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(p. 139) Session 9: Breath Counting Meditation / Assertiveness Training 

(p. 139) Session 9: Breath Counting Meditation / Assertiveness Training
Chapter:
(p. 139) Session 9: Breath Counting Meditation / Assertiveness Training
Author(s):

Michael H. Antoni

, Gail Ironson

, and Neil Schneiderman

DOI:
10.1093/med:psych/9780195327915.003.0011
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Subscriber: null; date: 24 January 2021

(Corresponds to chapter 10 of the workbook)

Materials Needed

Relaxation Training: Breath Counting Meditation

Outline

  • Discussion of home relaxation practice (5 minutes)

  • Conduct breath counting meditation (20 minutes)

  • Conduct sunlight meditation with autogenics (10 minutes)

  • (p. 140) Discussion of meditation exercises (10 minutes)

  • Assign homework (5 minutes)

Discussion of Home Relaxation Practice (5 minutes)

Determine and address any difficulties participants have had with meditation practice during the week, or with any symptoms that have arisen. Review participants’ Daily Self-Monitoring Sheets for adherence. Ask group members:

  • “How often do you find you are relaxing?”

  • “Where are you practicing relaxation?”

  • “What gets in the way for you?”

  • “Do you find yourself encountering obstacles to doing relaxation?”

  • “What do you say to yourself that keeps you from taking the time to practice relaxation?”

  • “What have you done or said to help keep your commitment to relax?”

Breath Counting Meditation (20 minutes)

This meditation technique (adapted from Davis et. al, 1988, and Mason, 1985) uses the breath in order to deepen the relaxation state. Explain to the group that in breath counting meditation, the breath is the object of focus. Instruct participants to concentrate on their breaths and count from one through 10 on successive inhalations and exhalations. Use the following script to conduct the exercise:

Get in a comfortable position. Take several long, deep breaths and begin to clear your mind. Let go of all the worries and concerns of the day. Close your eyes or fix them on a spot on the floor in front of you. You can either keep your eyes focused or let them go out of focus.

(p. 141) Take deep breaths and focus your attention on each part of the breath. First focus on the inhale. Then focus on the point at which you stop inhaling and start exhaling. Next focus on the exhale. Lastly focus on the pause between the exhale and the next inhale. Pay careful attention to the sensations in your body as you pause between breaths.

As your breathing finds a comfortable rhythm, turn your attention from your abdomen to the passage of the air through your nostrils. Be fully aware as the air comes through your nostrils and as it exits out through your nostrils. On your next breath, pause for just a moment after the inhalation. Become aware of the cool flow of air into your nostrils as you inhale. On the exhale, feel the warm flow of air out of your nostrils.

Begin to count your breaths on the exhale. Inhale … Exhale 1 … Inhale … Exhale 2 … Continue counting up to 10, and then start over at 1. If any thoughts come to mind, just let them pass through you. Do not judge or engage with them; just allow them to come and go. If you lose your focus of attention, relax your breathing and start over at the count of 1. If you start to lose count for any reason, just go back to the number 1.

If you begin to breathe unnaturally, to hyperventilate, or to hold your breath, just attempt to relax all the muscles in your chest and abdomen. You can always return to the easy rhythm of your own breath, the sound of air entering and leaving your body, the feeling of air at your nostrils. Then go back to your counting.

Repeat the counting sequence (inhale … exhale 1 …) for 20 minutes, adding imagery related to the physical sensations of breathing, and the feel and temperature of the inhalations and exhalations. Gradually slow the pacing of your instructions so the breathing slows over this period. End the meditation with:

We have come to the end of this meditation. At your own pace, begin to bring your awareness back to the room. As you practice becoming more aware of your breath, more aware of yourself, the benefits of this practice will expand, so that you can bring full attention to whatever you do during the rest of the day.

(p. 142) Sunlight Meditation with Autogenics (10 minutes)

Using the script from Session 7, repeat the sunlight meditation with autogenics. Mention to participants that they can also combine breathing instructions with autogenics to achieve an even deeper sense of relaxation.

Discussion Questions (10 minutes)

Ask participants to think about how they felt after the breathing exercise and then again after the sunlight meditation. Use the following questions in your discussion:

  • “How was this breath counting meditation exercise for you?”

  • “Was the sunlight imagery experience different for you this time?”

  • “What did you find easy and difficult about this experience?”

  • “How does meditation compare with autogenics or guided imagery?”

  • “Which relaxation exercise did you like most?”

Homework (5 minutes)

Have group members practice breath counting meditation on a daily basis (twice a day if possible). They should record stress levels before and after each practice on the Daily Self-Monitoring Sheet.

Stress Management: Assertiveness Training

Outline

  • Review homework (10 minutes)

  • Introduce interpersonal styles (10 minutes)

  • Discuss barriers to assertive behavior (15 minutes)

  • (p. 143) Present components of assertive communication (20 minutes)

  • Discuss using problem solving with conflicts (25 minutes)

  • Review steps to more assertive behavior (5 minutes)

  • Assign homework (5 minutes)

  • Hand out Session Evaluation Questionnaire (optional) (5 minutes)

Homework Review (10 minutes)

Determine if group members had any problems monitoring anger responses.

Discuss situations that elicited anger from participants in the last week and how they managed their anger. Identify responses that could be replaced with more effective strategies. Go through the steps to anger management as presented in the last session.

Interpersonal Styles (10 minutes)

Last session dealt with interpersonal skills to better communicate negative emotions such as anger. This session focuses on other interpersonal techniques to better communicate one’s needs and desires in different situations. These techniques are collectively referred to as assertiveness skills. One of the first steps in learning assertiveness skills is to become more aware of the different interpersonal styles that one can use in communicating.

When people’s intentions are not clearly communicated, then stressful interpersonal conflict may occur. Learning how to communicate assertively with others is a very important component of stress management training. This module demonstrates how passive, aggressive, and passive-aggressive interactions either turn people off or deny them the ability to communicate their needs effectively. After illustrating ineffective (passive or aggressive) communication patterns, you will introduce the group to a more effective communication strategy (i.e., assertiveness).

(p. 144) The following diagram explains the four basic interpersonal styles (you may want to put these on a flip chart). For each style, the communication pattern is defined and the pros and cons are given. It is important to recognize that each communication pattern produces both rewards and costs for the individual. Explain to the group that it’s our nature to seek to change unhealthy patterns only when the costs begin to outweigh the benefits. It is important to note that these “costs” may involve added stress that can result from unclear communications.

Four Basic Interpersonal Styles

  1. 1. Aggressive: Standing up for one’s rights by denying feelings of other people

    (+) Advantage: People usually don’t push an aggressive person around.

    (—) Disadvantage: People avoid an aggressive person.

  2. 2. Passive: Indirectly violating one’s own rights by failing to express honest feelings and beliefs

    (+) Advantage: Passive individuals rarely experience direct rejection.

    (—) Disadvantage: Other people end up making choices for the passive individual, making it hard for the individual to achieve personal goals. Passivity also leads to built-up resentment and guilt for not taking care of oneself.

  3. 3. Passive-Aggressive: Indirectly and passively resistant

    (+) Advantage: A passive-aggressive person avoids direct conflict.

    (—) Disadvantage: Passive-aggressiveness can often cause more interpersonal conflict than directly approaching a situation or person.

  4. 4. Assertive: Standing up for rights and expressing individual feelings and beliefs in a direct way that does not violate rights of others

    (+) Advantage: One can choose one’s own goals, not turn people off, promote self-efficacy and self-esteem, and decrease interpersonal conflict.

    (p. 145) (—) Disadvantage: People who are less comfortable or familiar with the direct expression of feelings and desires may withdraw from or grow anxious or irritable during an exchange with an assertive person.

Interpersonal Style Role-Play Exercise

As the group leaders, briefly role-play the following examples of interpersonal style. Have group members identify the interpersonal style used in each situation and come up with alternative assertive responses.

Aggressive Role Play

You’ve purchased merchandise that is defective and you storm into the store on a busy Saturday afternoon and loudly complain to the salesperson and call him a liar.

Passive Role Play

You are waiting in line and you are in a hurry and someone cuts in front of you. You do nothing.

Passive-Aggressive Role Play

Someone asks to borrow some money from you. You are uncomfortable about this request but grudgingly agree to give him the money tomorrow. Tomorrow comes and you conveniently forget to bring the money with you.

Alternative Assertive Responses

Discuss each of the above examples using the following questions:

  • “What behaviors helped you identify the interpersonal style?”

  • “Can you think of descriptions for these individuals?”

  • (p. 146) “How would you feel acting that way?”

  • “What are some alternative assertive responses for this situation?”

After the exercise, have participants think of a situation they encountered over the past week where they or someone else communicated in a nonassertive way. The following questions can be used in your discussion:

  • “Can you recall the situation, what was said, and how the receiving party reacted?”

  • “How would you classify the person’s communications? Passive? Passive-aggressive? Aggressive?”

  • “What alternative form of communicating could they use? How would an assertive communication sound?”

  • “How are the parties likely to feel afterward?”

Barriers to Assertive Behavior (15 minutes)

There tend to be two main reasons why people act nonassertively or aggressively. First, these individuals often misinterpret the meaning of assertive behavior (e.g., people who use passive styles think there is no way to be assertive without appearing pushy). Second, individuals who have difficulty displaying assertive behaviors often have irrational (and inaccurate) thoughts and beliefs. Go over with the group common examples of negative thinking and cognitive distortions that prevent assertive behavior.

Fear of Displeasing Others

When others disapprove of us, it may be unpleasant and uncomfortable. If we incorrectly interpret disapproval to mean that we are completely bad, we are more likely to become depressed and less likely to stand up for our rights.

(p. 147) Fear of Rejection or Retaliation

Often, our reaction to this fear is more immobilizing than the fear itself. When faced with the possibility of rejection or retaliation, we often see ourselves as helpless. We forget that we do not have to passively accept inappropriate treatment. We can protect ourselves or we can do things for ourselves that would make the rejection easier to face.

Mistaken Sense of Responsibility

When we internalize others’ hurt feelings, we take on the responsibility of making everyone else happy. When another person is hurt by your being assertive, it is important to discern whether you actually hurt the other person or whether the other person felt hurt because of his misinterpretation of your assertive behavior.

Mistaken View of Your Human Rights

Many people believe that they don’t have the right to stand up for their wants, needs, and wishes. It is very difficult to be assertive when you are denying yourself basic rights. Remember, you can accept and act on your own rights without violating the rights of others.

Reluctance to Forfeit Advantages of Being Nonassertive

It may be important to assess what benefits you may gain when acting nonassertively (e.g., if you don’t stand up for your rights, others may defend you and you are still safe; by never disagreeing, you can appear to be easy to get along with).

Feeling Vulnerable and Unsafe

Anger and aggression are often manifested in a person who feels threatened and powerless. It is important to be aware of situations in which you may feel vulnerable, making you more likely to lash out. By preparing yourself for these situations you can stay focused on any irrational thoughts that could cause you to communicate in an aggressive manner.

(p. 148) Emphasize to group members that in order to promote assertive instead of aggressive behavior, it is important that they monitor their thoughts for negative self-statements and cognitive distortions.

Discussion Questions

  • “Did you identify with any of the common barriers to assertive behavior?”

  • “What are some of your reasons why you do not behave assertively?”

  • “When do you behave nonassertively? Any recent situations come to mind?”

  • “Are you able to predict the situations where nonassertive responses are more likely to occur in your life?”

  • “Who are the people with whom you act nonassertively? What is it about them or your expectation about them that affects the way you communicate?”

Components of Assertive Communication (20 minutes)

There are several components to assertive communication. Explain that one of the most important components is the choice of words. You can use the following dialogue for explanation:

Taking ownership of a request by using the pronoun “I” at the beginning of a sentence communicates that you are being proactive and clear about what you want to say. The rest of the sentence should similarly convey clearly what it is that you sense or feel and what it is that you want. This might be something you want to see changed, decreased, or increased. Assertive communications also acknowledge your empathy toward the other person—where he might be coming from, what he might be feeling, and what his desires might include. This is typically followed with a statement about what you would like to see happen. By stringing together several such sentences you will be able to communicate assertively in all types of situations.

(p. 149) Some of the components of communicating assertively are summarized as follows.

“I” Language

Messages in the “I” language are good ways to express negative feelings in a nonblaming way. When using these statements you can point out how others’ behaviors concretely affect you while owning your own feelings about the situation. Compare the two examples:

  • Blaming “You” Message: “When you are late from work, you make me feel insecure.”

  • Assertive “I” Message: “When you are late from work, I often doubt myself and feel insecure about the relationship.”

“I Want” Statements

Clarify what you really want, which allows the other person to understand how to fulfill your wants. For example, “I want to eat dinner on time tonight.”

“I Feel” Statements

Clarify how you feel without blaming or attacking the other person. To facilitate communication, don’t use generalizations to describe how you feel; instead, be specific and quantify your feelings (e.g., extremely happy, slightly irritated). For example, “I feel slightly irritated when you don’t call to let me know you’ll be late.”

Empathic Assertion

This type of message contains two statements. The first statement recognizes the other person’s situation, feelings, beliefs, and wants. The second statement asserts your wants, feelings, and beliefs. This message communicates sensitivity for the other person without a total disregard for your rights. For example, “I know that you have a lot of work to get finished and that it is difficult for you to gauge when it will be done, but I need you to call if you are going to be late so I can organize my own schedule this evening.”

(p. 150) Effective Listening

Explain to participants that listening to others often encourages others to listen to one more attentively. In addition, effective listening reduces the likelihood that one will misinterpret the message. Effective listening does not mean one is passively agreeing with the other person’s message; instead, it means respecting the rights of the sender to express his thoughts and feelings. Effective listening usually consists of paraphrasing the content of the message and nonverbal communication that one is attentive (e.g., making eye contact, leaning forward, saying “uh-huh,” etc.).

For example, saying, “It sounds like you are really angry with me and want to avoid having a problem like this occur again” might be an effective way of letting the other person know that you understand that he is upset and wants a resolution to a given problem. Being open to others’ comments and criticisms is much more effective in terms of fostering good communication than blowing up, refusing to listen, or accusing the other person of something in order to reduce your feelings of guilt or hurt.

Exercise: Making Assertive Statements and Listening Effectively

Have participants refer to the exercise in the workbook entitled “Making Assertive Statements and Listening Effectively.” Have a group member assertively state each situation while the others listen. Then group members should brainstorm answers to the questions provided in the workbook. These questions are designed to provide group members with practice in coming up with more effective communication strategies to resolve common problems such as the examples given.

Using Problem Solving with Conflicts (25 minutes)

Finding Workable Solutions

Sometimes we must deal with situations that are more vague in terms of what the actual messages, desires, and feelings of the two parties are. Tell group members that they can apply what they have learned about (p. 151) making assertive statements to problem-solving conflicts using the following steps:

  1. 1. Recognize there is a problem and define it in clear terms. Be specific and avoid generalizations.

  2. 2. Identify possible solutions. Both parties should generate a variety of possible solutions.

  3. 3. Critique each possible solution. It is important to be assertive, but remember that the best solution will meet both parties’ needs.

  4. 4. Accept a solution. Both parties should discuss the expected outcomes and possible barriers to implementing the solution.

Problem-Solving Role-Play

Recall the example of difficulty with a partner who does not listen effectively used in Situation 1 of the exercise entitled “Making Assertive Statements and Listening Effectively.” Have two group members role-play this situation in front of the group. In the first role-play, have group members demonstrate the old and ineffective pattern of communication, where one partner does not listen and the other partner becomes increasingly frustrated. In the second role-play, have the two group members use more effective, assertive communication styles in order to bring up this communication problem, use the problem-solving steps, and resolve the situation in a manner agreeable to both parties. After the two role-plays are completed, have the other group members add their comments and suggestions.

Barriers to Conflict Resolution

Many things can get in the way of a successful resolution; however, many of these barriers reflect inaccurate beliefs about conflict, such as:

  • There is always a winner and a loser

  • Direct conflict is to be avoided at all cost

  • (p. 152) All conflicts must be resolved

  • One person is all right and the other is all wrong

This type of self-talk needs to be challenged and replaced with more rational and less extreme statements. Work with group members to brainstorm other, less extreme statements that could replace each of the above statements. Here are some examples:

  • Each person can walk away from a conflict having learned something

  • Direct conflicts can take a lot of out you but are sometimes productive in taking care of things before they fester and turn into resentments

  • Sometimes people just agree to disagree

  • Usually neither person is 100% correct in a conflict

Unsolvable Problems

There may be situations in which no workable solution is available or the risk of being assertive is too great. In such cases there are alternatives to directly assertive behavior, such as changing one’s environment, developing ways of satisfying oneself, and tending to one’s emotional needs. Remind participants that assertive communication is just one of the many coping strategies available to them. In Sessions 6 and 7, they learned about ways to manage and cope with controllable and uncontrollable stressful situations. Using these other coping strategies in addition to assertive communication will increase the likelihood of their having successful outcomes when experiencing interpersonal difficulty.

Steps to More Assertive Behavior (5 minutes)

  1. 1. Be able to identify the four interpersonal styles: passive, passive-aggressive, aggressive, and assertive.

  2. 2. Identify situations in which you want to be assertive.

  3. (p. 153) 3. Plan for change:

    • Look at both your and the other person’s rights, wants, and needs

    • Determine the desired outcome

    • Arrange a time and place to discuss the situation calmly

  4. 4. Define feelings using “I” messages. Express your request simply, firmly, and concisely.

  5. 5. Increase the possibility of getting what you want by being empathetic about the other person’s position.

  6. 6. Use body language that conveys that you are attentive.

  7. 7. Learn to listen:

    • Make sure you are ready to listen

    • Listen to and clarify what the other person said

    • Acknowledge what was said: communicate to the other person that you have heard his position

  8. 8. Be aware of barriers to assertive behavior, including counterproductive self-talk such as:

    • “My behavior will hurt someone else’s feelings or they’ll reject me”

    • “My job should be to make people happy and comfortable”

    • “In any conflict there has to be a winner and a loser”

Homework (5 minutes)

Session Evaluation (optional) (5 minutes)

See example of Session Evaluation Questionnaire at the end of chapter 3.