"I realized that my greatest enemy was not the illness, it was stress." 

--Ginger

THE WISDOM OF FATIGUE
     In CFS the relaxation response has particular importance. The experience of fatigue is caused by certain cytokines released by the immune system. These cytokines are detected by neural receptors throughout your body. These receptors send the message to the brain that there is an elevated presence of cytokines in the blood, and the brain responds by trying to slow you down. Why would the brain do this? Is the fatigue merely a mistake, an aberration which serves no purpose?
     Let us consider the possibility that the fatigue is a purposeful response on the part of your body. It serves the purpose of getting you to rest. This is your body's way of getting the relaxation needed to allow healing to take place. 
     Remember, your body knows how to heal. You can respect the fatigue as an intelligent response. Rather than thinking of it as an inconvenience or an adversary, it is part of your body's effort to promote healing. Its intention is to allow the deep relaxation needed so your body can realign itself with its inborn programming. When you argue with your body--that is, when you attempt to go on and ignore the symptom, it will escalate and win. You cannot defeat the wisdom of your body.

WHAT THE RELAXATION RESPONSE IS NOT
     There are a variety of popular images of what is meant by relaxation. To some people, it means lying on a sofa in front of the television. For others it means an evening at the movies, or reading a good book. For someone else it may mean taking a nap, or talking with friends. Perhaps the common denominator for most people is that it means not working or doing anything that is physically challenging.
     However, none of these activities is likely to lead to the relaxation response. In fact, it may be safe to say that many people have never experienced true relaxation. This is because it involves more than just a state of rest for your body.
     The relaxation response is a state of profound rest for both body and mind. This means that neither is active, which is why many people have not experienced it. The body may be in a state of repose, but the mind is another story. As long as your mind is busily engaged, your body is unable to totally relax. Every thought and feeling that passes through your mind has an effect on your body and its chemistry, however subtle. 
     This certainly applies to reading, television, and movies. Your mind is directly engaged, and is flooded with images which evoke reactions within you. This of course is the intention of such entertainment.
     You can sleep without necessarily having the benefits of deep relaxation. People with CFS know all too well how the mind can disturb sleep. The sleep center in the brain is not functioning properly, and the anxiety and other symptoms of the illness can further impair your ability to have refreshing and restful sleep. Yet sleep is the best your body can do on its own to approach the benefits of the relaxation response. These factors, on top of the natural anxiety of having a chronic illness, can seriously interfere.
     When you are sleeping, your mind remains active, in the form of dreaming. The dreams create all manner of feeling states and chemical changes in your body. We have all had the experience of waking up from a bad dream to discover sweaty palms or other signs of emotional upset. The level of relaxation we seek is deeper than that attained in sleep. And, if you can learn the art of creating this deeper state, then sleep will be much more beneficial.

THE KEY: CALMING YOUR MIND
     The key to creating the relaxation response is calming your mind. A calm mind is a mind with minimal activity--little or no thinking, analyzing, fantasizing, or worry. The more calm your mind is, the deeper is the state of relaxation for your body. This may come as a surprise to some, but the fact is that you can be fully awake, aware, and alert while at the same time your mind can be calm. 
     This of course forces you to examine your relationship to your mind. The most fundamental point you need to accept is that you are not your mind. In western cultures you are led to assume that "I and my mind are one... my mind is who I am." This view suggests that your mind is at the center of your being, it is the most essential part of you. 
     We can benefit, however, from the insights of eastern cultures that there is much more to you than your mind. An alternative point of view is that your mind is on the periphery rather than at the center of you. In the center is your soul or spirit or consciousness, something more basic than your mind. And your mind itself is like an organ which you can activate or deactivate. 
     While this is a somewhat awkward way of saying it, the point is that it is possible to separate from, or dis-identify with, your mind. You can see ourselves as having a relationship with your mind rather than simply being it. You must become interested in this relationship if you are to have any hope of being free of stressful thoughts and feelings, and their consequent ill effects in your body.
     Fortunately for you there is a great deal known about how to accomplish this. The relaxation response has been the province of mystics and spiritual seekers for thousands of years. This is because they have all discovered that your mind is the primary obstacle to spiritual growth and insight. As a result, hundreds of traditions have evolved for how to calm your mind. 
     Most of these traditions involve various forms of meditation. Many mind/body programs teach meditation as a means to reduce stress and create the relaxation response. While meditation techniques were originally developed for spiritual pursuits, it is a welcome side benefit that the states induced by meditation can create the optimal conditions for healing to occur in your body. 
     All the traditions are based on the insight that you can separate ourselves from your mind, and that by doing so you can learn to calm it. In CFS, since your mind and its functioning can be affected by the syndrome, this realization will help you to retain a sense of power and volition, that you are not simply helpless victims of the syndrome and its effects. When you can have some degree of mastery over this, you can more easily accept that the syndrome is transitory, the symptoms come and go, and that healing is possible.

HOW TO LAY THE GROUNDWORK
     What I will present here are the common denominators of many different traditions for calming your mind. There is no one right way, but there are many ways to achieve this. They all, however, share certain fundamentals, which are described below.

Willingness to Practice Regularly
     This endeavor involves the development of a skill. Regular practice is necessary to deepen your mastery of this skill. And with practice, your relaxation will deepen, will be achieved more rapidly, and the benefits will of course be greater. Yet without the commitment to regular practice the skill simply cannot be developed. Regular practice means daily, ideally at a specified time, and for a specified period such as thirty or more minutes.

Willingness to Work with Your Resistance
     The nature of the mind is to remain active. It has a tremendous momentum to keep on thinking all kinds of thoughts. When you initially sit down to learn the practice, you will discover how strong this momentum is. You must constantly remember your intention to stay with the practice, for your mind will resist the practice and prefer to remain active. 

Willingness to be Non-Judgmental of Yourself
     One of the traps you need to avoid is evaluation or judgement of your performance. These judgements, coming of course from your mind, are in fact a way your mind can sabotage your efforts to calm it. Most likely you will have thoughts such as "I'm getting nowhere with this... I don't like this... This is boring... I can't do this... I'm not doing it right..." etc. It is absolutely predictable and natural to have these thoughts, but again they should be understood as part of the natural resistance of your mind, and you must not be distracted by these judgements. If you are not careful to remember this, you can be easily demoralized or dissuaded from further practice.

Creating the Right Environment
     This means attending to the physical surroundings. Ideally you can find a place in your home which can become your special place for practice. Perhaps a corner in your bedroom, or some other place that is reserved for this process. This helps send a message to your mind that when you are in this place, this is what you do. Have the space arranged to be comfortable--a special chair, or cushions arranged in a certain way, so that you can feel at peace in this place. Gradually your mind will learn to expect relaxation when you are seated in this place.

Preventing Distractions
     I consider three types of distractions especially important here: noise, other people, and telephones. Perhaps you can think of others. Remember, your mind prefers to remain active, and any of these distractions will be seized upon immediately by your mind if given the opportunity. The best advice is:

     Noise. Avoid the interference of appliances, televisions, or other sources of noise. If you live with others, you must enlist their cooperation in maintaining quiet during your practice.

     Other People. If necessary, place a "do not disturb" sign on your door. Again, you must enroll the cooperation of others. Make sure you communicate to them the importance of respecting your quiet time. If you have small children, you may need to arrange help with this, for otherwise your ears will be tuned to the slightest hint of their needing attention from you.

     Telephones. The first choice is unplugging the phone at the wall. This way there is no ringing, no clicking of machines, and no imagining in your mind about who is calling and what they may be saying. Using an answering machine is the second choice, and if you do use one, turn off the volume and ringer, if possible. 
     I cannot overemphasize the importance of the prevention of outer distractions. They are the easiest to overlook, and the most likely to sabotage your practice. Remember, your mind may find the relaxation experience contrary to its nature, and may seize upon any opportunity to be active, however subtle. You are doing yourself a wonderful favor by creating the opportunity for true relaxation to happen, and the fundamentals must be in place.

TECHNIQUES TO CREATE THE RELAXATION RESPONSE
     Now that we have discussed the prerequisites, let us turn to specific techniques. Since the full relaxation of your body originates with the relaxation of your mind, you are basically working with your mind. The mind has been described as a stampeding herd of wild horses, a cage full of chattering monkeys, a freeway at rush hour, and many other metaphors, all of which characterize its seemingly uncontrollable nature. If left unattended, it will continue its random, chaotic activity. In fact, in this process, you will get to know your mind more deeply than ever before, for you will be in a new relationship with it. 
     Your mind can be slowed down and harnessed, or brought under control, so to speak. The means to accomplish this may be called mindfulness. This means your mind is full of what is happening right now, and you use a particular focus to occupy your mind's attention. Below are described some alternatives which you may use to practice mindfulness for relaxation.

Using the Breath
     You may choose to use the breath as the focus for your relaxation process. Each breath is long, slow, and deep, into the belly. Being mindful of the breath, you become a student of it, and concentrate all your attention on a particular aspect of the breath. There are several ways the breath can be used.

     Watching the breath. One method of watching is to focus on the expansion and relaxation of your belly. Notice how as you breathe in the belly expands outward as the diaphragm moves down, making more room for the lungs. As you exhale, notice how the belly is drawn back in, as if the belly button is reaching to touch the front of your spine. Follow the rhythm of this in and out movement, like a circle with no beginning point, just a continuous circular motion. This movement of the belly is like that of a person rowing a boat across a lake, with the arms moving in a circular motion, each stroke flowing into the next, with no clear ending or beginning for each stroke. 
     Another method of watching is to focus on a point just inside your nostrils. Imagine that there are millions of tiny, sensitive nerve endings that can feel the air moving in across this area of tissue. You might think of the air as an ocean of billions of molecules, like marbles, all rolling over each other and over these nerve endings as they cascade down you windpipe into your lungs. 
     Then the flow reverses, and this sea of marbles pours back out, again over those same nerve endings, as it leaves your body. And just as a tidal pool next to the ocean is constantly filled and emptied by the ebb and flow of the waves, so too the ocean of air constantly pours in and back out, through your nostrils. Maintain your focus on this area just inside the entrance.

     Counting breaths. This means counting each in-breath and each out-breath, in pairs. For example: (in-breath) one, (out-breath) one, (in-breath) two, (out-breath) two, repeating this process up to ten. When you reach ten you begin again at one. Whenever you realize you have been distracted by thought and have lost count (which will happen!), rather than trying to remember where you were, you begin again at one.

     Beginning-middle-end. Another approach with the breath is to focus on the beginning, middle, and end of each breath. This means that you conceive of the breath as having three segments, and you notice each of these segments, with each in-breath and with each out-breath. In other words, you notice the beginning, middle, and end of the in-breath, followed by the beginning, middle, and end of the out-breath. This too becomes a circular process, and you can fall into a comfortable rhythm of flowing in a circular motion.
     It is important in all the breathing techniques to use your senses, rather than just doing it as an intellectual exercise. Really focus your senses on the experience of each breath as intimately as you can. Feel the texture of the air, feel the rising and falling of your belly, the expansion of your rib cage as the ribs open like fingers on a hand with each breath... Attune to your senses as much as possible to experience the breathing. It is this use of the senses that will help you stay focused on the process and, in turn, calm the mind. Fritz Perls, M.D., the father of gestalt therapy, once used a phrase which captures this process: "Lose your mind, and come to your senses."

Using Words or Sounds
     Another method is to use a sound or word as the subject of your focus. This involves the repetition of the sound or word throughout the relaxation process. This too can be done in a variety of ways. One is to repeat the word on the out-breath. You can use a simple word, something which does not engage the mind, such as "one" or "ohm" or any other word which has a calming effect on you. 
     An alternative in this approach is to use a phrase which has a reassuring effect, such as "I am one," "I am calm," or "healing now." There are many variations of this technique possible, but they all have in common the repetition of the sound or words. It is the experience of repetition that has the calming effect on the mind. You can choose any word or phrase that appeals to you. Just be careful that it is not something that engages your mind or stimulates thinking. The emphasis is on simplicity and calmness. The process of repetition fills your mind and remains your focus throughout the process.

Using "Progressive Relaxation"
     A favorite technique of many people is called progressive relaxation. This involves a block of time and a quiet place, just like the earlier techniques described. However, your body itself is used as the focus of your attention. The aim is the same--that is, to disconnect from thought and spend a period of time in a state of deep relaxation of both body and mind.
     Progressive relaxation may be done either lying down or sitting. In either case, you find a comfortable position, one from which you will not need to move for twenty or thirty minutes. Observe the same fundamentals described earlier in preparing the environment and having a special place. 
     This technique involves focusing on various parts of your body, relaxing them one by one, spending approximately a minute in each area. You tense, hold, and then release the muscles of a particular area, before moving on to the next area. Hold or clench the muscles in the area for a count of ten, and then release for a count of ten, before moving on to the adjacent area. 
     In a variation of this technique, you can forgo the tensing and releasing of muscles, and instead focus on simply bringing your awareness to each area and imagining that area softening and melting, releasing any tension that was present. At the end of this chapter is a script to guide you through a progressive relaxation exercise using this variation. You are encouraged to experiment with both methods, and find which works best for you.

HANDLING YOUR MIND'S RESISTANCE
     The greatest challenge in relaxation method is staying focused, whether it be on the breath, word, sound, or parts of your body. And of course the source of this challenge is your mind, for it has a tremendous momentum toward continuous thinking. Your mind will go through a variety of strategies to distract you and engage you in its meandering ways. This may include continuously offering you its analysis about the process, as in "I'm not getting this... This is boring... I'm doing great... This is fun... How much longer? What time is it?"
     If that doesn't capture your attention away from the process, your mind may try thinking about the important issues or problems in your life, or resort to showing re-runs of horror movies about your illness. Its basic attitude will be, "Why waste this valuable time that could be put to constructive use, thinking about how to solve these problems?" Or it may choose to focus upon the details of daily living: "Let's see, how full is the gas tank? How much do I have in the checking account? When did I balance the checkbook last? What do I need to pick up at the store?" Your mind will find both subtle and not-so-subtle ways to distract you and engage you in thought.

Returning Home (Again and Again)
     Each time you discover you have lost your focus and have been caught up by your mind, your reaction is critical to the relaxation process. It is not realistic to expect that you should remain free of thought through the process and never succumb to your mind's seduction. The process is not one of attaining a fixed state of no-mind. Rather, it is a process of continuously and methodically returning back home to the meditation subject. 
     Some people find it helpful to imagine they are sitting by a river bank, and the thoughts are merely debris floating by. They do not need to jump in and float down the river with the debris. Or you may imagine the thoughts as merely clouds drifting across the sky, as you notice them and return to your focus.
     At first you may find that you stay focused only for a few seconds at a time before thoughts start crowding their way in. And each time you find yourself in thought, you simply return, as if to say "Oh yes, back to the breath..." There is no need for judgement of yourself or analysis of the thought. Just keep returning back to the focus. 
     This is when to be especially wary of self-evaluation, for if you persist with a judgmental attitude toward yourself or your performance, you will experience meditation as one insult after another because you will quickly see that your expectations do not hold.

Labeling Your Thoughts
     One strategy that may help you get some distance from your thoughts is to label them when they arise. Each time you find yourself captivated in thought, you take a step back and give that thought a descriptive label. You need only have a very short list of categories for, after all, most of your thoughts deal only with a limited range of issues. 
     You may use any labels you find useful. You could use a simple scheme such as worry, fear, desire, thinking, fantasy or other labels. The point is to distance yourself a little from the thought, and attaching a label can help you shift your focus back to the relaxation process.
     With time and practice, you will find that your skill increases noticeably. You will find the gaps between thoughts become wider, you will catch yourself more quickly, and less and less effort is required to return to your focus. You will also begin to notice patterns or characteristic types of thought that seem to keep arising, and this recognition will make it even easier to detach. 
     Ultimately you will discover deeper feelings of calm and peace than you thought possible. Finally, after each session you will find that your thinking is more clear and insightful. These are all worthwhile benefits which will add to the physiological benefits of the relaxation response.

THE USE OF MUSIC
     Many people enjoy using music in relaxation, and it can certainly have a soothing effect on your mind and emotions. However, music can both help and hinder your creating the relaxation response. One must be careful in how one uses it, and what music is selected. 
     There are certain guidelines for this. Remember, since your intention is to calm your mind and body, it is best to select music which does not engage your mind in following a melody. While this may feel pleasant, it does not help in making your mind be still so the relaxation response can arise. On the other hand, music which is simple and non-intrusive, such as involving long tones or ocean waves gently lapping on the shore, and no melody that compels you to participate in it, can have a calming effect for your mind and facilitate the relaxation response. Some people find that music is helpful in the early stages of learning to deeply relax, but then later becomes a distraction as they become more adept at calming the mind on their own.

EXERCISE: PROGRESSIVE RELAXATION
     Allow about twenty minutes to move through this process. Find a comfortable position, in an environment where you will not be disturbed or distracted.
     Begin by closing your eyes and bringing your awareness to your breath. Take a few moments to breath deeply and fully, emphasizing the length of the out-breath, letting it be long, deep, and thorough. After a few minutes when you feel your breathing has softened, bring your awareness to the toes of your right foot. Imagine that you can direct your breath into your toes, and as you breathe, your toes are softening and melting, letting go of any remaining tension. After a few breaths, bring your awareness to the rest of your right foot, and breathe into the entire foot, allowing it to soften, melt, and let go of any remaining tension.
     Now let this feeling of softening and melting spread up through your right ankle, and bring your awareness to your right calf muscle. Again breathing slowly into this area, feeling it soften and melt with each full deep breath. Spend a few moments sensing the feeling of softness and melting, and then let this feeling of relaxation slowly move up through your right knee into your right thigh, and again, feel your right thigh muscles softening and melting, just letting go of any remaining tension...
     Continue this process through the major muscle groups of your body, taking your time in each area (about a minute) until you feel a definite softening and melting sensation. Move from the right thigh to the hip, the buttocks, over to the left hip, down into the left thigh, knee, calf, ankle, foot and toes. Then move up through the pelvis, lower back, middle and upper back. Then around to the lower abdomen, solar plexus, rib cage, and chest. Then out to the shoulders, down the arms, the hands, to the finger tips. Move to the neck, throat, up the sides and back of the head, over the top of the scalp. Then down into the forehead, into the sinuses, eyes and eye sockets, cheeks, and mouth. Inside the mouth to the jaw muscles, the tongue, and the lips.
     Now scan the entire length of your body, to see if there are any remaining areas with the slightest tension. Direct your breath into those areas, and with a long, thorough out-breath, let it all go... 
     Now rest.

For information about Dr. Collinge's four-CD audio program of inspirational talks and guided self-healing exercises that accompany this book, click here.