[[#Breathing Techniques]] [[#Meditation Techniques]] [[#Co-Regulation Techniques]] [[#Visualization and Emotional Cultivation Techniques]] [[#Somatic Techniques|Somatic and Meditation Techniques]] # Breathing Techniques ## Box Breathing - Breathe in while counting to 4 slowly. Focus on the air entering through your nose. - Hold your breath for 4 seconds. - Slowly exhale for 4 seconds through slightly pursed lips. - Repeat. ## Breathing into Physical Sensations If there is a physical sensation that is bothering you, often pain or discomfort, you can try to imagine that you are breathing into that location in your body. Try to enter into the sensation deeply and without judgment rather than trying to distract or ignore as you normally would. This can sometimes reduce fear around symptoms and lead to a lessening of the sensation. This can be practiced with emotions too by breathing into physical sensations that accompany emotions, such as chest tightness or rapid heart rate that come with anxiety. ## Vase Breath The lungs are filled from the bottom to the top as if filling a vase. Sit or stand with back straight. Breathe in and out through the nose, filling the belly upwards. Hold in briefly Exhale from top to the bottom of the lungs. Breath should slow to about 8 breaths per minute. (7-8 seconds per breath) ## Pore Breathing Take in a deep vase breath. As you do, imagine you are taking in air through the pores in the skin. You can take in specific energies such as elemental or planetary energies. You can also pore breath qualities out of the body as well (such as the earth element if feeling sluggish). Focus on how the four elements feel when breathing them in or out. ## Release Breaths Release breaths are when you do a double inhale (take a deep breath and then inhale a little more) followed by a sigh. This type of breathing can allow for emotional releases to take place. I like to practice these when I am experiencing air hunger. ## Wim Hoff Breathing This breathing method is energizing and stimulating but can also come with a deep sense of wellbeing. I recommend using it in small doses at first to see how you tolerate it. It should not be your primary form of rest. You can learn how to do this style of breathing on YouTube or on Wim Hoff’s App. Wim Hoff also endorses cold exposure and strenuous yoga postures which I do not recommend you try until you are fully recovered. - Get into a comfortable, meditative position, sitting or lying down. - Rapidly take 30-40 full, deep breaths. Inhale through your nose or mouth and exhale through your mouth. Do this as fast and deep as you can. Each breath should fill the belly and chest and follow one another in short, powerful bursts. - After your last deep inhalation, relax. Let the breath leave your lungs as you relax fully. Stop breathing. - Wait until you feel the urge to breath again. - Then, take one final deep breath and hold it in your lungs for about 15 seconds as you bare down. # Meditation Techniques ## Mindfulness Meditation Just being able to notice thoughts, emotions, and physical sensations without judgment can be a fun and relaxing exercise. Some people with ME/CFS don’t tolerate this well but if you do feel free to add this to your repertoire of restful activities. When I was sick I tried meditation as a treatment but became frustrated when I would fall asleep every time I tried to meditate. Now I know that those naps were probably very helpful in my recovery. I now recommend prioritizing sleep and Yoga Nidra over a strict mindfulness meditation practice when you have ME/CFS. ## Yoga Nidra A personal favorite of mine, Yoga Nidra is actually a meditation practice rather than a movement practice. It encourages deep states of relaxation, even to the point of falling asleep. I don’t know of any more powerful tool for inducing the rest and digest state. It can not only promote sleep but it can bring restoration even when sleep is not possible. I recommend using at bedtime if you have insomnia as well as during the day when you need to rest or nap. Free guided meditations can be found on YouTube or through the Insight Timer App. # Co-Regulation Techniques Co-regulation is the process by which you calm your own nervous system by being connected to someone else who is calm and present. Our nervous system is designed to be on high alert when we feel alone. After all, alone meant we were in danger to our ancestors. Being with the tribe meant safety. Our rest and digest state is also our pro-social state. Safe interactions with others helps move us out of fight/flight and into rest/digest. This is one of the most important reasons that strong social support is so important. Coregulation with a partner, friend or family member could look like: 1. Eye contact 2. Cuddling 3. A hug 4. Breathing together 5. Laughing and joking together 6. Anything else that makes you feel safe and supported ## Cuddling Coregulation with safe and soothing physical touch is one of the most powerful ways to move the nervous system into a state of rest and digest. This may look like being held by a significant other, having a friend place their hand over your heart, or laying next to a sleeping pet. ## Finding Social Support Emotional and practical support from other human beings is very important for the management and healing from ME/CFS. Unfortunately, this disease tends to make us isolated and lonely by its very nature. I recommend my patients who are lonely seek out one or more of the following people to spend time with: 1. A therapist 2. An online friend with ME/CFS 3. A pen pal 4. A positive support group 5. An elderly or lonely neighbor # Visualization and Emotional Cultivation Techniques ## Find Joy in the Present Moment I remember when I was ill and couch-bound, I would look around the room and find a color - the color of a pillow or the wall or a dress in the nearby painting - and I would visualize that color out in nature. Perhaps that pillow was the color of a flower, or the sky, or a mountain lake. I was appreciating the beauty around me, in everyday objects I had never truly looked at before. Beauty and joy are internal states that can be cultivated at any time using our imagination. Even people who can't "see" things with their mind's eye can contemplate concepts that inspire awe, peace, or wonder. How can you cultivate joy in this exact moment? ## Practice Gratitude Gratitude is a habit and a choice. Those who are in the habit of reacting with gratitude will be happier and feel safer. Perhaps try a guided meditation that leads you into a deep state of gratitude. ## Daydreaming and Visualization As long as your thoughts remain positive, this can be a powerful way to allay boredom while resting. I once played a game where I would find a color in the room and imagine that color out in nature. The only limitation is your imagination. ## Don't Be Anxious about Being Anxious Anxiety is a symptom of ME/CFS and you will experience it, especially during PEM. It is common for all of the talk about reducing stress and prioritizing rest to cause my patients to become afraid of their anxiety, worrying that it will push them into PEM. Ironically, it is the fear of anxiety and, by implication, a fear of PEM, that is often the last hurdle to overcome. Let me emphasize this: as long as you are afraid of ME/CFS symptoms, your nervous system will continue to feel unsafe. So your final goal should be to see ME/CFS symptoms (everything from fatigue to brain fog to anxiety) as safe and welcome messengers, pointing you towards healing. They should be embraced and thanked for keeping you safe whenever they appear. Anxiety should be met with gratitude and love. Fatigue should be met with compassion. Brain fog should be honored as a warning sign and teacher. This mindset shift from fear to peace is key and can lead to major reductions in symptoms both immediately and over time. Stop pushing. Stop trying to escape or mask or avoid. Start listening. Start meeting these symptoms with love, not fear. They are there to protect and help you. They are there to point you towards healing. These statements can bring up anger in some people. ME/CFS is an illness that can steal our life and joy in a way that is difficult for others to even comprehend. This is true. I’ve been there. Nevertheless, fear and anger will not help you get your life back. Forgive your body. Forgive yourself. Start living out of love rather than fear. Your body will follow. ## The Letter Method Sometimes, the best way to release troubling emotions is to feel them fully and allow the emotional energy to run its course. This is a method I sometimes use when I feel like I am emotionally stuck, especially in anger. Find a quiet place to yourself and write a letter to the person you are angry at. This letter will never be shared so be brutally honest. Give your anger a voice. Now isn't the time to discredit your anger, avoid it or minimize it. Say everything that your anger feels. Write until you have said everything that your anger wants to say. You may want to take a little break here. Eat something. Breathe. Being angry is hard work. When you are rested, now is the time to read the letter. Imagine the person that you wrote the letter to is sitting or standing in front of you. Now read the letter out loud. Allow all of the anger and hurt or whatever other emotions you are feeling come through in the reading. Yell. Point. Stomp. Do whatever your anger feels like doing to fully express yourself as you read. If you have more to say that you didn't write down, go off script. Do whatever you need to do to feel fully expressed. When you have finished reading the letter, read it again. And again. And again. Read until all the anger is drained out of you. Read until you have shed all the tears and felt all the rage. Read until the anger is gone. Take a moment here to rest. Breathe. Be with your thoughts. Notice how your body is feeling. When you are ready, burn the letter or release it in some other way. ## Radical Acceptance What we resist persists. The harder we try to swim the faster we sink. Sometimes, letting go is the only way to regain control over our lives. These are paradoxes that become highly visible in the setting of ME/CFS. You will find that the harder you try to manage your medical condition - the harder you work to do everything right, the harder you try to pace or meditate or sleep - the worse you will feel. This is because ME/CFS is related to your nervous system being in the "on" position. Trying hard at anything is going to reinforce this excitatory state. The way forward is paradoxical and beautifully simple. It is the same mindset described in the Tao Te Ching - “Give evil nothing to oppose and it will disappear by itself.” Simple, but not easy. Our nervous system is screaming at us that we are in danger and we cope with this by trying to control the world and people around us. It took me a long time to recognize this impulse in myself as anxiety. Even longer to recognize that giving into the anxiety only reinforced it and made it stronger. So do what you can to resist nothing. Feeling anxious? Don't try to escape it. Feeling sad? Lean into it. How does it feel? Where does it sit in your body? Feeling scared? Embrace it. This is courage. Feeling powerless? Surrender. Feeling hopeless? Let go of the future and trying to control it. Sit in the present moment where all is well. This is all there is. # Somatic Techniques ## Naps If you feel sleepy, laying down and taking a nap is a great way to rest. If you tend to oversleep, try setting an alarm so you can fall asleep at night and maintain a regular sleep schedule. ## Trauma Release Exercises Trauma Release Exercises (TRE) induce the natural process of tremoring whereby the body releases physical energy stored when it prepares for fight or flight. This release allows the body to move from a state of stress to a state of rest and digest. Tremoring takes the form of involuntary, rhythmic muscle movements. This may be happening to you already, but if you don’t know what they are it can feel scary because the muscle movements are outside of your control. If you find that you are tremoring already, you can allow these helpful energetic releases to happen by relaxing into them. If you are not already experiencing tremoring, you can try to induce them with the help of TRE. You can search for “Trauma Release Exercises” to find YouTube videos walking you through the process. You can also read Waking the Tiger by Peter Levine for a more detailed discussion about the physiology of tremoring. There are trained coaches who teach TRE but I don’t know of any locally. I found that Trauma Release Exercises were a powerful tool in my own recovery and I recommend them for all of my patients. Unfortunately, I am not a TRE practitioner (yet) so I cannot teach you how to do these. You can, however, learn to do them yourself. [This is a very interesting video by a TRE practitioner explaining how he would go about teaching his patients with ME/CFS how to tremor](https://youtu.be/-qGKpylBQvo?list=TLGGgifrrmnvImEwODEwMjAyNA). He also explains why he thinks they work. [Here is another video on Trauma Release Exercises (TRE)](https://youtu.be/VBDJNCA9Myc?list=TLGGNWIcTkEOjiIwODEwMjAyNA) where you can follow along and try them for yourself. I consider modifying the exercises according to Dr. Robins' recommendations in the video yesterday: - Start by finding a safe place in the body first. Pendulate awareness between parts of the body that feel safe and parts that feel unsafe - Do the resting position (knees bent, feet flat on the floor, hip width apart) and the pelvic lift with feet flat on the floor. - Tremor for 20-30 seconds at a time and then straighten your legs for a minute and wait for the tremors to stop. - Remember that you are in control. - Do perhaps 2 rounds of tremoring and then stop. - Start with TREs maybe twice per week and then work your way up to more frequent and larger doses as tolerated. ### More Youtube Videos of TRE [Trauma Release Exercise with Dr. David Berceli at Trauma Release and Wellness Centre - YouTube](https://www.youtube.com/watch?v=SdQJg-HwsMQ) [TRE - Trauma Release Exercise // Guided meditation while shaking // Nervous System Regulation. - YouTube](https://www.youtube.com/watch?v=bJGJBliDD4A) [TRE® (Tension & Trauma Releasing Exercises): Full Instructions with Dr. David Berceli (OFFICIAL) - YouTube](https://www.youtube.com/watch?v=FeUioDuJjFI) ### TRE Practitioners and Teachers [The Breathe Network](https://www.thebreathenetwork.org/providers/mark-gerow/) [[Mark Gerow]] ## Progressive Muscle Relaxation The systematic tensing and then relaxing of muscle groups can be useful for muscle relaxation and entering into a state of rest. There are guided exercises on YouTube that walk you through this process. You will need to be well enough to tolerate the physical exertion that comes with tensing the muscles. TRE has a similar effect and is probably better tolerated but progressive muscle relaxation is an alternative if you have not been successful in inducing a tremoring response. ## The Half Salamander Exercise for Vagal Nerve Stimulation 1. Eyes looks right without turning head 2. Tilt head to the right towards shoulder 3. Hold for thirty to sixty seconds 4. Then eyes and head straight back to neutral 5. Eyes look left without turning head 6. Tilt head to the left towards shoulder 7. Hold for thirty to sixty seconds 8. Then return to neutral state ## Gentle Movement Movement done within the energy envelope can help with proper lymphatic drainage, blood flow and reduce deconditioning. It can also calm the nervous system and help the body to release stress. As more physical movement becomes possible you can consider incorporating Chi Gong, Yoga, walking and other gentle forms of exercise into your routine. ### Bed Yoga A gentle movement practice done while laying down is well tolerated by many patients with moderate to mild ME/CFS. If you feel it is safe for you, I encourage you to start a bed yoga practice such as the one seen here. I encourage you to pay attention to your body and not do anything that makes you feel worse. [Morning Yoga for POTS + Dysautonomia | Bed Yoga Class - YouTube](https://youtu.be/o5WNCvXRnBY?list=TLGGMPX_Ti9J4GIwODEwMjAyNA) ### Qi Gong and Tai Chi Qi Gong and tai chi are gentle movement practices that may be tolerated by some ME/CFS patients. I recommend starting with a movement practice done completely lying down such as this one: “[Lying Down Qigong and T'ai Chi Ch'uan (Tai Chi)](https://youtu.be/fpA4aWjI_HU?si=S0IPGeEhfaC-jgGL)” by Acupunx. By laying down you don’t need to worry about orthostatic stress. Do only a small portion of the video first and work up to the full 20 minutes as tolerated. As you get stronger and orthostatic problems improve, you can work your way up to a standing Qi gong practice such as the “[15 Minute Qigong Practice to Cultivate Calmness](https://www.youtube.com/watch?v=_YFSDvY6ZoM)” on the channel Tanner Murtagh MSW, RSW. ## Laying outside Being outside in nature can be very restorative. It comes with the added stress of sensory/environmental exertion (bright sunlight, heat or cold) and physical exertion (needing to walk to a place outside) but if the weather is good and you have the capacity, spending time in nature can often bring a deeper sense of peace and wellbeing. Use your own best judgment. Get sunlight if you can and it isn’t too hot. # Restful Entertainment ## Listening to Audiobooks or Soft Music The auditory sensory input should feel soothing and not overwhelming. Some people find that they are particularly sensitive to sound. Others find an environment that is too quiet to be stressful. Make your auditory environment comfortable for you. ## Listen to Boring Educational Material I have some patients who find that listening to “relaxing” stuff makes them feel frustrated but listening to an educational podcast or non-fiction book puts them to sleep. It’s OK if you just use that to give your brain something to do while you rest. Bonus points if you retain some information but don’t be frustrated if you have to listen to the same episode multiple times. Some popular options include the LDN Podcast or the Bendy Bodies Podcast.