Relaxation

Definition

Relaxation is an inclusive term used for a range of techniques intended to improve or maintain health through counteracting the effects of stress on the body. It is considered a form of complementary and alternative medicine (CAM); more specifically, relaxation is categorized as a mind/body approach because it focuses on the ways in which spiritual beliefs, emotional reactions to events, thought patterns, and psychological factors can influence physical health.

Some physical therapists and other health professionals distinguish further between active or movement-based forms of relaxation, such as t'ai chi and yoga , and passive or quiet forms of relaxation, in which the person sits or lies quietly in one place while focusing on breathing, visual images, or tensing and relaxing muscles.

Description

Background

Some relaxation techniques have been used for millennia as forms of preventive medicine (including mental health) and as part of a general healthy lifestyle. These include yoga and t'ai chi, recommended by the traditional medical systems of China and India, and meditation, practiced by members of all the world's major religions. The term relaxation itself, however, did not come into general use until the mid-twentieth century, when researchers who were studying the effects of stress on the body began to look at ways to counteract the harmful effects. This research began with Walter Cannon (1871–1945), a professor of physiology who coined the phrase “fight-or-flight reaction” in 1915 in a publication analyzing the body's response to fear and pain . Cannon's work was followed by that of Hans Selye (1907–1982), a Canadian scientist who studied the biochemical changes in the body that take place when a person is stressed.

There were also a few researchers in Europe, including Johannes Schultz, a German neurologist who developed a relaxation technique he called autogenic training (AT) to treat patients suffering from such complaints as asthma , chronic headaches , and insomnia . Schultz instructed his patients to visualize certain sensations (such as “my right arm is heavy” or “my heartbeat is calm and regular”) for brief periods several times a day in order to enter a state of relaxation.

Relaxation techniques became part of mainstream medicine in the United States in the mid 1970s, when Herbert Benson (1935–) published the first edition of The Relaxation Response, which became an immediate bestseller. Benson, a cardiologist on the faculty of Harvard Medical School, had been studying the effects of transcendental meditation (TM), a trademarked meditation technique introduced by Maharishi Mahesh Yogi (1917–2008), an Indian ascetic who had started a spiritual regeneration movement in India before moving to the United States. Benson found that people with high blood pressure who practiced TM were able to lower their blood pressure after several weeks of practice. After some experimentation, Benson concluded that almost any word or mental image was as effective a focus for meditation as the official TM words and phrases. Taking meditation entirely out of a religious or spiritual context, Benson published The Relaxation Response in 1975. In that book he outlined a six-step relaxation technique that has been widely popularized.

Types of relaxation techniques

This section focuses on passive rather than movement-oriented approaches to relaxation.

Major passive relaxation techniques include:

• Autogenic training (AT). AT is more widely practiced in Europe (particularly in the United Kingdom) than in North America because it is more complex than the relaxation response or meditation. According to an AT center in the United Kingdom, a person wishing to learn AT must attend 8 to 10 weekly sessions about an hour in length to learn the basic techniques and keep a chart or diary of his or her practices. AT is practiced three times daily for a period of 10 minutes: The person sits in a chair or lies down and focuses attention on the arms, heartbeat, and solar plexus in order to develop an attitude of “passive concentration.”
• Biofeedback. Unlike other approaches to relaxation, biofeedback requires the use of electronic equipment to monitor body functions that are not normally controlled voluntarily. For example, a person who wants to reduce muscle tension might be hooked up to a machine that flashes a red light when certain muscle groups become overly tense. The person learns to associate the light with the level of tension in the body at that moment. In order to stop the light from flashing, the person must relax the tense muscles. After awhile, the person can repeat the muscle relaxation when he or she feels tense without the need for an electronic sensor. Other body processes that can be monitored with biofeedback include skin temperature, heart rate, sweating, and brain wave activity.
• Mindfulness meditation. Mindfulness meditation is an approach to relaxation developed in the 1980s by Jon Kabat-Zinn, a psychologist in Massachusetts who had studied Buddhist meditation practice. Kabat-Zinn devised an eight-week program for chronic pain treatment and stress reduction. Persons practicing mindfulness meditation are taught to simply witness the sensations that arise in their bodies, let go of expectations, focus on the present rather than the past or future, and stop blaming and judging themselves. Kabat-Zinn's eight-week program requires a major time commitment; participants must practice a minimum of 45 minutes a day of yoga and meditation six days a week for all eight weeks.
• Religious or spiritual meditation. The primary difference between religious/spiritual meditation and the relaxation response or mindfulness meditation is that the practitioner focuses intentionally on a holy person, short prayer phrase, image, or brief hymn or chant from his or her specific religious tradition rather than trying to empty the mind. For example, a Christian might choose to focus on an icon (picture of a saint) or repeat a short prayer such as the Jesus prayer. A Hindu or Sikh might sing kirtan—traditional hymns from their holy books.
• Relaxation response. Benson's six-step technique requires sitting for specific minutes and focusing on breathing.
• Progressive muscle relaxation (PMR). PMR was developed by the American physician Edmund Jacobson (1888–1983). Jacobson did research on the effects of muscle tension on the body and developed a relaxation technique for patients with physical illnesses related to muscle disorders. In 1929 he published a booklet for the general public titled Progressive Relaxation, outlining his two-step technique. In PMR, the person deliberately tenses (for about 8 seconds) and then relaxes muscle groups in the body in a specific sequence (usually given as lower limbs; abdomen and chest; arms, shoulders, and neck; and the face). The entire process takes about 10 minutes a day. Although PMR is one of the older relaxation techniques, it is still commonly recommended by physical therapists.
• Visualization. Mental imagery is used to assist relaxation. For example, individuals might visualize a gently flowing stream, a snow-covered landscape, or any other image they find to be calming in order to relax their body and focus their mind.

Benson's six steps of the relaxation response

1. Sit quietly in a comfortable position.
2. Close the eyes.
3. Relax all the muscles, beginning at the feet and moving upward to the face.
5. Breathe through the nose. Become aware of the breathing and say the word “one” every time you breathe out.
6. Continue breathing in and saying “one” on breathing out for 10–20 minutes. Sit quietly afterward for a few minutes, first with eyes closed and then with eyes open. Do not stand up immediately.
7. Do not worry about success in achieving a deep level of relaxation; simply allow relaxation to occur at its own rate. When distracting thoughts occur during the breathing exercise, ignore them and simply go back to repeating “one” when breathing out.

Demographics

According to the National Center for Complementary and Alternative Medicine (NCCAM), mind/body techniques as a whole are one of the most popular forms of CAM in the United States, used by about 17 percent of the U.S. public each year. T'ai chi and yoga are practiced by millions of people in Asia as well as in the West, while meditation is used and taught by Christians, Jews, Buddhists, Muslims, Hindus, and by people with no specific religious affiliation. There are also some New Age groups that encourage meditation and visualization as ways to expand personal consciousness as well as heal physical disorders.

Purpose

Relaxation techniques have been used to treat a variety of stress-related physical and mental disorders:

• high blood pressure and heart disease
• gastrointestinal disorders, including constipation and irritable bowel syndrome
• anxiety and depression
• insomnia and other sleep disorders
• anger management
• chronic tension and migraine headaches
• lower back pain
• fibromyalgia

Relaxation techniques are also used to treat chronic pain in cancer patients, to prepare patients for surgery, and to speed recovery after surgery. Some advocates of these techniques maintain that they increase artistic and other forms of creativity by expanding the powers of the imagination and detaching people temporarily from everyday concerns.

Challenges

With the exception of autogenic training and biofeedback , relaxation techniques are relatively easy to use; they do not require a high level of education or commitment to any specific religion or philosophy. Except for biofeedback, they do not require special equipment or clothing. Many of the organizations have made instructional audiotapes, videotapes, or CDs for seniors interested in learning more about a specific approach to relaxation. The seniors most likely to find these interventions problematic are those in the early stages of dementia.

Risks

Relaxation techniques should not be practiced immediately after a heavy meal or after consuming alcohol (even in moderation). In addition, seniors should not stand up right away after practicing the relaxation response or meditation. The reason for this caution is that relaxation lowers the blood pressure, and sudden standing up after practicing relaxation may cause dizziness .

Autogenic training is not recommended for seniors with heart disorders, schizophrenia, alcoholism, or substance abuse. PMR should not be used by seniors with severe muscle injuries, back problems, or muscle spasms, as these may be made worse by the deliberate tensing of muscles required in PMR. The risks of using other relaxation techniques are minimal provided the senior is following instructions.

Results

A number of studies have reported benefits to seniors from the use of relaxation techniques:

• Mindfulness meditation has been found helpful in treating chronic lower back pain in seniors.
• The relaxation response has been used successfully to treat insomnia in seniors.
• Progressive muscle relaxation is effective in treating chronic pain in seniors, as is yoga. Meditation appears to be less effective with chronic pain in the elderly.
• Relaxation techniques together with exercise therapy improve psychological well-being as well as physical symptoms in seniors with congestive heart failure.
• Visualization appears to be less effective than massage therapy as an approach to relaxation in seniors.
• The relaxation response appears to improve memory and cognition in physically healthy seniors.
• Relaxation techniques relieve anxiety in seniors before surgery and lower the need for pain medications after surgery.

KEY TERMS

Autogenic training (AT) —A technique of relaxation developed in the 1930s in which the person sits or lies in a comfortable position and silently repeats phrases intended to focus attention on specific organs of the body.

Biofeedback —A relaxation technique that uses electronic devices to help a person learn to control body processes that are normally not consciously controlled, such as heart rate, muscle tension, or breathing.

Jesus prayer —A short prayer that started among Greek-speaking Christians in the fifth century as an aid to meditation. The believer may simply repeat the name of Jesus or the short phrase “Lord have mercy,” synchronized with his or her heartbeat.

Kirtan —The chanting or singing of sacred hymns, practiced by Hindus and Sikhs.

Meditation —A conscious mental discipline in which a person focuses attention on a specific word, phrase, or image in order to quiet the usual stream of thoughts, clearing the mind and thus relaxing the body.

New age —A general term for a group of spiritual movements that emerged in the 1970s and emphasized self-exploration, expansion of consciousness, and an interest in mystical or occult teachings.

Progressive muscle relaxation —A two-step relaxation technique that involves tensing various muscle groups in sequence for about 8 seconds and then releasing the tension.

Relaxation response —The body's inactivation of stress responses and return of stress hormone levels to normal after a threat has passed.

Stress management —A set of techniques and programs intended to help people deal more effectively with stress in their lives by analyzing the specific stressors and taking positive actions to minimize their effects.

Visualization —The use of mental imagery to focus attention and assist relaxation.

Resources

PERIODICALS

Galvin, J. A., H. Benson, G. R. Deckro, et al. “The Relaxation Response: Reducing Stress and Improving Cognition in Healthy Aging Adults.” Complementary Therapies in Clinical Practice 12 (August 2006):186–191.

Gooneratne, N. S. “Complementary and Alternative Medicine for Sleep Disturbances in Older Adults.” Clinics in Geriatric Medicine 24 (February 2008): 121–138.

Morone, N. E., and C. M. Greco. “Mind-Body Interventions for Chronic Pain in Older Adults: A Structured Review.” Pain Medicine 8 (May/June 2007): 359–375.

Morone, N. E., C. M. Greco, and D. K. Weiner. “Mindfulness Meditation for the Treatment of Chronic Low Back Pain in Older Adults: A Randomized Controlled Pilot Study.” Pain 134 (February 2008): 310–319.

Reeder, C. E., M. Franklin, T. J. Bramley. “Current Landscape of Insomnia in Managed Care.” American Journal of Managed Care 13 (November 2007): S112–S116.

Sharpe, P. A., et al. “A Randomised Study of the Effects of Massage Therapy Compared to Guided Relaxation on Well-Being and Stress Perception among Older Adults.” Complementary Therapies in Medicine 15 (September 2007): 157–163.

Sierpina, Victor R., John Astin, and James Giordano. “Mind-Body Therapies for Headache.” American Family Physician 76 (November 15, 2007): 1518–1524. Yu, D. S., et al. “Non-pharmacological Interventions in Older People with Heart Failure: Effects of Exercise Training and Relaxation Therapy.” Gerontology 53 (February 2007): 74–81.

OTHER

Benson, Herbert. “Summary of the Relaxation Response.” University of California Office of the President Human Resources and Benefits. [cited March 21, 2008]. http://www.ucop.edu/humres/eap/relaxationrespone.html.

Kabat-Zinn, Jon. “Suggestions for Daily Practice.” Oprah.com. [cited March 21, 2008]. http://www.oprah.com/download/pdfs/presents/2007/spa/spa_meditate_daily.pdf.

“Mind-Body Medicine: An Overview.” National Center for Complementary and Alternative Medicine (NCCAM) Backgrounder. Bethesda, MD: NCCAM, 2007. NCCAM Publication No. D239. May 2007 [cited March 21, 2008]. http://nccam.nih.gov/health/backgrounds/mindbody.htm.

ORGANIZATIONS

Association for Applied Psychophysiology and Biofeedback (AAPB), 10200 W. Forty-fourthth Ave., #304, Wheat Ridge, CO, 80033, (303) 422-8436, (303) 422-8894, [email protected], http://www.aapb.org/i4a/pages/index.cfm?pageid=1.

Benson-Henry Institute for Mind Body Medicine, 824 Boylston St., Chestnut Hill, MA, 02467, (617) 732-9130, (617) 732-9111, [email protected], http://www.mbmi.org/home/.

British Autogenic Society, The Royal London Homoeopathic Hospital, Great Ormond St., London, England, WC1N 3HR, 020 7391 8908, 020 7391 8908, [email protected], Center for Mindfulness (CFM), University of Massachusetts Medical School, 55 Lake Ave. N., Worcester, MA, 01655, (508) 856-2656, [email protected], National Center for Complementary and Alternative Medicine (NCCAM), 9000 Rockville Pike, Bethesda, MD, 20892, (301) 519-3153, (888) 644-6226, (866) 464-3616, [email protected], http://nccam.nih.gov.

World Community for Christian Meditation, St. Mark's, Myddelton Square, London, England, EC1R 1XX, +44 0207 278 2070, [email protected], http://www.wccm.org/home.asp?pagestyle=home.

Rebecca J. Frey Ph.D.

Relaxation

Definition

Relaxation therapy is a broad term used to describe a number of techniques that promote stress reduction, the elimination of tension throughout the body, and a calm and peaceful state of mind.

Origins

Relaxation therapy has been around for thousands of years in the forms of transcendental meditation (TM), yoga, t'ai chi, qigong , and vipassana (a Buddhist form of meditation meaning insight and also known as mindfulness meditation). Progressive relaxation, a treatment that rids the body of anxiety and related tension through progressive relaxation of the muscle groups, was first described by Dr. Edmund Jacobson in his book Progressive Relaxation, published in 1929. And in 1975, Dr. Herbert Benson published his groundbreaking work The Relaxation Response, which described in detail the stress-reduction mechanism in the body that short-circuits the "fight-or-flight" response and lowers blood pressure, relieves muscle tension, and controls heart rate. This work gave further credence and legitimacy to the link between mind and body medicine. A number of today's commonly used relaxation techniques, such as cue-controlled relaxation, are a direct result of Benson's work in this area.

Benefits

Stress and tension have been linked to numerous ailments, including heart disease , high blood pressure, atherosclerosis, irritable bowel syndrome , ulcers, anxiety disorders, insomnia , and substance abuse. Stress can also trigger a number of distinct physical symptoms, including nausea, headache, hair loss, fatigue , and muscle pain . Relaxation therapies have been shown to reduce the incidence and severity of stress-related diseases and disorders in many patients.

Description

There are a number of different relaxation methods available. Some of the most widely taught and practiced by healthcare providers include progressive relaxation, cue-controlled relaxation, breathing exercises, guided imagery , and biofeedback .

Progressive relaxation

Progressive relaxation is performed by first tensing, and then relaxing, the muscles of the body, one group at a time. Muscle groups can be divided a number of different ways, but a common method is to use the following groupings: 1) Hands and arms; 2) head, neck, and shoulders; 3) torso, including chest, stomach and back; and 4) thighs, buttocks, legs, and feet. The patient lays or sits in a comfortable position, and then starts with the first muscle group, focusing on the feeling of the muscles and the absence or presence of tension. The patient then tenses the first muscle in the group, holds the tension for approximately five seconds, and releases and relaxes for up to 30 seconds. The contrast allows the individual to notice difference between feelings of tension and feelings of relaxation. The procedure is repeated with the next muscle in the group, and so on, until the first group is completed. The patient then starts on the next muscle group.

Progressive relaxation can be guided with verbal cues and scripts, either memorized by the patient or provided on instructional audiotapes. The procedure remains the same, but the individual is prompted on which muscles to flex and relax and given other cues about noticing the difference between the tense and relaxed state. Some individuals may prefer progressive relaxation that is prompted with a tape, because it allows them to completely clear their minds and to just follow the given instructions.

Deep breathing exercises

Individuals under stress often experience fast, shallow breathing. This type of breathing, known as chest breathing, can lead to shortness of breath, increased muscle tension, and inadequate oxygenation of blood. Breathing exercises can both improve respiratory function and relieve stress and tension.

Before starting to learn breathing exercises, individuals should first become aware of their breathing patterns. This can be accomplished by placing one hand on the chest and one hand on the abdomen, and observing which hand moves farther during breathing. If it is the hand placed on the chest, then chest breathing is occurring and breathing exercises may be beneficial.

Deep breathing exercises are best performed while laying flat on the back, usually on the floor with a mat. The knees are bent, and the body (particularly the mouth, nose, and face) is relaxed. Again, one hand should be placed on the chest and one on the abdomen to monitor breathing technique. The individual takes a series of long, deep breaths through the nose, attempting to raise the abdomen instead of the chest. Air is exhaled through the relaxed mouth. Deep breathing can be continued for up to 20 minutes. After the exercise is complete, the individual checks again for body tension and relaxation. Once deep breathing techniques have been mastered, an individual can use deep breathing at any time or place as a quick method of relieving tension.

Release-only relaxation

Like progressive relaxation, release-only relaxation focuses on relieving feelings of tension in the muscles. However, it eliminates the initial use of muscle tensing as practiced in progressive relaxation, focusing instead solely on muscle relaxation. Release-only relaxation is usually recommended as the next step in relaxation therapy after progressive relaxation has been mastered.

In release-only relaxation, breathing is used as a relaxation tool. The individual sits in a comfortable chair and begins to focus on his breathing, envisioning tension leaving the body with each exhale. Once even, deep, abdominal breathing is established, the individual begins to focus on releasing tension in each muscle group, until the entire body is completely relaxed.

Cue-controlled relaxation

Cue-controlled relaxation is an abbreviated tension relief technique that combines elements of release-only relaxation and deep breathing exercises. It uses a cue, such as a word or mental image, to trigger immediate feelings of muscle relaxation. The cue must first be associated with relaxation in the individual's mind. This is accomplished by choosing the cue, and then using it in breathing and release-only relaxation exercises repeatedly until the cue starts to automatically trigger feelings of relaxation outside of the treatment sessions. Cues can be as simple as the word "relax," and are frequently used on relaxation audiotapes. They can also be a visual cue, such as a mental image of a white sand Caribbean beach, a flower-filled meadow, or other relaxing images. Guided imagery also uses such visualization exercises to produce feelings of relaxation.

HERBERT BENSON 1935–

Dr. Herbert Benson, the guru of mind/body medicine , was born in 1935. He graduated from Wesleyan University and the Harvard School of Medicine. He nurtured his interest in mind/body relationships and developed an expertise in behavioral medicine and spiritual healing. In his research, Benson straddled the thin line between medicine and religion. He conceived of what he called a three-legged approach to health care: self-care, pharmaceuticals, and medical treatment or surgery. His most significant work was his discovery of the relaxation response, which is the connection between lowered blood pressure and transcendental meditation. He was quoted by Daphne Howland of BeWell.com saying that "[B]elief is one of the most powerful healing tools we have in our therapeutic arsenal."

Benson served as the Mind/Body Institute Associate Professor of Medicine at Harvard School of Medical and worked as the Chief of the Division of Behavioral Medicine at the Beth Israel Deaconess Medical Center in Boston, Massachusetts. In 1988 he founded the Mind/Body Medical Institute in Boston, where he served as founding president. He lectured extensively about his work. On November 5, 1997 Benson addressed the Committee on Appropriations of the U.S. House of Representatives and spoke on the topic of "Healing and the Mind." Benson authored scores of scientific papers along with six books pertaining to his years of study, including The Mind/Body Effect in 1979, Relaxation Response in 1990, and Timeless Healing: The Power and Biology of Belief in 1996. Altogether his books sold over four million copies. Among his many honors and awards Benson received the John Templeton Spirituality and Medicine Curricular Award in 1999.

Gloria Cooksey

Guided imagery

Guided imagery is a two-part process. The first component involves reaching a state of deep relaxation through breathing and muscle relaxation techniques. During the relaxation phase, the person closes his eyes and focuses on the slow, in and out of his breathing. Or, he might focus on releasing the feelings of tension from his muscles, starting with the toes and working up to the top of the head. Relaxation tapes often feature soft music or tranquil, natural sounds such as rolling waves and chirping birds in order to promote feelings of relaxation.

Once complete relaxation is achieved, the second component of the exercise is the imagery, or visualization, itself. Relaxation imagery involves conjuring up pleasant, relaxing images that rest the mind and body. These may be experiences that have already happened, or new situations.

The individual may also use mental rehearsal. Mental rehearsal involves imagining a situation or scenario and its ideal outcome. It can be used to reduce anxiety about an upcoming situation, such as childbirth , surgery, or even a critical event such as an important competition or a job interview. Individuals imagine themselves going through each step of the anxiety-producing event and then successfully completing it.

Biofeedback

Biofeedback, or applied psychophysiological feedback, is a patient-guided treatment that teaches an individual to manipulate muscle tension through relaxation, visualization, and other cognitive techniques. The name biofeedback refers to the biological signals that are fed back, or returned, to the patient in order for the patient to develop techniques of controlling them.

During biofeedback, one or more special sensors are placed on the body. These sensors measure muscle tension, brain waves, heart rate, body temperature, and translate the information into a visual and/or audible readout, such as a paper tracing, a light display, or a series of beeps. While the patient views the instantaneous feedback from the biofeedback monitors, he begins to recognize what thoughts, fears, and mental images influence his physical reactions. By monitoring this relationship between mind and body, he can then use thoughts and mental images deliberately to manipulate heart beat, brain wave patterns, body temperature, and other bodily functions, and to reduce feelings of stress. This is achieved through relaxation exercises, mental imagery, and other cognitive therapy techniques.

As the biofeedback response takes place, the patient can actually see or hear the results of his efforts instantly through the sensor readout on the biofeedback equipment. Once these techniques are learned and the patient is able to recognize the state of relaxation or visualization necessary to alleviate symptoms, the biofeedback equipment itself is no longer needed. The patient then has a powerful, portable, and self-administered treatment tool to deal with problem symptoms.

There are dozens of other effective therapies that promote relaxation, including hypnosis, meditation, yoga, aromatherapy, hydrotherapy , t'ai chi, massage, art therapy , and others. Individuals should choose a type of relaxation therapy based on their own unique interests and lifestyle requirements.

Preparations

If an individual is considering relaxation therapy to alleviate physical symptoms such as nausea, headache, high blood pressure, fatigue, or gastrointestinal problems, he or she should consult a doctor first to make sure there isn't an underlying disorder or disease causing the symptoms. A complete physical examination and comprehensive medical history will be performed, and even if an organic cause for the symptoms is found, relaxation exercises may still be recommended as an adjunct, or complementary, treatment to relieve discomfort.

Relaxation therapy should always take place in a quiet, relaxing atmosphere where there is a comfortable place to sit or recline. Some people find that quiet background music improves their relaxation sessions. If an instructional audiotape or videotape is to be used, the appropriate equipment should be available.

The relaxation session, which can last anywhere from a few minutes to an hour, should be uninterrupted. Taking the phone off the hook and asking family members for solitude can ensure a more successful and relaxing session.

Precautions

Most commonly practiced relaxation techniques are completely safe and free of side effects.

Relaxation techniques that involve special exercises or body manipulation such as massage, t'ai chi, and yoga should be taught or performed by a qualified healthcare professional or instructor. These treatments may not be suitable for individuals with certain health conditions such as arthritis or fibromyalgia . These individuals should consult with their healthcare professionals before engaging in these therapies.

Biofeedback may be contraindicated (not recommended) in some individuals who use a pacemaker or other implantable electrical devices. These individuals should inform their biofeedback therapist before starting treatments, as certain types of biofeedback sensors have the potential to interfere with their use.

Relaxation therapy may not be suitable for some patients. Patients must be willing to take a very active role in the treatment process, and to practice techniques learned in treatment at home.

Some relaxation therapies may also be inappropriate for cognitively impaired individuals (e.g., patients with organic brain disease or a traumatic brain injury) depending on their level of functioning. Given the wide range of relaxation therapies available, if one type of relaxation treatment is deemed inappropriate for these patients, a suitable alternative can usually be recommended by a qualified healthcare professional.

Side effects

Relaxation therapy can induce sleepiness, and some individuals may fall asleep during a session. Relaxation therapy should not be performed while operating a motor vehicle or in other situations where full and alert attention is necessary. Other than this, there are no known adverse side effects to relaxation therapy.

Research & general acceptance

Relaxation therapies have been successfully used in relieving stress and anxiety for many years, and are generally well-accepted by the medical community for this purpose.

Recent research published in 1999 has also indicated that relaxation therapy may be useful in reducing the incidence of preterm labor in women at risk for delivering prematurely. The study also found that women who discontinued relaxation exercises for whatever reasons delivered earlier and had lower birth weight babies than those who continued the treatment.

Training & certification

Relaxation therapy techniques are used by many licensed therapists, counselors, psychologists, psychiatrists, and other healthcare professionals. There are many self-help books, audiotapes, and videos available that offer instruction in relaxation techniques.

Resources

BOOKS

Davis, Martha et al. The Relaxation & Stress Reduction Workbook. 4th edition. Oakland, CA: New Harbinger Publications, Inc., 1995.

PERIODICALS

Lindgren, Maryclaire. "Relaxation Techniques Improve Preterm Labor Outcomes." Women's Health Weekly (July 26, 1999): 5-7.

ORGANIZATIONS

The American Psychological Association. 750 First St. NE, Washington DC 20002-4242. (800) 374-2721. http://www.apa.org.

OTHER

Brennan, Patricia. "Stress First Aid Kit." (Guided imagery audiotape set.) Available from Inside Out Publishing at (888) 727-3296 or http://www.facingthedawn.com.

Paula Ford-Martin

Relaxation

Definition

Relaxation therapy is a broad term used to describe a number of techniques that promote stress reduction, the elimination of tension throughout the body, and a calm and peaceful state of mind.

Origins

Relaxation therapy has been around for thousands of years in the forms of transcendental meditation (TM), yoga, t'ai chi, qigong, and vipassana (a Buddhist form of meditation meaning insight and also known as mindfulness meditation). Progressive relaxation, a treatment that rids the body of anxiety and related tension through progressive relaxation of the muscle groups, was first described by Dr. Edmund Jacobson in his book Progressive Relaxation, published in 1929. And in 1975, Dr. Herbert Benson published his groundbreaking work The Relaxation Response, which described in detail the stress-reduction mechanism in the body that short-circuits the "fight-or-flight" response and lowers blood pressure, relieves muscle tension, and controls heart rate. This work gave further credence and legitimacy to the link between mind and body medicine. A number of today's commonly used relaxation techniques, such as cue-controlled relaxation, are a direct result of Benson's work in this area.

Benefits

Stress and tension have been linked to numerous ailments, including heart disease, high blood pressure, atherosclerosis, irritable bowel syndrome, ulcers, anxiety disorders, insomnia, and substance abuse. Stress can also trigger a number of distinct physical symptoms, including nausea, headache, hair loss, fatigue, and muscle pain. Relaxation therapies have been shown to reduce the incidence and severity of stress-related diseases and disorders in many patients.

Description

There are a number of different relaxation methods available. Some of the most widely taught and practiced by health care providers include progressive relaxation, cue-controlled relaxation, breathing exercises, guided imagery, and biofeedback.

Progressive relaxation

Progressive relaxation is performed by first tensing, and then relaxing, the muscles of the body, one group at a time. Muscle groups can be divided a number of different ways, but a common method is to use the following groupings: 1) Hands and arms; 2) head, neck, and shoulders; 3) torso, including chest, stomach and back; and 4) thighs, buttocks, legs, and feet. The patient lies or sits in a comfortable position, and then starts with the first muscle group, focusing on the feeling of the muscles and the absence or presence of tension. The patient then tenses the first muscle in the group, holds the tension for approximately five seconds, and releases and relaxes for up to 30 seconds. The contrast allows the individual to notice the difference between feelings of tension and feelings of relaxation. The procedure is repeated with the next muscle in the group, and so on, until the first group is completed. The patient then starts on the next muscle group.

Progressive relaxation can be guided with verbal cues and scripts, either memorized by the patient or provided on instructional audiotapes. The procedure remains the same, but the individual is prompted on which muscles to flex and relax, and given other cues about noticing the difference between the tense and relaxed state. Some individuals may prefer progressive relaxation that is prompted with a tape, because it allows them to completely clear their minds and tojust follow the given instructions.

Deep breathing exercises

Individuals under stress often experience fast, shallow breathing. This type of breathing, known as chest breathing, can lead to shortness of breath, increased muscle tension, and inadequate oxygenation of blood. Breathing exercises can both improve respiratory function and relieve stress and tension.

Before starting to learn breathing exercises, individuals should first become aware of their breathing patterns. This can be accomplished by placing one hand on the chest and one hand on the abdomen, and observing which hand moves further during breathing. If it is the hand placed on the chest, then chest breathing is occurring and breathing exercises may be beneficial.

Deep breathing exercises are best performed whilelying flat on the back, usually on the floor with a mat. The knees are bent, and the body (particularly the mouth, nose, and face) is relaxed. Again, one hand should be placed on the chest and one on the abdomen to monitor breathing technique. The individual takes a series of long, deep breaths through the nose, attempting to raise the abdomen instead of the chest. Air is exhaled through the relaxed mouth. Deep breathing can be continued for up to 20 minutes. After the exercise is complete, the individual checks again for body tension and relaxation. Once deep breathing techniques have been mastered, an individual can use deep breathing at any time or place as a quick method of relieving tension.

Release-only relaxation

Like progressive relaxation, release-only relaxation focuses on relieving feelings of tension in the muscles. However, it eliminates the initial use of muscle tensing as practiced in progressive relaxation, focusing instead solely on muscle relaxation. Release-only relaxation is usually recommended as the next step in relaxation therapy after progressive relaxation has been mastered.

In release-only relaxation, breathing is used as a relaxation tool. The individual sits in a comfortable chair and begins to focus on breathing, envisioning tension leaving the body with each exhalation. Once even, deep, abdominal breathing is established, the individual begins to focus on releasing tension in each muscle group until the entire body is completely relaxed.

Cue-controlled relaxation

Cue-controlled relaxation is an abbreviated tension relief technique that combines elements of release-only relaxation and deep breathing exercises. It uses a cue, such as a word or mental image, to trigger immediate feelings of muscle relaxation. The cue must first be associated with relaxation in the individual's mind. This is accomplished by choosing the cue and then using it in breathing and release-only relaxation exercises repeatedly, until the cue starts to automatically trigger feelings of relaxation outside of the treatment sessions. Cues can be as simple as the word "relax," and are frequently used on relaxation audiotapes. They can also be a visual cue, such as a mental image of a white-sand Caribbean beach, a flower-filled meadow, or other relaxing images. Guided imagery also uses such visualization exercises to produce feelings of relaxation.

Guided imagery

Guided imagery is a two-part process. The first component involves reaching a state of deep relaxation through breathing and muscle relaxation techniques. During the relaxation phase, the person closes the eyes and focuses on the slow inhalations and exhalations. Or, he or she might focus on releasing the feelings of tension from their muscles, starting with the toes and working up to the top of the head. Relaxation tapes often feature soft music or tranquil, natural sounds such as rolling waves and chirping birds in order to promote feelings of relaxation.

Once complete relaxation is achieved, the second component of the exercise is the imagery, or visualization itself. Relaxation imagery involves conjuring up pleasant, relaxing images that rest the mind and body. These may be experiences that have already happened, or they may be new situations.

The individual may also use mental rehearsal. Mental rehearsal involves imagining a situation or scenario and its ideal outcome. It can be used to reduce anxiety about an upcoming situation, such as childbirth, surgery, or even a critical event such as an important competition or a job interview. Individuals imagine themselves going through each step of the anxiety-producing event and then successfully completing it.

Biofeedback

Biofeedback, or applied psychophysiological feedback, is a patient-guided treatment that teaches an individual to manipulate muscle tension through relaxation, visualization, and other cognitive techniques. The name biofeedback refers to the biological signals that are fed back, or returned, to the patient in order for the patient to develop techniques of controlling them.

During biofeedback, one or more special sensors are placed on the body. These sensors measure muscle tension, brain waves, heart rate, and body temperature; and translate the information into a visual and/or audible readout, such as a paper tracing, a light display, or a series of beeps. While the patient views the instantaneous feedback from the biofeedback monitors, he begins to recognize what thoughts, fears, and mental images influence his physical reactions. By monitoring this relationship between mind and body, he can then use thoughts and mental images deliberately to manipulate heart beat, brain wave patterns, body temperature, and other bodily functions, and to reduce feelings of stress. This is achieved through relaxation exercises, mental imagery, and other cognitive therapy techniques.

As the biofeedback response takes place, the patient can actually see or hear the results of his efforts instantly through the sensor readout on the biofeed-back equipment. Once these techniques are learned and the patient is able to recognize the state of relaxation or visualization necessary to alleviate symptoms, the biofeedback equipment itself is no longer needed. The patient then has a powerful, portable, and self-administered treatment tool to deal with problem symptoms.

There are dozens of other effective therapies that promote relaxation, including hypnosis, meditation, yoga, aromatherapy, hydrotherapy, t'ai chi, massage, art therapy, and others. Individuals should choose a type of relaxation therapy based on their own unique interests and lifestyle requirements.

Preparations

If an individual is considering relaxation therapy to alleviate physical symptoms such as nausea, headache, high blood pressure, fatigue, or gastrointestinal problems, he or she should consult a doctor first to make sure there is not an underlying disorder or disease causing the symptoms. A complete physical examination and comprehensive medical history will be performed, and even if an organic cause for the symptoms is found, relaxation exercises may still be recommended as an adjunctive, or complementary, treatment to relieve discomfort.

Relaxation therapy should always take place in a quiet, relaxing atmosphere where there is a comfortable place to sit or recline. Some people find that quiet background music improves their relaxation sessions. If an instructional audiotape or videotape is to be used, the appropriate equipment should be available.

The relaxation session, which can last anywhere from a few minutes to an hour, should be uninterrupted. Taking the phone off the hook and asking family members for solitude can ensure a more successful and relaxing session.

Precautions

Most commonly practiced relaxation techniques are completely safe and free of side effects.

Relaxation techniques that involve special exercises or body manipulation such as massage, t'ai chi, and yoga should be taught or performed by a qualified health care professional or instructor. These treatments may not be suitable for individuals with certain health conditions such as arthritis or fibromyalgia. These individuals should consult with their health care professional before engaging in these therapies.

Biofeedback may be contraindicated (not recommended) in some individuals who use a pacemaker or other implantable electrical devices. These individuals should inform their biofeedback therapist before starting treatments, as certain types of biofeedback sensors have the potential to interfere with their use.

Relaxation therapy may not be suitable for some patients. Patients must be willing to take a very active role in the treatment process, and to practice techniques learned in treatment at home.

Some relaxation therapies may also be inappropriate for cognitively impaired individuals (e.g., patients with organic brain disease or a traumatic brain injury) depending on their level of functioning. Given the wide range of relaxation therapies available, if one type of relaxation treatment is deemed inappropriate for these patients, a suitable alternative can usually be recommended by a qualified health care professional.

Side effects

Relaxation therapy can induce sleepiness, and some individuals may fall asleep during a session. Relaxation therapy should not be performed while operating a motor vehicle or in other situations where full and alert attention is necessary. Other than this, there are no known adverse side effects to relaxation therapy.

Research and general acceptance

Relaxation therapies have been successfully used in relieving stress and anxiety for many years, and are generally well-accepted by the medical community for this purpose.

Recent research published in 1999 has also indicated that relaxation therapy may be useful in reducing the incidence of preterm labor in women at risk for delivering prematurely. The study also found that women who discontinued relaxation exercises, for whatever reasons, delivered earlier and had lower birth weight babies than those who continued the treatment.

KEY TERMS

Qigong— An exercise practice derived from traditional Chinese medicine that is designed to facilitate energy flow throughout the body.

T'ai chi— A martial art that uses exercise to balance the body's energy flow to the body center in order to promote physical well-being.

Training and certification

Relaxation therapy techniques are used by many licensed therapists, counselors, psychologists, psychiatrists, and other health care professionals. There are many self-help books, audiotapes, and videos available that offer instruction in relaxation techniques.

Resources

BOOKS

Davis, Martha, et al. The Relaxation & Stress Reduction Workbook. 4th edition. Oakland, CA: New Harbinger Publications, Inc., 1995.

PERIODICALS

Lindgren, Maryclaire. "Relaxation Techniques Improve Preterm Labor Outcomes." Women's Health Weekly (July 26, 1999): 5-7.

ORGANIZATIONS

The American Psychological Association. 750 First St. NE, Washington DC 20002-4242. (800) 374-2721. 〈http://www.apa.org〉.

OTHER

Brennan, Patricia. "Stress First Aid Kit." (Guided imagery audiotape set.) Available from Inside Out Publishing at (888) 727-3296 or 〈http://www.facingthedawn.com〉.

relaxation is that blissful state of being at peace with oneself and with the world. As Robert Browning put it about a hundred years ago, ‘God's in his heaven/All's right with the world’. It is the consequence of an untroubled mind in a relaxed body — a body free from undue tension. It is something that we are all born knowing how to do, or rather to be — since relaxation is more a state of being, than an activity, although sometimes it becomes a skill that we have to relearn.

Relaxation creates measurable changes in the body, such as a reduction in oxygen consumption, heart and respiratory rate, blood pressure, blood cortisol levels, and muscle tension, and an increase in the production in the brain of serotonin which leads to feelings of calmness and well-being. There is also a noticeable change in the pattern of our brain waves (electroencephalogram) when we are deeply relaxed. Very deep relaxation and meditation produce a pattern that combines the so-called alpha and theta rhythms, indicating a state of harmony. The collection of bodily changes that accompany relaxation is sometimes referred to as ‘the relaxation response’.

The body and mind — or body/mind, since they are so intricately interconnected — is designed to cope with periods of effort interspersed with periods of rest and relaxation. Unless we allow the body/mind these respites, we become irritated, unhappy, stressed, and vulnerable to disease. Most of us instinctively know how to achieve relaxation, whether it is through leisure activities — taking walks, dancing, playing sports or games, knitting, reading, listening to music, watching television, having a drink, spending time with friends, laughing, making love — or simply doing nothing. Some forms of relaxation involve virtually no effort, other forms require effort as a means to achieve relaxation. Methods of relaxation that address both the physical and mental sides tend to be most effective. Exercise often works in this way. It gets us ‘out of our heads’ and into a greater awareness of our bodies. Thus, it distracts us from our worries. It also gives us a sense of accomplishment and ‘satisfied tiredness’, which may be related to the exercise-induced production of endorphins — the body's own morphine-like substances. Happy, healthy people tend to know what relaxes them and take time for it.

Problems arise when we fail to see relaxation as being important and continually prioritize getting through our ‘to do’ list. We get lost in the endless cycle of ‘doing’. It became something of a feature of late-twentieth-century life to see constant busyness as the norm; to make oneself available for round-the-clock demands by means of mobile phones, laptop computers, faxes, and e-mails. The pace of modern life has speeded up to such an extent that we often feel that we simply cannot afford the time to relax because we have to run so hard to keep up.

Chronic stress can lead to significant physical and mental health problems — so a habitual stressed state requires serious attention. Firstly, we need to become aware that there may be a problem. Secondly, spending more time relaxing is half the battle. Nevertheless, we may feel dissatisfied with our usual repertoire and in need of new and more effective methods of relaxation.

Ancient Asian methods tend to be at the basis of most of what has been more recently learned about relaxation. Yoga and meditation are the most well–known methods. Starting to practise them may turn into a life-changing experience. Other relaxation methods, like ‘cue-controlled relaxation’ or ‘progressive relaxation’, have also blown over from the East. In essence, these Western adaptations have in common a way of regulating and slowing down the breathing, relaxing the muscles, and reducing mental activity. Progressive relaxation and cue-controlled relaxation differ in that the first requires the tensing of muscles before relaxing them, while the second addresses release of muscle tension directly: this may be preferred by a person who is already aware of how it feels to be tense.

The instructions are these (adapted by de Vries from Benson, 1975):1. Sit down in a relaxed position and close your eyes. Make sure your position in the chair allows you to relax as many of your muscles as possible. Become aware of where you need tension for your posture.2. Concentrate on your breathing, and slow it down. Breathe through your nose, making your exhalation longer. You will notice a little tension associated with inhalation. Concentrate on making exhalation feel pleasurable.3. Pay attention to your position, and feel each part of you being supported by the chair so that you can relax your muscles further. Adjust your position if you wish to.4. Begin searching your body for any signs of tension. Start at your feet and work your way up. If you find any tension, focus your attention on it, and, as you exhale, relax it away. Once you have reached your shoulders, work your way down your arms first and then finish with the neck and head. Pay extra attention to areas you know you find difficult to relax. Shoulders, neck, hands, and jaw are examples. Hands can be made to relax by ‘instructing them’ to feel ‘soft’.5. Keep breathing slowly through your nose, and begin to think or say the word ‘one’ to yourself. You don't need to produce sound as long as you make sure that you move your lips to say ‘one’. Keep doing this for 5 to 10 minutes. If you get distracted, don't worry about it, simply go back to saying the word and continue repeating it. Because of its neutral content the word ‘one’ helps to take attention away from worrying thoughts.6. When you are ready to end your relaxation training session, open your eyes and sit up slowly. Take one or two more deep, slow breaths. Notice that you are both relaxed and alert. This is one of the main reasons why you will want to practise relaxing, for example, just prior to beginning any performance before an audience.

This exercise can be used in many different circumstances. A comfortable chair is not even needed. In the beginning it may take about a quarter of an hour. After regular practice it may take only a couple of minutes to bring about the desired effect. Eventually, just sitting down and closing the eyes may automatically trigger the relaxation response. This makes it an excellent technique to use in preparation for exciting or stressful activities like hosting a party, making a speech, doing an exam, or going for an interview.

Relaxation is necessary for our health and sense of well-being. If we've forgotten how to do it, an exercise like cue-controlled relaxation may help — but essentially relaxation comes from a balanced lifestyle as reflected in this old Irish Prayer.

Take time to work
It is the price of success.
Take time to meditate
It is the source of power.
Take time to play
It is the secret of perpetual youth.
Take time to read
It is the way to knowledge.
Take time to be friendly
It is the road to happiness.
Take time to laugh
It is the music of the soul;
And take time to love and be loved.

Áine Kennedy, and Jan M. A. de Vries

Bibliography

Ban Breathnach, S. (1995). Simple abundance. Bantam Books, London.
Benson, K. (1975, 1976). The relaxation response. Morrow Books, New York.
Davis, M.,, Robbins Eshelman, E.,, and and McKay, M. (1995). The relaxation and stress reduction workbook. New Harbinger, Oakland, CA.
Gerzon, R. (1998). Finding serenity in the Age of Anxiety. Simon and Schuster, London.
Kirsta, A. (1986). The book of stress survival. Allen and Unwin, London.

Relaxation

What Is the Relaxation Response?

What Are Other Forms of Relaxation?

Conclusion

Resources

Relaxation marks a state of ease or rest, often associated with a freedom from routine or work and freedom from stress.

KEYWORDS

for searching the Internet and other reference sources

Stress

Stress Management

Meditation

Yoga

A hot, bubbly bath may ease stress for Shanna, while an on-your-toes racquet ball game releases the day’s tensions for Wayne. Maria finds that hot cocoa with a friend is “pure relaxation” and the antidote to stress. Ways to relax are countless. On weekends, city parks teem with children and adults pursuing relaxation as they play chess, practice tai chi*, jog, bicycle, kick soccer balls, shoot baskets, and sit on park benches to read. Still, one person’s form of relaxation may be stressful to another.

* tai chi

(ty chee) is an ancient Chinese system of body movements, practiced as a meditative form of exercise.

What Is the Relaxation Response?

The Harvard professor of medicine Herbert Benson reported in the 1970s that the body has the capacity to achieve a special relaxed state, the direct opposite of the state of stress. Benson called this state the “relaxation response” and found that it can easily be achieved through meditation. The relaxation response involves a deep state of rest associated with decreases in heart rate, breathing rate, blood pressure, muscle tension, metabolism*, oxygen consumption, and active thinking. With daily practice of 20 to 30 minutes, the relaxation response reportedly can help keep the body young and the mind alert and might help increase energy, improve concentration, and extend memory.

* metabolism

(me-TA-bo-li-zum) is the chemical processes in the body that convert foods into the energy needed for body functions.

What Are Other Forms of Relaxation?

There are other ways to achieve a state of deep relaxation. These include abdominal breathing, progressive muscle relaxation, yoga, and creative imagery.

Abdominal breathing

Practicing abdominal breathing (from deep in the stomach) can lead to a state of extreme relaxation. This kind of breathing differs from shallow chest breathing, or panting, which actually can cause an increase in nervousness. Abdominal breathing is the kind of breathing that is practiced in meditation or yoga.

Progressive muscle relaxation

Progressive muscle relaxation was developed in the early twentieth century by Dr. Edmund Jacobson. It is a program of tensing and relaxing muscles in an organized pattern so that that body “learns” how to release muscular tension. This form of relaxation can be paired with the gradual presentation of feared objects or ideas to help reduce phobias* or anxiety. When it is used in this way it is called systematic desensitization.

* phobias

(FO-bee-as) are in-tense, unrealistic fears of certain objects or situations.

Yoga

Yoga is a system of mental and physical exercise that focuses the mind to eliminate distractions. There are various forms of yoga practice, but stages of the training often involve disciplined behavior, mastery of bodily posture, control of breathing, and meditation. In particular, hatha yoga, which focuses on bodily postures and control of breathing, is believed to improve the overall health of the body.

Hatha yoga involves engaging the body in a series of postures designed to connect the body’s movement with the breath. This practice increases peoples’ awareness of their own bodies and thoughts, which often results in a sense of self-assurance and peace, as well as an ability to calm themselves in stressful situations. Duomo/Corbis

Creative imagery

There are various forms of creative imagery, including guided imagery, in which a therapist or other person describes peaceful scenes or images that create a restful, relaxed state. In some instances, people may form a mental picture of their own place of relaxation. This procedure often is used to lessen the pain and worry of medical procedures. For example, to diminish the pain of needles during injections for kidney disease, 9-year old Luke pictures himself walking on the sands of the beaches of Hawaii, as he did when he was 5 years old, before his illness began. In some instances, self-instruction may be used (“With every breath I take, I relax more deeply”;) to intensify the relaxation.

Conclusion

The human stress response occurs when people face situations that they perceive as dangerous, difficult, or overwhelming. Anxiety or other psychological symptoms may develop when people believe that inner or outer resources for coping with these stressful aspects of life are lacking or unavailable. The relaxation response is the physiological opposite of stress and can counteract its effects. Effective relaxation restores a person’s ability to cope with life’s daily hassles and stresses.

See also

Hypnosis

Phobias

Resilience

Stress

Resources

Book

Hipp, Earl. Fighting Invisible Tigers: A Stress Management Guide for Teens. Minneapolis: Free Spirit Publishing, 1996. For ages 11 and up.

Organization

www.KidsHealth.org, a website sponsored by the Nemours Foundation and the Alfred I. duPont Hospital for Children, has an article called “Spotlight on Stress” that talks about relaxation. http://kidshealth.org/teen/mind_matters/feelings/stress.html