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The Pretzel

​Helpful for times you may experience high stress or panic

  1. Extend your arms out in front of you with palms facing each other

  2. Rotate your arms so that the backs of your hands are touching, and your thumbs are pointing down

  3. Lift your dominant hand over top of the other hand so the palms are facing each other once again (arms should be slightly twisted)

  4. Interlock your fingers

  5. Bend your arms down towards your belly and pull them up through so that they are resting on your chest (Your arms should make a pretzel shape)

  6. Keep hands resting on chest and close your eyes and slow breath (3 – 5 breathing described below)

See video for demonstration ->

Guided Box Breathing

Box breathing has 4 steps: 
1. Breath in through your nose for a count of 4 
2. Hold the air in your lungs for a count of 4
3. Breathe out of your mouth for a count of 4
4. Wait for a count of 4

Repeat at least 4 times or as many as needed 

Visualization from @360Calm

Progressive Muscle Relaxation

Click play for an audio recording of a
guided progressive muscle relaxation

Guide: Lori Sacrey

Text: From

Accompanying music by Bach

Progressive Muscle RelaxationLori Sacrey
00:00 / 05:32

3 - 5 Breathing

​Helpful for times you may experience stress 

  1. Place one hand on your upper chest and the other on your belly button. 

  2. Inhale through your stomach to a count of 3 in your mind, letting it inflate. Allow your chest to remain still.  

  3. Exhale through your mouth to a count of 5 in your mind, feeling your stomach deflate. Again, allow your chest to remain still. 

  4. Repeat this three times. 


Interlocking Hands

​Helpful for times you may experience stress 

  1. Put your hands in a prayer position in front of your chest and interlock your fingers 

  2. Starting with the pinkie finger on the right hand, lift each digit one at a time in order (right pinkie, left pinkie, right ring, left ring, right middle, left middle, right index, left index, right thumb, left thumb)

  3. Once all 10 fingers have been lifted one at a time, do it in reverse order (start with left thumb, then right thumb, left index, and so on)

  4. Notice what you were thinking about as you did that (likely focused on doing it right!)


Cognitive-based Strategies You Can Use

Positive Reframing


Focus on the negative thoughts and feelings and ask yourself two questions:

  1. What are advantages or benefits of this negative thought or feeling?

  2. What does this negative thought or feeling say about me and my core values that's beautiful, positive, or even awesome?

Example: "I worry that clients won’t like me"

Benefits of this thought: I care what people think of my ability as a clinician and this thought shows that doing a good job is very important to me.


The thought is trying to motivate me to continue to do a good job!  Remember that our thoughts are trying to support us and motivate us to be the best versions of ourselves.


They just do a really bad job of it – like they got the cheer all backwards and mixed up.


When we tell ourselves that we are going to fail, those thoughts are really trying to cheer us on so that we won’t fail, but they are all upside down.


Try to think of what the cheer is trying to say, because they represent our deepest values.


Example: "I am going to fail."


This is really saying that you care a lot about doing a good job and try your best to achieve your goals.

Adapted from David Burns, MD

Emotional Reasoning


When you assume your emotions reflect the way things really are.


“I feel like I am a bad employee, so I must be a bad employee”.

It’s important to remember that feelings are NOT facts and just because you feel a certain way does not mean that that is a true representation of the situation. Be mindful to separate feelings from facts when evaluating a situation.


Self-Compassion, as described by Dr. Kristin Neff, includes three elements:

1. Self-Kindness versus Self-Judgment

2. Common Humanity versus isolation

3. Mindfulness versus Over-Identification

Dr. Neff also includes an exercise that can help one practice self-compassion when feeling like one does not have much compassion for oneself and ones experience.  Click here for a description of the elements of self-compassion, Dr. Neff's exercise, as well as my take on her self-compassion exercise. 

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