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What is an effective self-soothing method i can teach my clients when stressed?

(The 4 elements exercises)

Article in Journal of EMDR Practice and Research · January 2007

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c linic a l q &a

What Is an Effective Self-Soothing Technique That I Can

Teach My Client to Use at Home When Stressed?

Editorial Note: The Clinical Q&A is a regular journal feature in which master clinicians answer a question
posed by a reader who is requesting assistance with clinical challenges. In this issue’s column, responses
are written by two clinicians who are EMDR approved consultants: Farnsworth Lobenstine, a licensed in-
dependent clinical social worker from Amherst, Massachusetts, and Elan Shapiro, a psychologist in private
practice from the Haifa area of Israel. Readers can send questions for future issues to [email protected].

Question: What is an effective self-soothing technique begins. As you breathe in, put the tongue on the roof of
that I can teach my client to use at home when your mouth. As you breathe out, let the tongue drop down
stressed? to the bottom of your mouth, where it usually rests when
you’re not talking or eating. I remind my client, “As your
ANSWER BY FARNSWORTH E. LOBENSTINE: chest rises, let your tongue rise. As the chest falls, let your
tongue fall.” We continue this for about two minutes.
The Over-Energy Correction (OEC) is the single most
So why is this so powerfully calming? As I have indicated,
calming technique I have ever learned and taught. It can
from a Chinese medicine perspective, the setup phase helps
also be very helpful for inducing restful sleep. In fact, I have
to center and contain the energy in the body. Slow, deep
done this so often for sleep that I cannot demonstrate it to
breathing is part of many meditation practices. The posi-
my clients without yawning. So I just tell them why!
tion of the tip of the tongue, touching the gums above and
The OEC is similar to Cook’s Hook-Up, which was de-
below the front teeth, activates the Governing and Central
veloped by Wayne Cook in the 1970s. The OEC is taught
(or Conception) Vessels, which are just below the nose and
by many yoga practitioners and clinicians using energy
just below the lower lip. The Governing Vessel, which ends
therapies. It is based on Chinese medicine and was devel-
below the nose, is understood to control the yang meridians
oped to correct an over- or under-energy state by using the
that ground us to the earth, and the Central Vessel, which
meridians of energy, or chi, in the body. I often teach it to
ends just below the lower lip, is understood to control the yin
clients in the first few sessions. Then I can encourage home
meridians that link us to the heavens. Consequently this ex-
use and we may use it before or after EMDR.
ercise is a very relaxing, grounding, and balancing procedure
You can easily teach this exercise to your clients after
because it coordinates all of the energy, or chi, in the body.
practicing it a few times yourself. As you sit, hold your arms
straight out in front of you, back of the hands together, fin-
RESPONSE FROM ELAN SHAPIRO:
gers extended and thumbs down. Put one hand over the
other, so that palms are now touching, and interlace your Over the years I had used various self-soothing, stress man-
fingers. With hands clasped, bring them to rest over your agement exercises for clients, most of them familiar (e.g.,
heart. (If your right wrist was on top with hands clasped grounding, breathing, safe place) and some novel (e.g., pro-
in front of you, the left wrist will be on top when they are ducing saliva). I found that while each of these had their
resting on your chest.) Cross your ankles so that the same individual merits, they tended to have relatively weak and
side is on top. If it is more comfortable to have the left wrist short-lived effects, and were not suitable for everyone. So,
on top next to your chest, then put the left ankle over the to enhance their effectiveness and general application, I
right ankle. This setup phase is thought to center and con- combined them in a package, which made sense and could
tain the energy in the body. Now the really powerful part be easily remembered. I added a mechanism for frequent

122 Journal of EMDR Practice and Research, Volume 1, Number 2, 2007

© 2007 Springer Publishing Company DOI: 10.1891/1933-3196.1.2.122
reminders and practice. The outcome is a four-part exercise outwards. Look around and notice three new
called the 4 Elements Bracelet Method: Earth, Air, Water, things. What do you see? What do you hear?
and Fire, which is practiced every time the client notices Notice three things.” (Don’t ask this if it draws
a certain bracelet or sticker on his or her watch or mobile attention to ongoing dangers, e.g., if there are explo-
phone. The acronym for the four elements in the original sions still going on.)
Hebrew also creates the word for mother, so it is called the
• AIR: BREATHING for BALANCE and CEN-
“mother bracelet” method.
Practicing the 4 Elements at random times during the
TERING
day is a way of enhancing the effects of the individual exer- • (Anxiety equals excitement without oxygen and
cises and managing stress by preventing the accumulation you stop breathing. When you start breathing,
of responses to stressors and keeping the client within their your anxiety reduces). Say, “As you continue
arousal “window of tolerance” (Ogden & Minden, 2000). feeling the SECURITY NOW of your feet on
Over time, and with frequent practice, the bracelet acquires the GROUND, take three or four deeper slower
secondary conditioning power to reduce stress rapidly. breaths from your stomach, making sure to
I used this package of exercises for more than 10 years breathe all the way out to make room for fresh
with my clients and taught it to my supervision groups. energizing air. As you breathe out, imagine
However, it was only after encouragement in 2006 from that you are letting go of some of the stress and
my colleague, Brurit Laub, that I wrote it down. Fortu- breathing it out. Direct your attention inwards
nately it was therefore readily available as one of the re-
to your center.”
sources we were able to distribute to the EMDR volunteers
who went to the North of Israel during the missile attacks
• WATER: CALM & CONTROLLED. Switch on
of the recent Lebanese war. the RELAXATION RESPONSE.
Advantages of this package that were noted during this • Say, “As you continue feeling the SECURITY
experience were: NOW of your feet on the GROUND and feel
CENTERED as you BREATHE in and out,
1. It gave the helpers confidence that they could do some-
thing tangible immediately in difficult circumstances
notice if you have saliva in your mouth. Make
(e.g., in the shelters). more saliva because when you are anxious or
2. Giving people the bracelet or sticker had an empower- stressed your mouth often dries, since part of
ing effect, which allowed people to carry this transferred the stress emergency response (which has to do
object, after the clinician had left, reminding them that with the sympathetic nervous system) is to shut
they could help themselves to reduce stress and anxiety. off the digestive system. When you start making
3. After the initial stabilization of the first three elements it saliva, you switch on the digestive system again
seemed easier to access the safe place images and experi- (or the parasympathetic nervous system) and the
ences. Consequently, it can be used for additional prepa- relaxation response. This is the reason why peo-
ration and stabilization in emergency situations, or for ple are offered water or tea or chewing gum after
clients who are easily flooded, prior to doing the safe or a difficult experience. A Spanish surgeon uses this
calm place exercise, which is then introduced as the 4th
production of saliva to train his patients to ignore
Element (“Fires” the imagination).
pain while he performs surgery without anes-
The 4 Elements can also be used in group situations and thetics. When you make saliva, your mind can
for various ages, modifying the instructions when needed optimally control your thoughts and your body.
for younger children. Direct your attention up to making saliva.”
• FIRE: LIGHT up the path of your IMAGINA-
Instructions for the Therapist TION
• Say, “As you continue feeling the SECURITY
Provide the client with the handout material in Table 1 NOW of your feet on the GROUND and feel
and explain the 4 Elements in the following manner. CENTERED as you BREATHE in and out and
Say to the client, “Let’s take a current reading of your feel CALM and in CONTROL as you produce
stress level where 10 equals the most stress and 0 no more and more SALIVA, bring up the image of
stress at all. Where are you now with stress on our your SAFE PLACE (or some other RESOURCE).
0–10 scale?” Where do you feel it in your body? (Install with
• EARTH: GROUNDING, SAFETY in the PRES- brief slow bilateral stimulation or butterfly hugs.) Di-
ENT /REALITY rect your attention to feeling good in your body.”
• Say, “Take a minute or two to ‘land’. . . to be • 4 ELEMENTS
here now. Place both feet on the ground, feel • Say, “As you continue feeling the SECURITY
the chair supporting you. Direct your attention NOW of your feet on the GROUND; and feel

Journal of EMDR Practice and Research, Volume 1, Number 2, 2007 123

Clinical Q&A
TABLE 1. 4 ELEMENTS HANDOUT FOR CLIENTS

Fire (light your

imagination)
Water (Saliva)
Air (breathing)
Earth (grounding)

Rationale:
• External and internal stress triggers have a cumulative effect during the day.
• We cope better with stress when we stay within our arousal window of tolerance.
• An antidote to stress triggers: frequent random monitoring of stress level with simple stress reduction actions to keep
stress levels within our arousal window of tolerance.
Suggestions:
• Wear a 4 Elements bracelet (such as a colored rubber band or string or use a bracelet that you wear on a regular basis)
on your wrist. Every time you notice it, take a quick reading of your current stress level (Subjective Units of Disturbance
or SUD) and perform some brief self-calming /self-control exercises (see below for the 4 Elements). Then take a second
SUD reading.
• Alternative: Place a small sticker or label on your watch, mobile phone, and so forth.
• The (modest) goal is to reduce your stress level by 1 or 2 units each time, to do this at random times and at various initial
stress levels. By preventing your stress responses from accumulating, you may be better able to stay within your window
of tolerance.
Tips:
• Opt to use a rubber band and a label on your cell phone or watch.
• The rubber band can be stretched (gently) and released each time, to signal the beginning of the 4 Elements exercise and
to stop negative thoughts and to ground quickly in the present.
• The sequence of the 4 Elements (Earth-Air-Water-Fire) is designed to follow the body up from the feet to the stomach
and chest, to the throat and mouth and up through the head.

CENTERED as you BREATHE in and out; and • “Please practice the 4 Elements Exercise at least
feel CALM and in CONTROL as you produce 10 times a day for the first two weeks. It is help-
more and more SALIVA; you can let the FIRE ful to practice when your stress levels are not
LIGHT the path to your IMAGINATION to high, to create the positive conditioning that
bring up an IMAGE of a place where you feel will help you to use it more effectively when
SAFE/CALM, or a memory in which you felt your stress is high.”
good about yourself. Go with that (brief slow bi-
lateral stimulation). Now touch your bracelet (or Option: this can be a way of introducing the safe
sticker, etc.) and focus on that. (Brief slow bilat- place exercise as the fourth element, especially when
eral stimulation to install the bracelet). Now, let’s there is a greater need for stabilization during ongo-
take a current reading of your stress level where ing danger.
10 equals the most stress and 0 no stress at all.
Where are you now with stress with our 0–10 Acknowledgment. Thanks to Marilyn Luber for editing sug-
scale? gestions in this version of the 4 Elements protocol.

124 Journal of EMDR Practice and Research, Volume 1, Number 2, 2007

Clinical Q&A

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