M., Sorbero, M.E. & Maglione, M.A. (2017). Mindfulness meditation for chronic pain: Systematic review and meta-analysis. Annals of Behavioral Medicine, 51, 199-213. DOI 10.1007/s12160-016-9844-2


Hosseni, M. (2017). The effectiveness of MBSR intervention in alleviating pain during detoxification among substance abusers: An experimental study. NeuroQuantology, 15(4), 107-113. doi: 10.14704/nq.2017.15.4.1152


Jain, H. & Singh, R. (2016). Developing psychological capital through mindfulness based stress reduction (MBSR) therapy. Indian Journal of Health and Wellness, 3(2), 79-84.

James, K. & Rimes, K.A. (2018). Mindfulness-based cognitive therapy versus pure cognitive behavioural self-help for perfectionism: A pilot randomized Study. Mindfulness, 9, 801–814. DOI 10.1007/s12671-017-0817-8

Jazaieri, H., Goldin, P.R., Werner, K., Ziv, M. & Gross, J.J. 2012).  A randomized trial of MBSR versus aerobic exercise for social anxiety disorder. Journal of Clinical Pschology, 68(7), 715-731, DOI: 10.1002/jclp.21863


Kabat-Zinn, J. (2011). Some reflections on the origins of MBSR, skillful means, and the trouble with maps. Contemporary Buddhism, 12(1), 281-206. DOI: 10.1080/14639947.2011.564844


Kabat-Zinn, J. (1990, 2013). Full catastrophe living – Using the wisdom of your body and mind to face stress, pain, and illness. Bantam Books: New York, NY.

Kelly, A. & Garland, E.L. (2016). Trauma-informed mindfulness-based stress reduction for female survivors of interpersonal violence: Results from a stage 1 RCT. Journal of Clinical Psychology, 72(4), 311-328. DOI: 10.1002/jclp.22273


Kerr, C.E., Josyula, K. & Littenberg, R. (2011). Developing an observing attitude: An analysis of meditation diaries in an MSBR clinical trial. Clinical Psychology and Psychotherapy, 18, 80-93. DOI: 10.1002/cpp.700


Khaddouma, A., Gordon, K.C. & Strand, E.B. (2017) Mindful mates: A pilot study of the relational effects of Mindfulness-based stress reduction on participants and their partners. Family Process, 56(3), 636-651. doi: 10.1111/famp.12226


La Cour, P. & Petersen, M. (2015). Effects of mindfulness meditation on chronic pain: A randomized controlled trial, Pain Medicine, 16. 641-652.


Maddock, A., Hevey , D. & Eidemeuller, K. (2017). Mindfulness training as a clinical intervention with homeless adults: A pilot study. International Journal of Mental Health & Addiction, 15, 529–544. DOI 10.1007/s11469-016-9718-7

Mak, W.W.S., Chan, A.T.Y., Cheung, E.Y.L., Lin, C.L.Y. & Ngai, K.C.S. (2015). Enhancing web-based mindfulness training for mental health promotion with the health action process approach: Randomize controlled trial. Journal of Medical Internet Research,17(1), e8. doi:10.2196/jmir.3746

Mak, W.W.S., Chio, F.H.N., Chan, A.T.Y., Lui, W.W.S. & Wu, E.K.Y. (2017). The efficacy of internet-based training with telephone support in the enhancement of mental health among college students and young working adults: Randomized controlled trial. Journal of Medical Internet Research,19(3):e84. doi:10.2196/jmir.6737

Mak, W.W.S., Tong, A.C.Y., Yip, S.Y.C., Lui, W.W.S., Chio, F.H.N., Chan, A.T.Y.& Wong, C.C.Y. (2018). Efficacy and moderation of mobile app-based programs for mindfulness-based training, self-compassion training, and cognitive behavioral psychoeducation on mental health: Randomized controlled noninferiority trial. JMRI Mental Health, 5(4), 1-18.

Merkes, M. (2010). Mindfulness-based stress reduction for people with chronic diseases. Australian Journal of Primary Health, 16, 200-210. Doi:10.1071/PY09063


Nathan, H.J., Poulin, P., Wozny, D., Taljaard, M., Smyth, C., Gilron, I., Sorisky, A., Lochnan, H. & Shergill, Y. (2017), Randomized trial of the effect of mindfulness-based stress reduction on pain-related disability, pain intensity, health-related quality of life, and A1C in patients with painful diabetic peripheral neuropathy. Clinical Diabetes Journals 35/5/294. DOI: 10.2337/cd17-0077


Ornidi, A. & Zarger, F. (2015). Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headaches. Journal of Research in Medical Sciences, 20, 1058-1063.


Petersen, M. & La Cour, P. (2016). Mindfulness—what works for whom? Referral,

feasibility, and user perspectives regarding patients with mixed chronic pain. The Journal of Alternative and Complementary Medicine, 22(4), 298-305. DOI: 10.1089/acm.2015.0310


Sevilla-Llewellyn-Jones, J., Santesteban-Echarri, O., Pryor, I., McGorry, P. & Alvarez-Jimenez, M. (2018). Web-based mindfulness intervebntions for mental health treatment: Systematic review and meta-analysis. JMIR Ment alHealth, 5(3), e10278. doi:10.2196/10278

Spijkerman, M.P.J., Pots, W.T.M. & Bohlmeijer, E.T. (2016). Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomized controlled trials. Clinical Psychology Review, 45, 102–114

Turner, J.A., Anderson, M.L., Balderson, B.H., Cook, A.J., Sherman, K.J. & Cherkin, D.C. (2016). Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: Similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain, 257(11), 2434-2444. 10.1097/j.pain.0000000000000635.

Ye, H. (2017). Impact of mindfulness-based stress reduction (MBSR) on student’s social anxiety: A randomized controlled trial. NeuroQuantology, 15(4),101-106. doi: 10.14704/nq.2017.15.4.1134


Zeidan, F. & Vago, D.R. (2016). Mindfulness meditation-based relief: A mechanistic account. Annals of the New York Academy of Sciences 1373, 114-127.  doi: 10.1111/nyas.13153

Definition of Stress
  • Stress is defined as a individual's response to his environment. Stress is measured in terms of arousal or stimulation. As such, stress must be present for a person to function.
  • Everyone has their own normal (homeostatic) level of arousal at which they function best. If something unusual in the environment occurs, this level of arousal is affected.

Stress as a process involves environmental event (a stressor)

  • its appraisal by the individual
  • various responses of the organism

Reevaluations resulting from responses and changes in the stressors.

  • Depends on the quality of an external stimulus
  • Depends on the response to such stimulus
  • Depends on the results from interaction between stimulus and response

Diathesis and Stress Interaction

  • Diathesis: is the predisposition (genetics) of the human body to disease or disorder
  • Stress: is the term which refers to the factors in the environment: which offer challenge, distress, problems to solve, which are unique to each individual and as a result are the environmental condition which elicit disease or disorder in the individual or are the conditions in the human which are ripe for the disease or disorder.

What are sources of stress?

There are four categories of sources of stress:

1. Change of any kind can induce stress because of:
  • fear of the new, the unknown
  • feelings of personal insecurity
  • feelings of vulnerability
  • fear of rejection
  • need for approval
  • lack of tolerance for ambiguity
  • fear of conflict
  • fear of taking a risk
  • fear of developing trust
  • fear of inability to cope with changed circumstances

2. Individual personality characteristics that can induce stress include:
  • low self-esteem
  • feelings of over-responsibility
  • fear of loss of control
  • fear of failure, error, mistakes
  • fear of being judged
  • lack of belief in “being good enough”
  • chronic striving to be perfect
  • chronic guilt
  • unresolved grief over a loss or a series of losses
  • chronic anger, hostility, or depression

3. Interpersonal issues that can induce stress include:
  • a lack of adequate support within the relationship
  • a lack of healthy communication within the relationship
  • a sense of competitiveness between the parties involved
  • threats of rejection or disapproval between people
  • an inability to be appropriately assertive
  • struggle for power and control in the relationship
  • poor intimacy or sexuality within the relationship
  • chronic conflict and disagreement with no healthy resolution
  • over-dependency of one party on another
  • a troubled person who refuses to recognize the need for help

4. System (family, job, school, club, organization) issues that can induce stress include:
  • lack of leadership
  • lack of sense of direction
  • uncooperative atmosphere
  • competitive atmosphere
  • autocratic leadership
  • unclear expectations
  • a chronic sense of impending doom
  • a lack of teamwork
  • confused communications
  • developmental disability or chronic ill health of one or more members.
Social Readjustment Rating Scale (SRRS) - The Holmes and Rahe Stress Scale

The Social Readjustment Rating Scale (SRRS), more commonly known as the Holmes and Rahe Stress Scale, was created to helps us measure the stress load we carry, and think about what we should do about it.

In 1967, psychiatrists Thomas Holmes and Richard Rahe decided to study whether or not stress contributes to illness. They surveyed more than 5,000 medical patients and asked them to say whether they had experienced any of a series of 43 life events in the previous two years.

Each event, called a Life Change Unit (LCU), had a different "weight" for stress. The more events the patient added up, the higher the score. The higher the score, and the larger the weight of each event, the more likely the patient was to become ill.

To learn the level of stress (distress) in your life, mark down the value at the right of each of the following events if it has occurred within the past 24 months and add the values of all the items you identified with:
Event (Value)
  1. Death of spouse (100)
  2. Divorce (73)
  3. Marital separation (65)
  4. Jail term (63)
  5. Death of close family member (63)
  6. Personal injury or illness (53)
  7. Marriage (50)
  8. Fired from job (47)
  9. Marital reconciliation (45)
  10. Retirement (45)
  11. Change in family member's health (44)
  12. Pregnancy (40)
  13. Sexual difficulties (39)
  14. Addition to family (39)
  15. Business readjustment (39)
  16. Change in financial status (38)
  17. Death of close friend (37)
  18. Career change (36)
  19. Change in number of marital arguments (35)
  20. Mortgage or loan over $10,000 (31)
  21. Foreclosure of mortgage or loan (30)
  22. Change in work responsibilities (29)
  23. Son or daughter leaving home (29)
  24. Trouble with in-laws (29)
  25. Outstanding personal achievement (28)
  26. Spouse begins or ceases working (26)
  27. Starting or finishing school (26)
  28. Change in living conditions (25)
  29. Revision of personal habits (24)
  30. Trouble with boss (23)
  31. Change in work hours, conditions (20)
  32. Change in residence (20)
  33. Change in schools (20)
  34. Change in recreational habits (19)
  35. Change in church activities (19)
  36. Change in social activities (18)
  37. Mortgage or loan under $10,000 (17)
  38. Change in sleeping habits (16)
  39. Change in number of family gatherings (15)
  40. Change in eating habits (15)
  41. Vacation (13)
  42. Christmas season (12)
  43. Minor violation of the law (11)

Interpretation of your score:

Below 150      You have only a low to moderate chance of becoming ill in the near future.

150-299          You have a moderate to high chance of becoming ill in the near future.          

300 or above  You have a high or very high risk of becoming ill in the near future.

How to analyze your score:

If your total score is more than 150, find ways to reduce stress in your daily life so that your stress level doesn't increase. The higher the score, the harder one needs to work at staying physically well.

For more information on this scale go to:

Suggested uses for SSRS scale:

  • Become familiar with the different events and the amounts of stress they promote.
  • Put the list of events where your family can easily refer to it several times a day.
  • Practice recognizing the stress level when one of these events happens.
  • Think about the meaning of the event for you and identify your feelings.
  • Think about the different ways you can adjust to the event.
  • Take your time in arriving at decisions.
  • Anticipate life changes and plan for them well in advance whenever possible.
  • Pace yourself. It can be done even if you are in a hurry.
  • Look at the accomplishment of a task as a part of ongoing daily living; avoid looking at such an achievement as a stopping point. Congratulate yourself and push ahead.
  • Recognize that your internal mechanism of coping with stress is directly tied to how your health and well-being will be influenced by it.

Is all stress bad?

Not all stress is distress:

  • a certain amount of stress or pressure is necessary and shows a positive adaptation being made by a person. This is called eustress.
  • Bad or negative stress is called distress: the negative physiological and emotional response when stress is intense and unresolved.


There are three degrees of stress:

  1. Low: This is distress leading to boredom, fatigue, frustration, or dissatisfaction.
  2. Optimum: This is eustress leading to creativity, problem solving, progress, change, learning, and energetic satisfaction.
  3. High: This is distress leading to exhaustion, illness, lack of concentration, excessive mood swings, low self-esteem, and irrational problem solving.


There are three phases of arousal:
  1. Phase 1 Alarm phase: When an unusual (or stressful) event occurs, the output of energy drops for a short period as the event is registered in the person's mind.
  2. Phase 2 Adaptation phase: Next, the output of energy increases above the normal level; arousal is heightened as the person seeks to deal with the situation. Adaptation responses available to humans include physically running away, fighting, freezing (self-immobilization), suppression emotion, or learning.
  3. Phase 3 Exhaustion phase: Finally the person's available energy is expended and his capacity to function effectively is reduced.

Physiological Effects of Stress

Sympathetic Nervous System (system responsible for mobilizing body resources in urgent situations) stimulate the adrenal medulla of the adrenal glands

The adrenal stimulation results in production of catecholamines, Epinephrine and Norepinephrine, affecting the body’s heart rate, respiration, blood flow and muscle strength.

Stress causes the pituitary gland (structure connected to hypothalamus in forebrain) to release the andreno-corticotropic hormone (ACTH).

ACTH stimulates the adrenal cortex of the adrenal gland to secrete glucocorticoids. The most important of the glucocorticoids is cortisol which mobilizes the body’s resources by increasing energy and decreasing inflammation especially in injuries.

The signs of this physical response include


  • heart rate
  • blood pressure, respiration
  • perspiration
  • pupil dilation
  • muscle tension


What are the results of chronic stress?

In the state of chronic stress

  • heart rate
  • blood pressure
  • respiration are chronically elevated

Common stress-related illnesses include:

  • Coronary artery disease
  • Peptic ulcer
  • Mental illness

Negative Impact of Prolonged Stress Response

There is a negative impact on the body’s organs, mental functioning and Immune system

There is an impact on the immune system which impedes the immune system from destroying viruses, bacteria, tumors, and irregular cells

Stress impacts immunosuppression and  it is an important influence on health and illness of the individual

Hormone Stress Cascade during Severely Stressful or Traumatic Events

1. Hypothalamus is activated by messages from nervous system or blood stream during a “stressful event” and it releases CRH which initiates the fight-flight response.

2. Corticotrophin-releasing hormone (CRH) is a polypeptide hormone secreted by the hypothalamus into the pituitary portal system where it triggers the release of adrenocorticotropic hormone (ACTH) from the pituitary gland. During stress it surrounds the pituitary gland which then releases ACTH.

3. Adrenocorticotropic Hormone (ACTH) stimulates the adrenal glands to release Cortisol and Adrenalin

4. Cortisol and Adrenalin increase heart rate and metabolic rate

ACTH - Adrenocorticotropic Hormone

  • ACTH stimulates the adrenal cortex of adrenal gland to secrete glucocorticoids.
  • Most important of glucocorticoids is cortisol which mobilizes body’s resources by increasing energy and decreasing inflammation especially in injuries.
  • ACTH triggers “survival hormones” during the stressful event especially Cortisol until the threat is removed.
  • With long-term stress or constantly repeating triggers such as with re-experiencing the hormone release does not shut down

Bilateral response of brain to stress and trauma

  • Major stress and trauma are right side of brain activity – rich in images of the stressor and trauma
  • The left side of the brain which involves talking shuts down in severe stress and trauma. The bracus area of the brain on the left side of the brain becomes unresponsive under severe stress and trauma and individuals are heard to say: “I don’t have words to tell you what I have experienced.”
  • There is a need to help both sides of the brain to recover from the stress and trauma so there is a need for bilateral processing similar to used in EMDR
  • It is important to realize that humans use their body to help their brain think through things and to process the stress and trauma


  • The Hippocampus is involved in learning and memory
  • Damage to the hippocampus causes memory problems and interferes in new learning and even current memory.
  • Victims of PTSD have been found to have smaller hippocampuses-the more memory problems they had the smaller was their hippocampus
  • Adults who have been severely physically and/or sexually abused have similar memory problems with reduced hippocampus
  • Smaller hippocampus does result in dissociative symptoms-greatest decrease in volume of the hippocampus correlates to most pronounced symptoms of dissociation
  • Depression is also associated with reduced hippocampus size
Stress Management Videos

Video 1: Mindfulness Meditation - Quick 15 Min Stress Relief Version at:

  • This is a Jon-Kabat Zinn style Mindfulness Meditation. As you listen you learn to value the transient nature of life and realize that you can tolerate anything for the moment. It's great for those who may have tried silent meditation and found it difficult. Traditionally, mindfulness meditation is done with your eyes closed.  However, the video offers you the ability to refocus your thoughts should you feel the need to open your eyes.

Video 2: Guided Meditation for Reducing Anxiety and Stress--Clear the Clutter to Calm Down at:

  • This is a guided meditation to take you on a journey of relaxation.  You will clear the clutter of your mind to calm you.   It will reduce your stress level,  as well as improve your overall health and well being when practiced regularly. 

Video 3: Mindfulness Meditation to help Relieve Anxiety and Stress at:

  • This is a mindfulness meditation with Josh Wise. This meditation will help you connect with your breath. Relax. Let go of stress. Release anxiety. Allow yourself to relax. Simply breathe and watch your breath. Notice what it feels like. No need to change anything or do anything. Simply accept this moment just as it is. Enjoy.

Video 4: 15 Minute Meditation for Stress Relief and Building Confidence at:

  • This guided meditation and relaxation is a great way to start the day. It can also be used before an event you are nervous about or after a stressful event to help calm down. Share with anyone you feel will find value in this meditation. Do not use this as a replacement for seeking medical advice if necessary. Do not listen while driving.

Video 5: Stress Relief ~ Daytime Meditation To Let Go Of Stress | Mindful Breathing Meditation at:

  • Breathe the stress, tension, and anxiety away. Find yourself...your mind, body, and spirit return to a state of balance, peace, and wellness.This deep breathing meditation for stress reduction guides you through simple breathing techniques to reduce chronic stress, tension, and anxiety. After listening to this session, find yourself...your mind, body, and spirit return to a state of balance, peace, and wellness.
YouTube Videos & Articles on How Stress Affects the Body

1. How Stress Affects your Body by Sharon Horesh Bergquist at

2. What does Stress do to Your Body? by Seeker at:

Articles related to this video:

3. 10 Signs Your Body is Begging for Help at:

4. How Stress Affects You Body and Mind at:

5. Stress and Your Brain by Jaime Tartar at TEDxNSU at:


6. Stress Management Strategies: Ways to Unwind at:

Apps for Stress Management

Guided Mind (cost: free)

Relax and get guided through meditations on a variety of topics dealing with the stresses and challenges of day-to-day life. At:


Mindfulness - Everyday guided meditations (cost: free)

Science-backed audios for everyone from entrepreneurs to stay at home moms. Use Mindfulness to quiet the chatter in your brain and to achieve clarity. Come back anytime you need an extra dose of serenity. At;


The Mindfulness App – meditate (cost: free)

Start your journey to a more relaxed and healthier state of mind with The Mindfulness App. Whether you are just starting out or experienced in meditation, The Mindfulness App will help you to become more present in your daily life. At:


Take a Break! - Meditations for Stress Relief (cost: free)

Take a break now and let your stress melt away! You can enjoy the deep relaxation, stress relief and benefits of meditation now with this app by Meditation Oasis™. Featuring two popular meditations from the the Meditation Oasis podcast, the app gives you the option to listen with or without music or nature sounds. You can also listen to the relaxing music and nature sounds alone. At:


Calm (cost: free)

Calm Body sessions are 10 minute guided video lessons on mindful movement and gentle stretching. Lessons include "Morning Wakeup", "Afternoon Reset", "Back Care" and "Evening Wind Down". Addition programs on the app include: Calm Masterclass, Breathe Bubble, Scenes selector, Calm Body, and your Profile. At:


Headspace: Meditation Breathe, sleep, relax & focus (cost: free)

Headspace is the simple way to reframe stress. Sleep trouble? Meditation creates the ideal conditions for a good night’s rest. Relax with guided meditations and mindfulness techniques that bring calm, wellness and balance to your life in just a few minutes a day. At:

Coping with Stress 

How can people cope with stress in healthy positive ways?

People can cope with stress while in a variety of positive ways, such as these. Write down which positive coping strategies you can and are willing to use in your stress reduction efforts.


  1. Exercise: aerobic exercise, walking, swimming, dancing
  2. Stress‑reduction Activities:  stretching, progressive muscle relaxation, breathing, self‑hypnosis, yoga
  3. Mental Relaxation Techniques: Mindfulness, meditation, centering, clearing mind, imagination, visual imagery
  4. Spirituality: prayer, worship, letting go and letting God, valuing, commitment, one day at a time
  5. Recreational Diversions: music, hobbies, movies, theater, reading, cards, sewing
  6. Interpersonal Relationship Enhancement: affirmation, networking, assertiveness, setting limits, creating supportive structures, expressions of love, affection, and concern
  7. Problem Solving: time management, brainstorming, priority setting, rational thinking, thought stopping, re‑labeling, organizing, and planning
  8. Family Life Skills: esteem building, conflict resolution, togetherness, support, positive reinforcement
  9. Intellectual Practices: learning new concepts, learning new behavior patterns and attitudes, developing new insights, making subjective data objective, creating new generalizations and rules based on a reasonable analysis of data
  10. Sense of Humor: putting things into perspective, lightening up, reducing the intensity, having fun, joking, clowning around, being a little kid again

What are some negative ways in which people cope with stress?

People cope with stress in a variety of negative ways, such as these. Write down which of the following behaviors you have used prior to recovery.


  1. Impulsive Behavior: acting before thinking about consequences, binging, continually getting into trouble
  2. Compulsive Behavior: addictive‑like behavior that gets out of control and results in overindulging, alcoholism, workaholism, drug abuse, excessive eating, smoking, shopping, sex, gambling
  3. Obsessive Behavior: meticulous‑like behavior that you find the need to repeat over and over again, picky picky, neat freak, overly organized, rigid thinking, inflexible
  4. Vindictive Behavior: seeking revenge for real or imagined hurts or offenses, conniving, stubborn
  5. Blaming Behavior: laying the blame for problems on others, fault finding, overly critical
  6. Worrying: anxious, tense, keeping problem in constant focus, not being able to let go of it, mulling over the problem in your mind
  7. Anger: having temper tantrums, ventilating hostility, using sarcasm, cynicism, screaming
  8. Withdrawn Behavior: denial of problem, passivity in face of stress, pulling away, isolation
  9. Depressed Behavior: weepy or tearful, blue, despairing, guilty, downcast, lethargic
  10. Physical Illness: real or psychosomatic illnesses, headaches, back pain, muscle tension, gastrointestinal problems, hypertension, diabetes. There are many illnesses related to stress, some terminal.

What are the benefits of coping with stress in a healthy way while in recovery?

When you cope with stress while in recovery in a healthy, positive way, you can experience:

  • A sense of accomplishment.
  • Enhancement of self‑esteem.
  • Improved interpersonal relationships.
  • Improved physical health.
  • A clear mind.
  • Less anxiety.
  • A feeling of being in control of your life.
  • A sense of being centered, focused, and "on target'' in life.
  • Peace and harmony, a sense of good will for and from others.
  • A reduction of the emotional cues that lead to impulsive or compulsive habits.
  • A sense of mastery over your life's obstacles.
More Videos to Deal with Stress

Video 1: Simple tips to help you DE-STRESS. (Stress management techniques & Personality Development) at

This video speaker encourages 5 tips for De-stressing:

  1. Exercise - Be Active Exercise in almost any form can act as a stress reliever. It won't make your stress disappear but being active can definitely boost your feel-good endorphin and take you away from your daily worries. So be it 40 minutes of brisk walking, yoga, aerobics or some laps in the pool you will find that you have forgotten the day's irritation and concentrating on your body. The results are - energy, optimism, calm mind and fit body.
  2. Connect with people A problem shared is a problem halved. A good support network of colleagues, friends and family can ease your work troubles and help you see in a different way. If you don't connect with people, you won't have support to turn to when you need help. The activities we do with friends help us relax and we often have a good laugh with them., which is an excellent stress reliever And may be your friends or colleagues can also help you out with some solutions to your problems.
  3. Avoid unhealthy habits Don't rely on alcohol, smoking and caffeine as your ways of coping. This will not help you to relieve any stress in fact it will create new problems. It might provide temporary relief but it won't make the problems disappear. Drink plenty of water and eat healthy small nutritious means. Hunger and dehydration provoke anxiety and stress. So, stay fit and healthy.
  4. BE positive Look for positives in life and things for which you are grateful. Write down three things at the end of everyday which went well and for which you are grateful. People don't always appreciate what they have. They always tend to crib and complain about everything. Make a conscious effort to train yourself to be more positive about life. Change your perspective and you will be able to see your situation from a more positive point of view.
  5. Plan something Rewarding at the end of your stressful day Rewards like taking a hot water bath or half an hour of reading a good book or even watching your favorite T.V show helps. So basically, I am talking about some me time. Put aside work, housekeeping and family concerns for brief period before bed time. Don't spend this time planning for the next day or doing house chores. Remember you need time to recharge and energize yourself. You will be much prepared to face the next day. So, take control of the situation you are in and say goodbye to stress with these techniques above

Video 2: How to make stress your friend  with Kelly McGonigal – A TED Talk at:

  • Stress. It makes your heart pound, your breathing quicken, and your forehead sweat. But while stress has been made into a public health enemy, new research suggests that stress may only be bad for you if you believe that to be the case. Psychologist Kelly McGonigal urges us to see stress as a positive and introduces us to an unsung mechanism for stress reduction: reaching out to others.
3 Exercises To Manage Stress

1.  Full Breathing Exercise
Step 1:  Lie prone on the floor. Loosen your belt and restrictive clothing.


Step 2:  Relax and exhale as completely as possible. Begin to inhale slowly making your belly rise. Now move your rib cage. Now your chest. Hold it for a second. Now, exhale completely, all the air out of your lungs. Try it again. This is complete breathing. Breathe normally for a while, and in the next minute take at least one more complete breath. Pause one minute.


Step 3:  You are still lying prone. As you lie there you will begin stretching muscles to achieve unblocked circulation. Bring your arms above your head and stretch them away from you fully. Now stretch your legs and feet downward, away from you, take a deep breath, let go and relax. Pause ten seconds. Feel the effects of the stretch on your body and on your breathing. Pause 15 seconds. Now sit up very slowly.


Step 4:  Stand up for this part of the exercise. There are three very basic stretching postures to increase flexibility.
  • backward bend
  • forward bend
  • side-to-side bend

 As you do your backward bend pay attention to stretching your abdomen and back muscles. Important:Go only as far as you can. Don't push yourself. Bend slowly. As you do your forward bend, pay attention to the stretch of your back muscles and backs of legs; blood in head and arms. As you do your side stretch, pay attention to stretching in your chest, sides and neck.


Step 5:  Assume a comfortable sitting posture, one you can hold for 15 to 20 minutes. This could be in a chair. Get comfortable and close your eyes when you are ready. Please note everything you are aware of C outside sounds, your bodily awareness, thoughts; note this awareness and do not change it. Then, notice shifting from outside sounds to thoughts of bodily awareness.


After approximately five minutes of this, notice that breathing is occurring; again, not to change it but only to notice it. One can enhance this noticing by attaching the words breathing out to the breath as it leaves the nostrils and breathing in as the breath reenters. As awareness shifts from breathing to thoughts of external sounds, allow that to happen and the return to breathing out-breathing in (following the breath).


Continue this for five to seven minutes. At this point, try to incorporate some visual imagery in the form of a golden light with the in-breath. See yourself breathing in this golden light and watching it fill the inside of your body. This could be in a particle, vapor, smoke, or mist-like form, whatever is comfortable for you. Visualize this light in your head, shoulders, chest and breath out any tensions in the form of a black color. Continue until you visually experience your whole body as being filled with this golden light. Experience that feeling.


Stay with this experience for another minute or two. Then, become aware of your breath again, with your body sitting on the floor or chair (feeling grounded). When ready, open your eyes.


Step 6:  Try this breathing exercise for 15 to 20 minutes daily until you are able to achieve full breathing and stress reduction in a progressively shorter period of time.

2. Thought Stopping Exercise
Systematically address your fears which cause stress and anxiety for you, you may need to use “thought stopping" as a technique to cease your obsessing or dwelling on the fear, feared objects, or events. If it is needed, follow these directions:

Directions for Thought Stopping
Step 1: Use the relaxation training and breathing exercises above to get yourself relaxed. It is important to be relaxed to stop a recurring thought.

Step 2: With a recorder, record the word stop on alternating 1, 2, and 3 minute intervals for a 30-minute recording. Call yourself into a relaxed state before using the ``Stop'' tape. Then, think of your fear, feared object, or event. Every time you hear stop; stop the thought. Return to the thought again and only stop the thought when you hear stop. Do this for 30 minutes every night for two weeks or until you are able to stop the thought every time you hear stop.

Step 3: After you are trained to stop thoughts by using the Stop recording, you are ready to stop your thoughts by yelling stop out loud. For 30 minutes think of your fear, feared object, or event and yell stop to stop the thought. Once you stop the thought go back to thinking about the thoughts for awhile, then yell stop again. Do this over and over again for 30 minutes each night for two weeks or until you are able to stop the thought every time you yell stop.

Step 4: After you have trained yourself to stop thoughts by yelling stop, you are ready to train your thoughts to stop by whispering stop. For 30 minutes repeat the process of dwelling on your fears, feared object, or event, but this time whisper stop to stop your thoughts. Do this for 30 minutes nightly for two weeks or until you are able to stop the thought every time you whisper stop.

Step 5: After you have trained yourself to stop thoughts by whispering stop, you are ready to train your thoughts to stop by thinking the word stop. For 30 minutes repeat the process of dwelling on your fears, feared object, or event, but this time think stop to stop your thoughts. Do this for 30 minutes nightly for two weeks or until you are able to consistently stop the thoughts by thinking the word stop.

Step 6: Use thinking the word stop to stop thoughts of your fear, feared object, or event from then on. It is a technique that will halt your dwelling on the fearful thought in the future.

3. Personal Progressive Relaxation Exercise

What is the Relaxation Response?

The signs of this physical response include:


heart rate

blood pressure


pupil dilation

muscle tension

Stress-management strategy is to evoke the relaxation physical response on a regular, daily basis.


The physical response to relaxation is as follows:

Progressive relaxation consists of:

1. Learning to relax:
You may have grown to accept a certain high level of stress and anxiety as normal. You may be unfamiliar with what it feels like to be relaxed, calm, and unstressed. With progressive relaxation you learn what it feels like to be relaxed, you learn to increase relaxation to a new level. By doing this you not only improve your physical well being by reducing hypertension, headaches, and other physical complaints, but you improve your mental state by reducing stress, anxiety, irritability, and depression.


2. The physical setting:
Progressive relaxation should take place in a quiet, attractive room. You should be completely supported. There should be no need for exertion to maintain body support. You should wear comfortable, loose-fitting clothing during the sessions.


3. The process:
Lie on the floor or a bed and follow the directions of the relaxation technique (contained latter in this chapter) as you tense and relax various muscle groups. After the initial tensing of the muscles, release the tension instantly and completely. This is very important in order to get the pendulum effect. The muscles relax beyond the point of their normal relaxed state. You should then feel the important difference between tension and relaxation. You should concentrate on the feeling of relaxation, learn what it is to relax and how to increase it. Continually repeat to yourself, “Know what it feels like to be relaxed, deepen the relaxation, know what it is to be relaxed.”
Do's and don'ts of relaxation:
Do:  Make sure you have comfortable, loose clothing and proper back support
Don't: Put yourself in an awkward position or in a position that will make it easy to fall asleep


Do: Allow your mind to quiet down. If tense thoughts enter while you are relaxing, let them pass out of your head.
Don't: Think your way into tension. If you can't clear your mind, take a long, deep breath and let it out slowly.


Do: Stay alert and conscious while you are relaxing. Pay close attention and note any changes in your body (feelings that stand out for you).
Don't: Allow yourself to become groggy and sleepy. If you start falling asleep, open your eyes and sit up. When you are ready, return to relaxation posture.


Do: Go at your own pace and let go of your muscles as your body decides to give up tension.
Don't: Expect yourself to relax all at one. Like any other physical exercise, you must practice letting go step by step.


Do: Give your body messages of appreciation for relaxing as you notice these feelings going through your body.
Don't: Get down on yourself for not relaxing. Your body should be trusted to go at its own pace.


Do: Stay aware of your breathing. Observe how much air you're taking in full breaths at regular rhythms.

Don't: Smoke before, during or after relaxation as it tightens lung tissue and blood vessels. Let your body breathe.

Relaxation Training Technique

Directions: Record these directions for yourself by reading them slowly. Use the tape daily to practice the relaxation response:

Settle back as comfortably as you can and close your eyes. Let your self relax to the best of your ability. Now, as you relax like that, clench your right fist. Just clench your fist tighter and tighter and study the tension as you do so. Keep it clenched and feel the tension in your right fist, hand, and forearm. Now relax. Let the fingers of your right hand become loose, and observe the contrast in your feelings. Now, let yourself go and try to become more relaxed all over. Once more, clench your right fist really tight - hold it, and notice the tension again. Now let go, relax; your fingers straighten out and you notice the difference once more. Repeat that with your left fist. Clench your left fist while the rest of your body relaxes; clench that fist tighter and feel the tension. Now relax. Again, enjoy the contrast. Repeat that once more. Clench the left fist, tight and tense. Now do the opposite of tension: relax and feel the difference. Continue relaxing like that for a while. Clench both fists tighter and tighter, both fists tense, forearms tense. Study the sensations. Relax; straighten out your fingers and feel the relaxation. Continue relaxing your hands and forearms more and more.

Now bend your elbows and tense your biceps, tense them harder and study the tension feelings. All right. Straighten out your arms, let them relax and feel that difference again. Let the relaxation develop. Once more, tense your biceps; hold the tension and observe it carefully. Straighten the arms and relax; relax to the best of your ability. Each time, pay close attention to your feelings when you tense up and when you relax. Now straighten your arms. Straighten them so that you feel the most tension in the triceps muscles along the backs of your arms; stretch your arms and feel that tension. Now relax. Get your arms back into a comfortable position. Let the relaxation proceed on its own. The arms should feel comfortably heavy as you allow them to relax. Straighten the arms once more so that you feel the tension in the triceps muscles; straighten them. Feel that tension  - relax. Now concentrate on pure relaxation in the arms without any tension. Get your arms comfortable and let them relax further and further. Continue relaxing your arms even further. Even when your arms seem fully relaxed, try to go that extra bit further; try to achieve deeper and deeper levels of relaxation.

Let all your muscles go loose and heavy. Just settle back quietly and comfortably. Wrinkle up your forehead now; wrinkle it tighter. Now, stop wrinkling your forehead; relax and smooth it out. Picture the entire forehead and scalp becoming smoother as the relaxation increased. Now, frown and crease your brows and study the tension. Let go of the tension again. Smooth out the forehead once more. Now, close your eyes tighter and tighter. Feel the tension. Relax your eyes. Keep your eyes closed, gently and comfortably, and notice the relaxation. Now clench your jaws, bite your teeth together; study the tension throughout the jaws. Relax your jaws now. Let your lips part slightly. Appreciate the relaxation. Now press your tongue hard against the roof of your mouth. Look for the tension. All right. Let your tongue return to a comfortable and relaxed position. Now purse your lips. Press your lips together tighter and tighter. Relax the lips. Note the contrast between tension and relaxation. Feel the relaxation all over your face, all over your forehead and scalp, eyes, jaws, lips, tongue and throat. The relaxation progresses further and further.


Now attend to your neck muscles. Press your head back as far as it can go and feel the tension in the neck now roll it to the left. Straighten your head and bring it forward. Press your chin against your chest. Let your head return to a comfortable position and study the relaxation. Let the relaxation develop. Shrug your shoulders. Hold the tension. Drop your shoulders and feel the relaxation. Neck and shoulders relaxed. Shrug your shoulders again and move them around. Bring your shoulders up and forward and back. Feel the tension in your shoulders and in your upper back. Drop your shoulders once more and relax. Let the relaxation spread deep into the shoulders, right into your back muscles; relax your neck and throat, and your jaws and other facial areas as the pure relaxation takes over and grows deeper, deeper, ever deeper.

Relax your entire body to the best of your ability. Feel that comfortable heaviness that accompanies relaxation. Breathe easily and freely in and out. Notice how the relaxation increase as you exhale. As you breathe out, just feel that relaxation. Now breathe right in and fill your lungs inhale deeply and hold your breathe. Study the tension. Now exhale, let the walls of your chest grow loose and push the air out automatically. Continue relaxing and breathe freely, gently. Feel the relaxation and enjoy it. With the rest of your body as relaxed as possible, fill your lungs again. Breathe in deeply and hold it again. That's fine, breathe out and appreciate the relief. Just breathe normally. Continue relaxing your chest and let the relaxation spread to your back, shoulders, neck and arms. Merely let go. Enjoy the relaxation.

Now let's pay attention to your abdominal muscles; your stomach area. Tighten your stomach muscles, make your abdomen hard. Notice the tension. And relax. Let the muscles loosen and notice the contrast. Once more, press and tighten your stomach muscles, make your abdomen hard. Notice the tension. And relax. Let the muscles loosen and notice the contrast. Once more, press and tighten your stomach muscles. Hold the tension and study it, relax. Notice the general well being that comes with relaxing your stomach. Now draw your stomach in, pull the muscles in and feel the tension this way. Relax again, let your stomach out. Continue breathing normally and easily. Feel the gentle massaging action all over your chest and stomach. Now pull your stomach in again and hold the tension. Push out and tense like that; hold the tension. Once more, pull in and feel the tension.

Now relax your stomach fully. Let the tension dissolve as the relaxation grows deeper. Each time your breathe out, notice the rhythmic relaxation both in your lungs and in your stomach. Try and let go of all contractions anywhere in your body. Now direct your attention to your lower back. Arch your back, making your lower back quite hollow, and feel the tension along your spine. Settle down comfortably again, relaxing the lower back. Just arch your back and feel the tension as you do so. Try to keep the ready of your body as relaxed as possible. Try to localize the tension throughout your lower back area. Relax once more, relaxing further and further. Relax your lower back, relax your upper back. Spread the relaxation to your stomach, chest, shoulders, arms and facial area, these parts relaxing further, further, further, ever deeper.

Let go of all tensions and relax. Now flex your buttocks and thighs. Flex your thighs by pressing down your heels as hard as you can. Relax and note the difference. Straighten your knees and flex your thigh muscles again. Hold the tension. Relax your hips and thighs. Allow the relaxation to proceed on its own. Press your feet and toes downward, away from your face, so that your calf muscles become tense. Study the tension. Relax your feet and calves. This time, bend your feet toward your face so that you feel tension along your shins. Bring your toes right up. Relax again. Keep relaxing for a while.

Now let yourself relax further all over. Relax your feet, ankles, calves and shins, knees, thighs, buttocks and hips. Feel the heaviness of your lower body as you relax still further. Now spread the relaxation to your stomach, waist, lower back. Let go more and more. Feel that relaxation all over. Let it proceed to your upper back, chest, shoulders and arms, right to the tips of your fingers. Keep relaxing more and more deeply. Make sure that no tension has crept into your throat; relax your neck and your jaws and all your facial muscles. Keep relaxing your whole body like that for a while. Let yourself relax all over.

Now you can become twice as relaxed as you are merely by taking in a deep breath and exhaling slowly. With your eyes closed you become less aware of objects and movements around you, thus preventing any surface tensions from developing. Breathe in deeply and feel yourself becoming heavier. Take in a long, deep breath and let it out very slowly. Feel how heavy and relaxed you have become.

In a state of perfect relaxation you should feel unwilling to move a single muscle in your body. Think about the effort that would be required to raise your right arm. As you think about raising your right arm, see if you can notice any tensions that might have crept into your shoulder and arm. You decide not to lift the arm but to continue relaxing. Observe the relief and the disappearance of tension.

Just carry on relaxing like that. When you wish to get up, count backward from four to one. You should then feel fine, refreshed, wide awake and calm.