Incorporating Relaxation & Guided Imagery into Treatment Protocols with MS Dr. Miriam Franco, MSW, Psy.D., MSCS Relaxation techniques are key to restoring and maintaining a healthy body and mind and to gain control of worries.  It can profoundly activate the body’s relaxation response (slow breathing & lower blood pressure) and promote well-being. People with MS have a higher prevalence of depression and anxiety which have been associated with decreases in adherence to treatment, quality of life, and functional status. Multiple studies have shown that use of directed sensory images has been found to change behavior, relieve symptoms and improve mood and fatigue associated with MS. GI significantly reduced fatigue and depression and improved quality of life among MS patients.  GI has also been documented to increase short-term immune function  to shift pain responses in MS patients, and lower MRI anxiety.  My new app, ImageryWork has an entire section devoted to the application of GI exercises for managing MS. Here are some GI tracks to incorporate into treatment protocols:   FOR THE EARLY DIAGNOSED Relieve Stress: De-Stress 101 Improve positive thinking and sustain motivation for treatment goals: Imagine the Possibilities Lower Anxiety/Injection Anxiety: Lower Anxiety/Injection Anxiety with MS FOR INFUSION/VENIPUNCTURE FEARS Going to a Safe Place TO REDUCE/SHIFT PAIN RESPONSES De-Stress 101 TO ENHANCE REST PERIODS Imagine the Possibilities Going to a Safe Place Lower Anxiety with MS TO RELIEVE MRI ANXIETY StressFree MRIs TO REDUCE CAREGIVER STRESS Relieve Caregiver Stress To learn more about incorporating GI into MS treatment protocols and access all available tracks, subscribe to  ImageryWork my new Guided Imagery app!

Relieving Caregiver Stress: Quickly, Easily, and At Home With Guided Imagery Dr. Miriam Franco, MSW, Psy.D., MSCS Whether a spouse, a parent, or child of a loved one with a chronic illness, the value of the services that the caregiver provides is invaluable on a personal and national level.  Approximately 43.5 million unpaid caregivers have provided care in the last year and about 15.7 million adult family caregivers provide care for someone who has Alzheimer’s Disease (Caregiver Disease Facts and Figures). The toll of caregiving is enormous when insufficient relief from stress and insufficient support exists.  The Family Caregiver Alliance has cited Caregiver depression and stress to be a national crisis. Stress upon the caregiver of family members with dementia has been shown to impact the caregiver’s immune system up to 3 years after caregiving ends, thus increasing their chances of developing a chronic illness themselves. Family caregivers who provide 36 plus hours per week are more likely than non-caregivers to experience symptoms of anxiety and depression. For spouses, the rate is 6 times higher, for the caring of a parent the rate is twice as high. Family caregivers experiencing extreme stress have been shown to age prematurely.  this level of stress can take as much as 10 years off family caregiver’s life. The bottom line is that caregivers need to practice fast, effective, and convenient stress reduction techniques that don’t require months of practice and can easily be incorporated in brief moments of time throughout their day. Relaxation and Guided Imagery (GI) techniques are a perfect fit for any caregiver’s circumstances and can be easily practiced sitting in a doctor’s office, waiting on the phone, before going to sleep, or any brief moment or transition in the day.   They are simple yet profound mind-body techniques that restore and maintain a healthy body and mind and gain control of worries. It can radically activate the body’s relaxation response (slower breathing and lower blood pressure) and promote well-being. First, you learn to lower muscle tension in the body and breathe from the belly to lower stress.  Sensory imagery is then evoked, starting with simple centering techniques, such as imagining a safe place or ideal place of relaxation with your senses and then you’re guided to imagine more elaborate sensory exercises.  Because the body deeply resonates with sensory images practiced in a relaxed state, GI has been found to reduce pain or headache, improve mood and renew energy. Many studies have documented GI’s efficacy in reducing anxiety, depression and fatigue (Case et al, 2018; Apostolo et al, 2009) in shifting pain experience (Jensen et al, 2009) and its unique ability to improve short-term immune function (Trakhtenberg, 2008). Thus, it’s an ideal tool for any caregiver! I have taught GI to many caregiver groups (Parkinson’s, MS, Alzheimer’s, stroke) and participants have found it easier to use and practice than meditation, easier to stay with (especially if they are prone to anxious thinking), a fast and fun way to empower themselves, restore and renew energy and regain purpose and balance in their caregiver role.  As a result, I developed a specific GI exercise: Relieve Caregiver Stress that any caregiver can practice at home. It’s available on my new GI app: ImageryWork.  Check it out and pass it along to any caregiver who could benefit from it—it’s a gift of love and support.      To learn how to practice  Relieving Caregiver Stress, visit  ImageryWork my new Guided Imagery app  

Imagine the Possibilities with Guided Imagery Dr. Miriam Franco, Psy.D. Relaxation & Guided Imagery (GI) are gentle, effective mind-body techniques that teach people how to become deeply relaxed and then guides them through sensory images. GI induces The Relaxation Response and also increases right brain processing.  In this state, the emotions, mood and physical state we associate with an image appear very vivid, immediate and emotionally charged.  As a result, it can evoke rapid changes in mood, perception and behavior and performance.  Our bodies in this deeply relaxed state are open to receive sensory images and treat the imagined image as if it’s happening. Because our bodies do not discriminate between sensory images in the mind and what we call reality, with practice, the effects created reverberate deep within the body. Typically, GI is used to lower anxiety, improve short-term immune function, promote rest and vigor, promote healing, coping and well-being. It is fast and powerful in its effects and you don’t even have to be a believer for it to work.   It can, however, be an empowering technique that can help people prepare and rehearse new tasks, roles, challenging procedures or life events or improve athletic or artistic performance. This type of imagery is referred to as End Result Imagery.             Developing a new idea cannot take place without imagery. One first imagine then creates. With end result imagery exercises, one imagines with their senses what it is like to experience, in a highly relaxed state of mind and body, particular goals and outcomes.  That is, spending time imagining how it will feel to have this outcome in one’s life, picturing it, hearing what others would be saying and feeling in one’s body what it would be like to experience this end result.  With a bit of practice, the mind and body start to know how to evoke the experience of having this end result.  This can be extremely effective in reducing jitters associated with a new skill, sustaining motivation for long-term goals or even learning how to be open to receive this end result in your life. Numerous, successful athletes, such as Arnold Schwarzenegger, Kayla Harrison (Olympic Judo title), Mariel Zogunis (US Fencing champion) and Missy Franklin (4 times Olympic Gold swimmer) Lindsay Vonn (Olympic Skier), Carli Lloyd (World Cup Soccer) and actors , like Jim Carrey, Oprah Winfrey, Will Smith have utilized visual imagery to improve their skills, remain in the flow and imagine overcoming their fears. Though GI used to be referred to as visualization, it actually can involve any or all of the five senses and when practiced it is experienced as a whole felt body state. Approximately 60 % of Americans are primary visual processors, but one does not have to be highly visual to benefit from end result GI. Successful outcomes can be achieved by a multi-sensory approach.             In my work, I use end result imagery to prepare people for surgery, help students master test anxiety,  improve performance at large, cope with painful or distressing medical procedures (MRIs , infusions /injections, dialysis), relieve caregiver stress or even reduce the stress of wedding planning and wedding day jitters for brides (my Stressfree Bride track).             For most Westerners, GI is easier to use than traditional meditation as it requires less time and discipline to acquire a high level of skill and it can be used by almost anyone, even folks with mild dementia. And it’s a relaxed, curious and playful approach to self-improvement.             To learn how to practice Imagine the Possibilities yourself and improve your performance, visit ImageryWork my new Guided Imagery app

Defeating Dental Fears, Staying Calm at the Dentist Dr. Miriam Franco, Psy.D.   Anxiety or the experience of fear going to the dentist and receiving dental treatment are leading factors for why people avoid dental care.  It is reported to be the fifth most common cause of anxiety (Agras et al, 1969) and is estimated to affect 9 to 15% of Americans.  Dentists report that it is a common problem and many practices have adopted either pharmacological interventions to ease anxiety or behavior modification techniques such as mindfulness approaches that incorporate deep body relaxation or a combination of both. People with dental fear dread upcoming appointments or avoid them all together. With dental phobia, even if they know the fear is irrational, they still experience panic.  Typically, they only go to the dentist when their oral health has declined leading to complicated and traumatic treatment processes that further exacerbates and reconfirms their fears.  Thus, a vicious cycle is re-enforced if these patients are not managed therapeutically. Some of the more common causes of dental fear and anxiety is fear of pain that may originate from an earlier dental experience, fear of injection, feelings of helplessness and loss of control, fear of gaging, and discomfort associated with loss of personal space associated with either lying back in the dental chair or sitting in the dental chair and having the dentist or hygienist working in such close proximity to their face. Dental anxiety is often stimulated by sensory triggers and sensations in the mouth such as the smells of the dentist’s office, the sounds of the drill, the sights of needles, or sudden shifts in pressure or vibrations in the mouth as a result of dental work.  If the anxiety is untreated and not discussed adequately by the dentist or hygienist, feelings of betrayal and distrust can increase. The most effective strategies for defeating dental fears and anxieties include 3 steps according to the American Dental Association.  The first is to have a frank discussion with your dentist so that your dental team can understand and adopt a supportive approach including signals, like raising your hand, if you need to take a break or if your pain intolerance becomes intolerable.  The second step requires frequent practice of distraction such as wearing headphones or learning to de-sensitize yourself by squeezing a stress ball or a fidget spinner in your hand and imagining a ‘happy place’.  The third step incorporates the practice of deep relaxation, breathing from the belly, and an imagery based body relaxation or body scan in which you imagine letting go of tension stored in your body. As a Guided Imagery specialist and psychotherapist, I have frequently worked with patients presenting with dental fear and anxiety.  I am impressed with the profound, positive effects Guided imagery offers these patients.  As a result of combining deep autogenic relaxation, distraction techniques that foster de-sensitization to phobic and sensory reactions and sensory-laden guided imagery exercises that allow people to imagine a safe place and images of people easy to love dental anxiety can be significantly reduced. I have designed a Defeat Dental Fears, Staying Calm at the Dentist Guided Imagery intervention on my new app, ImageryWork that enables folks suffering from dental anxiety to practice deep relaxation, desensitization and sensory imagery to remain calm throughout the entire dental procedure.  Guided imagery is an extremely, effective, non-painful, inexpensive and easy mind-body technique people can practice in advance of dental appointments for best results and can also listen to in the waiting room and during dental procedures. In my Defeat Dental Fear Guided Imagery track, major strategies recommended as best practices for dental anxiety by the American Dental Association, deep relaxation, diaphragmatic breathing, distraction, letting go of tension stored in the body (body scan) and imagining yourself in a safe relaxing place are all incorporated in this Guided Imagery intervention. If you or a loved one suffer from dental anxiety, fears or phobia, or you’re a dentist or dental hygienist, check out my new Defeat Dental Fear Guided Imagery at ImageryWork and start smiling knowing you can now learn how to protect your teeth and your oral health. Download the  ImageryWork app to get a free download of De-Stress 101 and access Defeating Dental Fear tracks!

De-Stress 101: Who taught you how to relax? Dr. Miriam Franco, Psy.D. Most Americans know how to vacation well- go the full nine yards for two weeks, and then remain stressed out most of the year. Even the American healthcare system is admired for its capacity to respond to time-limited acute situations, as in crisis management. Yet, when coping with chronic conditions or vacillating states of being, we tend to possess few skills or practice.  We are really novices at “relaxing” and “letting go” of stress in our day to day lives. Our mojo is self-actualization and we ascribe great value to being efficient and busy. We tend to think hard about relaxing, evoking left brain skills to “conquer” relaxation via logic and reason and downplay our right brain skills of being in the moment and heightening sensory awareness and intuition.  In fact, we WORK AT relaxing which is counterintuitive to how to become relaxed, but is very American. If you stop to think about it, who taught you how to relax?  When I ask this question at my Stress Reduction and Guided Imagery workshops, I am usually met with blank stares. I wait a moment, knowing it takes time to recap because we are all exiles from childhood.  Every time, the group responds slowly at first and then, with solemn unison, they whisper: “No One!” Our families are not just our personal families, they are primary social institutions, conveyors of culture.  Families are where we learn all our initial behaviors, including positive and negative health behaviors and values. Most of us did not learn at home how to cope with anxiety or heightened stress nor do we know what it feels like to be deeply relaxed and still conscious. In fact, a significant number of adult Americans have great difficulty letting go of the day and experiencing restful sleep let alone relaxing. Learning to let go of stress is learning to tune in, become mindful of other ways of slowing down, of being, of connecting.  It is, so to speak, a paradigm shift where you become attuned to a different way of knowing and experiencing, connecting to your inner capacities. This is referred to in meditation practice as open attention and learning to connect with a natural presence. Most of us need strategies for “how to get this started” because we grew up in a culture that is foreign to becoming attuned to our more authentic selves, to being present rather than doing and accomplishing.  We tend to build ourselves from the outside in rather than from the inside out. The quickest and easiest way to first learn to “tune in”, attend to being in our bodies and letting go stress and judgments about ourselves is to utilize Relaxation and Guided Imagery techniques.  These gentle yet powerful tools teach us how to relax our bodies first, and slow breathing and heart rate. As you are guided to scan through your body and imagine how it looks and feels to relax different parts of your body, you can interrupt fretful thoughts and playfully imagine, with your senses, an ideal place of relaxation, a safe place to envision with your senses, or even imagine someone easy to love.  These centering images start to create new neuronal strategies, new ways of just being open to becoming more aware of how it feels to relax and not worry about getting it right, but simply engaging in the moment of being aware. And because in this relaxed state sensory images are sustained, your body learns to take in and resonate these images allowing their healing properties to continue to reverberate in your body and your mind is free to follow. Breathe…. Exhale slowly, and download my ImageryWork app to get a free download of De-Stress 101 and enjoy!

Become a StressFree Bride  Dr. Miriam Franco, Psy.D. Picture yourself planning your wedding with a clear, calm focus and relaxed body…Feel yourself lower wedding day nerves with deep, cleansing breaths that center you as you glide down the aisle effortlessly… practice letting go of tension and worry lines before wedding photos as you imagine an ideal place of relaxation or someone easy to love … learn how to retain clarity of focus and purpose amidst the flurry of wedding reception details and wedding guests …and open yourself up to your loving, generous spirit as you embark on your wedding journey, relaxed and joyful, ready to celebrate the transition to married life as you dress and prepare to greet your groom and wedding guests… Whether you experience the occasional, mild wedding jitters, a few sleepless nights, major wedding planning stress or wedding day nerves, you can benefit from the power of Guided Imagery.  Guided Imagery is a gentle yet profound mind-body technique that has been found to empower people to cope with the anticipation of life transitions, such as weddings, with less stress and greater ease. My StressFree Guided Imagery will teach you first how to become deeply relaxed and then how to use your own sensory images to practice ways to shift the way you experience your emotions and thinking–to actually imagine, with your senses, how to feel differently and sustain this awareness. Any bride to be can use it. It is a tool that can help the bride plan a wedding with patience and remind her to take time for herself while preparing for the emotional and mental challenges of a wedding while remaining open to the joy, fun, and celebration of her wedding journey.  Guided Imagery will transform you into a Stressfree Bride!   Subscribe to ImageryWork—my Guided Imagery app and replace your  “wedding day nerves” with joy and confidence