A plethora of modalities exist to help you manage your stress levels, assuming that you incorporate these new behaviors into your lifestyle on a regular basis. They include, but are not limited to relaxation, positive thinking, goal setting and time management, as well as regular exercise and proper nutrition. This section includes some techniques for adoption into daily routines from Powell & George-Warren (1994) and the resources section below. Note that information on physical activity and nutrition will not be covered here. For this information, refer to the National Center on Physical Activity and Disability (NPCAD) website (www.nchpad.org) or call their free hotline at 800-900-8086 for this and other health promotion resources in the references section below.

A. Relaxation:

Getting Started

Relaxation can be practiced in many different forms and environments. To begin, consider a few guidelines:

• Locate a quiet environment where you feel comfortable. Use a blanket if necessary to stay warm.
• Situate yourself in a comfortable position. A seated position is preferred over lying down, so that one does not have the tendency to fall asleep.
• Reserve a regular time each day for practicing relaxation.
• Focus on a word, phrase, sound, or the rhythm of your breath that is repeated regularly throughout the session. It is natural for your mind to wander: simply focus again.
• Use a timer if necessary, so that you can focus on your relaxation practice rather than the time you are allocating to it.
• To learn proper techniques, practice with relaxation tapes from your local library, or take a class in your community, such as meditation, qi-gong, and various forms of yoga. For example, see NPCAD's factsheet on Yoga for Persons with Disabilities at http://www.nchpad.org/295/1834/Yoga~for~Individuals~with~Disabilities.

Positions for Practicing Relaxation Exercises:

Sitting:

• Sit in a comfortable chair where your back is supported, your feet are on the ground, and your knees are bent.
• Your head should feel as if it is a helium balloon, and your spine should lengthen, as if it is floating up freely.

Lying Down:

• Lie flat with your arms comfortably resting at your side.
• Your legs should rest slightly apart.
• A blanket can be used to keep warm.
• Use a small pillow under your neck and/or under your knees, if you experience any strain in this position.

Breathing Guidelines:

• Watch how a baby breathes, with her/his abdomen rising and falling. Place your hand on your belly/abdomen area, and practice breathing from this area, as you watch your hand rise and fall.
• Use your nose to inhale and then exhale through your nose or mouth.
• Breathe initially while lying down, and then practice from a sitting or standing position.
• Consult the following website (http://swamij.com/breath.htm) for tips on proper breathing guidelines and additional exercises.

Quick Exercises

Each of these simple exercises can be practiced throughout the day when you have limited time but desire the benefits of relaxation.

In-Out Breathing

Breathe slowly and steadily. As you inhale, silently say 'in' and as you exhale, silently say 'out'. Repeat for 5 to 10 minutes. Preferred mantras, terms, or images can be substituted for 'in-out', if desired.

Self-Massage

Use your fingers, hands, and fists to massage your facial muscles, neck, shoulders, arms, and/or hands. Focus on areas experiencing tension. During massage, practice deep breathing.

Relaxation Response

This exercise can be practiced with the eyes open or closed. Breathe deeply from your abdomen. Hold for two to three seconds. Exhale slowly. While exhaling, let your jaw and shoulders drop. Experience the relaxation response in your arms and hands, as well as throughout your body.

Walking/Wheeling Meditation

Being conscious of your breathing while walking or wheeling can be an ideal exercise to focus your attention on the present, in order to relax your body and clear your mind. Begin walking or wheeling until you establish a comfortable pace. Become aware of the number of steps or pushes you take between breaths. For example: breathe in 1-2-3-4, exhale out 1-2-3-4.

Progressive Relaxation
To learn a complete progressive relaxation series, go to http://www.healthy.net/Health/Article/Relaxation_Techniques_for_Relief_of_Anxiety_Stress/1205, or follow exercises indicated in Manning et al. (1999). To practice a tension-relaxation procedure, try the following: Focus on the muscle group you would like to target, such as your right arm. Inhale and squeeze this muscle group as hard as possible for about 8 seconds. Then, exhale as you release the tension. Experience the sensation as the tightness flows out of your arm, and through your hand and fingertips. Relax for at least 15 seconds, and then repeat the tension-relaxation procedure again for another muscle group.

B. Positive Thinking & Speaking
Similar to a computer, we save our ideas and beliefs within our consciousness, which have an effect on how we conduct and experience our life. Everyone has positive and negative thoughts, yet listening to positive thoughts can help you realize a positive disposition. It just takes practice. It is important to realize that the quality of the input from our consciousness can only be as beneficial as the input. If our mind operates like a 'Yes' machine, accepting all that we input into it, we must fill our mind with positive, life-enhancing messages.

The following exercises can be practiced to re-affirm the positive messages that you input in your mind:

Affirmations

Affirmations can be practiced throughout each day to reprogram positive messaging to your consciousness. Use words, prayers, poems, or sentences of your own that convey a positive message for you. Use the following guidelines to develop your own affirmation practice:

• State affirmations in the present tense, as if it has already has happened, and you are witnessing this occurring in your life.
• Use the pronoun 'I', or your own name.
• Repeat positive, life enhancing messages within a positive context. Do not, for example, utilize negative terms within the affirmation, 'My neck is not in pain'.
• Be specific about the messages you want to realize in your life.
• Say affirmations aloud and speak while looking into a mirror to make a stronger connection with the message. Tape record the affirmations to establish a stronger sensory connection with the message. Make use of pre-recorded affirmation tapes/CDs. NOTE: do not listen to such tapes/CDs while driving or using heavy machinery.
• Write down your affirmations and display note cards in places where they are easily visible for you, such as on your computer monitor, vanity, and car dashboard.

Visualization

Visualization is a technique that can be practiced to envision what you would like to materialize in your life, whether it be better health, a clearer career focus, greater internal peace, or other qualities or outcomes.

• Relax. Find a quiet environment free of distractions. Wear comfortable clothing.
• Think about your goal.
• Imagine details: How will you feel? What will you be wearing? Who will accompany you?
• If necessary, record your impressions in a small notebook.
• Return to these images as much as possible throughout the day. Use affirmations to enhance and reaffirm your visualization exercises.
• To become more proficient, attend workshops, listen to visualization audiotapes, and consult books from your local library.

C. Goal Planning and Time Management
Goal planning and time management allows you to prioritize goals for your life, and how you are currently managing your time in order to achieve those goals. Note that determining your goals can be exercised in conjunction with visualization exercises.

Determining Your Goals

• Envision your goal and write it down. Don't worry about correct spelling and grammar.
• Is there anything you need to achieve these goals in terms of knowledge and skills?
• Is there anything that could prevent you from accomplishing this goal?
• Who can help you in attaining this goal? Friends? Family? Co-workers?
• Detail steps to achieving your goal, with a realistic time frame.
• Visualize yourself in the future as already having achieved this goal.
• Once you have achieved any goal, it is important to acknowledge this by rewarding yourself in a tangible way, i.e., going for a walk with your friend, reading a good book, etc.

Set Time Management Priorities
As most of us perceive that our demands exceed our resources, necessitating our need to set priorities that will guide our actions. Each day on your TO DO list, determine which tasks are A, B, and C priority according to the following definitions. Note that these priorities can fluctuate on a day-to-day basis.

• Priority A: 'Must Do': High importance. These tasks have immediate deadlines attached to them and/or are critical for advancement.
• Priority B: 'Should Do': Medium importance. These tasks contribute to project development but do not have immediate deadlines.
• Priority C: 'Could Do': Less important. Can be rescheduled to do at another time.

It may also be helpful to schedule certain tasks for when you are experiencing the most or least optimal energy level during the day. For example, focus on activities necessitating higher intellectual acuity at your peak times, whereas routine office work can be done later, or delegated to others, if possible.

Time Allocations

• Sketch a large circle onto a blank piece of paper. In a pie chart format, color code slices to what percentage of time you are allocating to various activities throughout the day. Break down categories in ways that seem most useful, i.e., work, housework, leisure, exercise/health promotion, sleep, etc. This can give you a proportional representation to how you are spending your time.
• In a notebook, write down all your activities over the course of the day, including phone calls, e-mails, meetings, family responsibilities, transportation, socializing, etc. Review them and color code the time you are prioritizing your projects instead of others' emergencies.

Simple Yet Effective Time Managmement Tips

• Determine your core values to determine your immediate and long-term goals, and a TO DO list of daily tasks.
• Use a simple, written TO DO list: Prioritize your essential tasks and work on the sequentially. Make sure it is written down and portable.
• Eliminate time wasters: consolidate errands, eliminate unnecessary meetings, etc.
• Do your most undesirable tasks first while you are full of energy, which should give you energy to do other tasks.
• Say 'no' to some tasks, and delegate those you need not do yourself.
• Strive for excellence, but know when perfectionism is unnecessary and impeding your progress.
• Consolidate time for returning telephone calls, e-mails, and handling mail and paperwork: By designating specific times for these tasks, they are less likely to interfere with deadlines and important projects.
• Stick to a schedule: Schedule ample time for sleeping, eating, running errands, and managing household tasks so that you will not feel rushed.
• Plan for emergencies: Get up 10-15 minutes earlier to account for the unexpected. Have extra sets of car and house keys for emergencies.