My Pain

Sample Plan



  1. Are you ready to use abdominal breathing in your day to day life?
  2. Do you have any concerns or possible barriers to using this technique?
    Remember to do exercises. Find time to do abdominal breathing
  3. How will you overcome those concerns or barriers?  What will you do to make it possible?
    • Three times a week at beginning
    • Increase gradually
  4. Where will you do your breathing exercise? How long?
    • At the computer in the morning
    • Five minutes
  5. How often will you do this exercise? When will you start this new routine?  How long do you think it will take you to master this technique?
    9:00 a.m. Monday, Wednesday and Friday
  6. What is your action plan?
    I will do abdominal breathing at 9:00 a.m. on Monday, Wednesday and Friday at my computer for five minutes for one week.

Sample Response Worksheet



  1. Were you successful in your action plan? If not, what changes would you make to solve your problems?
    • No, only did two days a week because I was in a meeting at 9:00 a.m.
    • I will change the time from 9:00 a.m. to noon.
  2. Were you comfortable learning this breathing technique?
    Yes, I felt relaxed and pleased I was  taking some action to help myself
  3. Did you notice any changes in your body during or after this exercise?
    • Thinking more clearly
    • Improved concentration
  4. Did you notice any changes in your pain or your response to pain?
    • Less pain in lower back while working on computer
  5. Did you notice any other changes? How did this exercise make you feel, emotionally?
     No other changes.
    • Emotionally I felt more in control
  6. What would you do differently next time to prepare for this type of exercise?
    • I would close my eyes to help focus