We live in a day and age that offers countless
opportunities for advancement and growth in every facet of life. The 21st
century has embarked on new, innovative technologies that have spawned
tremendous increases in the quality of life for each and every one of us.
In the past few hundred years, advances in medicine, technology, science,
and communication have revolutionized life as we know it. The average life
expectancy has practically doubled, once lethal and incurable illnesses
have been eradicated, and our ability to communicate with the rest of the
world is only a point and a click away. These are incredible times to be
living in, and technologies such as computers, televisions, telephones,
and cars have made life so much easier and convenient. Times of tremendous
growth and prosperity also require that you grow and adapt with them.
Sometimes it is difficult to keep up with such a fast-paced and ever
changing society, so it is very important to learn and utilize skills that
will help you succeed in the 21st century. These skills will not only help
you gain control of your life, but they will also help you gain that extra
advantage needed to make it in today’s global world.
One of the skills that is highly important to learn and implement
into your daily life is relaxation. Relaxation can be highly beneficial if
practiced routinely in one’s everyday life. Techniques involving
relaxation are widely used by people to reduce anxiety and cope with
stress-related problems. In the clinical setting, relaxation procedures
are active, educational forms of therapy that can decrease the occurrence
of tension and anxiety disorders. Clinical Relaxation can ease or
eliminate problems for those already afflicted as well. In clinical
intervention, the client and therapist work collaboratively to understand
the source of the problem and its impact in that person’s life. Relaxation
therapy is initiated and taught in the clinician’s office but is practiced
primarily in the client’s own environment. There are countless methods
used to achieve relaxation, but the procedures that are most commonly
practiced in the clinical setting are Jacobson’s (1938) Progressive
Muscular Relaxation, Schultz and Luthe’s (1969) Autogenic Training, and
Benson’s (1975) Relaxation Response (Weiten & Lloyd, 1998). In the
last few decades, a substantial amount of data has been collected on many
factors relating to relaxation such as: specific effects of different
methods of relaxation; individual differences in response to treatment;
variables that increase adherence to treatment; and relaxation therapy
effects on specific health problems. The following sections review the
empirical research on relaxation procedures and will also provide the
building blocks necessary to succeed in achieving the relaxation
Note: PMR =
progressive muscular relaxation; CT = cognitive therapy; EMG BFK =
electromyographic biofeedback; T BFK = thermal biofeedback.
The Specific Effects Model
frequently observed desynchronies across behavioral, cognitive, and
somatic measures of anxiety has led researchers (e.g., Davidson &
Schwartz, 1976) to develop the specific-effects model. They suggest that
relaxation oriented to one modality will benefit symptoms of that
modality. Based on this model, for example, Jacobson's progressive
relaxation, a somatic treatment, will help somatic symptoms such as
The Relaxation Response Model
H. Benson (1975, 1983), based in his observation of the relaxation
effects, argued that all the relaxation techniques produce a single
"relaxation response," characterized by diminished sympathetic
Davidson, and Goleman (1978), suggests that the majority of the relaxation
procedures have highly specific effects, as well as more generally
stress-reducing effects, therefore, the specific effects of various
relaxation techniques may be superimposed upon a general relaxation
effect. For example, AT have specific effects on the autonomic
functions included in the autogenic exercises, but it also produces a
general decrease in physiological arousal.
somatic-cognitive-behavioral distinction has been proposed by different
researchers to help in the selection of appropriate relaxation techniques.
Their rationale is that techniques directed to one of these modalities
appear to have their greatest and most consistent effects on that
Jacobson's Method versus Modified Jacobsonian
The many differences between the Jacobson's
PMR technique and modified PMR methods warrant separate
consideration. Applied relaxation, Differential relaxation, and
Rapid relaxation are included among the modified methods. Table 1
presents a comparison between these methods. (For a review of
modified PMR methods, see Bernstein and Carlson, 1993).
Table 1. Comparison
between Jacobson's PMR method and modified PMR
|greater somatic physiological
||greater cognitive & behavioral
|focuses on changing levels of muscle
tension per se, using tensing and relaxing exercises
||focuses on perception of
physical and emotional tension, or cognitive activity associated
|avoid aids (e. g., hypnotic suggestion)
because risks of dependence on them
||use aids to enhance compliance and
perception of relaxation|
|use methods to produce perception of very
low levels of muscle tension
||use methods that involve gross
|emphasize using sessions to teaching
muscular relaxation (a state of emotional or cognitive relaxation
may not be experienced during training sessions)
||emphasize using sessions to create a
sense of relaxation (a state of emotional or cognitive relaxation
may be experienced during training sessions)|
|generalization of relaxation skills are
achieved by daily practice, particularly applying the skills in
situations that might elicit emotional or physical
||generalization of relaxation is achieved
by cognitively creating cue words that can be used as "conditioned
stimuli" to reproduce the relaxation
*adapted from Lehrer, Woolfolk, & Goldman, 1986.
Comparison of Methods
Meditation versus Relaxation
According to Benson (1975), the best techniques are the ones that
are simple to teach and to learn. He suggested that his relaxation
technique, which involved saying the word "one" with each exhalation, was
preferable to other techniques because it is easy to administer and
produces effects equivalent to those of more complex techniques (Greenwood
& Benson, 1977). However, research suggests that meditation and
PMR produce differential effects. Meditators demonstrate alpha
levels even when not meditating, while PMR does not appear to have
consistent effects on EEG activity; PMR produces greater decreases in
systolic blood pressure than meditation (Delmonte, 1984; English &
Baker, 1983; Lehrer, 1978). From a philosophical perspective
meditation and relaxation therapies are different. Meditation is a
means toward achieving personal growth and finding a system of values and
philosophy of life, whereas relaxation techniques are designed as
treatments for particular disorders (Kokoszka, 1990).
Autogenic Training and Progressive
Muscular Relaxation Methods
The exercises in AT
emphasize sensations involving the autonomic nervous system (e.g., warm
hands, slow heart rate). These techniques have been found to have
greater effects than PMR on autonomic measures and disorders associated
with autonomic dysfunction. AT helps to decrease heart rate in
subjects with high anxiety and treat migraine headaches (Lehrer, Atthowe,
and Weber, 1980). PMR has greater effects on muscular tension and
symptoms associated with it than AT does. PMR is more effective than
AT in the treatment of muscle contraction headaches.
Drug Therapy versus Relaxation
Although much research remains to be done in
this area, Lehrer and Woolfolk's (1993) review of anxiety studies
comparing drug and behavioral treatments (relaxation, exposure) is worth
mentioning it. They concluded that both treatments have similar
short-term effects, but behavioral treatments had better long-term effects
than drug treatments. Drug therapy was not effective in treating
phobic avoidance unless some exposure to the phobic object is made.
They also found that Imipramine medication increases willingness to engage
in exposure, whereas Benzodiazepine tends to foster medication dependency
and reduce people's willingness to use relaxation to control anxiety.
Differences between Autogenic Training and
The effects of AT on peripheral temperature are assumed to be
similar to those of TBFK (Surwit, 1982) and some research showed a
considerable overlap in their effects. Surwit, Pilon, and Fenton
(1978) found no differences between TBFK and the combination of TBFK and
AT on physiological or self-report measures of symptoms associated with
Raynaud's disease. Similar effects for the two techniques were
observed in studies of mild hypertension and hand temperature changes
(Blanchard, Khramelashvili, McCoy, Aivazyan, McCaffrey, Salenko, Musso,
Wittrock, Berger, Gerardi, and Pangburn, 1988; Kluger, Jamner, and Tursky,
1985). Additional research has showed that TBFK produces greater
rises in finger temperature, greater symptom reduction of migraine
headaches, and greater blood pressure reductions than AT (Aivazyan,
Zaitsev, Salenko, Yurenev, and Patrusheva, 1988; Freedman, 1989, 1991;
Freedman & Ianni, 1983; Sargent, Solbach, Coyne, Spohn, &
Freedman, Sabharwal, lanni, Desai, Wenig, & Mayes (1988),
suggest that relaxation therapy may inhibit the beta sympathetic component
known to increase hand warming; TBFK may enhance this component
increasing finger temperature.
Tensing and Relaxing Training versus
The results of Weinstein and Smith’s study
(1992) of anxious individuals found that isometric squeeze relaxation is
relatively more appropriate for those who have more difficulty focusing,
and meditation for those who already possess well-developed relaxation
skills at a trait level.
Exercise and Music versus Relaxation
The results of Lehrer and Woolfolk's (1993)
review of the literature comparing exercise with relaxation techniques
suggests that exercise may have effects similar to but smaller than those
of relaxation techniques. They also found that the combination of
relaxation and music produces greater psychological effects than each
Cognitive Effects of Autogenic Training and
AT has more cognitive effects
than PMR, a purely somatic-oriented technique, because it contains a
mixture of cognitive and somatic elements. There is evidence that
the specific suggestions (e.g., warmth, heaviness) in AT have the specific
effect of producing these sensations, compared with PMR; in addition, AT
seems to produce more vivid images and emotions than PMR (Borgeat,
Stravynski, & Chaloult, 1983; Lehrer, Atthowe, & Weber, 1980;
Shapiro & Lehrer, 1980).
Relaxation versus Cognitive Therapies
Cognitive therapy produces greater changes than relaxation therapy
in disorders that are assessed by cognitive measures (e.g., anxiety,
pain), whereas problems assessed primarily by somatic measures tend to
show a greater response to relaxation therapy (Lehrer & Woolfolk,
1993). Most current studies provide evidence that cognitive therapy
adds significantly to the effects of relaxation therapies and may even be
superior to the latter in some disorders.
Programs Combining Somatic and Cognitive
Therapists combine relaxation methods with cognitive methods to
produce more effective therapeutic interventions. "Stress
inoculation training" (Meichenbaum, 1985, 1993, 1996) and "anxiety
management training" (Deffenbacher & Suinn, 1982; Suinn, 1975, 1990;
Suinn & Richardson, 1971) are two examples of therapy packages that
combine relaxation and cognitive methods. Most combinations of
relaxation and cognitive training are more effective than is either
therapy alone (Chang-Liang & Denney, 1976; Goldfried & Trier,
1974; Mitchell & Mitchell, 1971). The least effective of these
combinations is cue-controlled relaxation (Grimm, 1980; Franklin, 1986,
1989). Training in how to apply relaxation skills in daily life is
an advisable addition to relaxation therapy (Aponte & Aponte, 1971;
Cooke, 1968; Freeling & Sheinberg, 1970; Moore, 1965).
Conversely, relaxation therapy is an advisable addition to cognitive
approaches in treatment of stress-related problems.
Relaxation: Effectiveness Studies
are highly efficient and produce long-term benefits in the treatment of
clinical anxiety (Borkovec & Sides, 1979; Bernstein & Borkovec,
1973; Clum, Clum, & Surls, 1993; Rasid, & Parish, 1998).
report the elimination of panic attacks via cognitive or breathing
techniques in at least 80-90% of their clients (Barlow, 1988; Beck, 1988;
Clark, 1986; Clark, Salkovskis, & Chalkley, 1985). A recent
study investigated the efficacy of applied relaxation and cognitive
behavior therapy for treating panic disorder. Thirty-eight outpatients
with no or mild avoidance were assessed. Both treatments yielded
significant improvements that were maintained or furthered at
follow-up. Sixty-five percent of those who received AR were
panic-free after treatment, and 82% were panic-free at follow-up, and 74%
of those who received CBT were panic-free after treatment, and 82% were
panic-free after follow-up. These treatments made lasting changes in
generalized anxiety and depression, which has shown that AR and CBT are
effective treatments for panic disorder without avoidance (Oest &
Generalized Anxiety Symptoms
Different multi-component (cognitive, relaxation, and exposure
techniques) treatments for the treatment of generalized anxiety have shown
significant improvements of anxiety (Borkovec & Costello, 1993).
Deffenbacher and Suinn (1987) recommend teaching relaxation as a
self-control procedure as part of these treatments. Expressive Relaxation
Training has proven to be quite effective in the treatment of anxiety.
This method was used to treat male and female psychiatric outpatients with
general anxiety disorders. Ratings of anxiety, depression, avoidance
behavior, social impairment disability, and quality of interpersonal
relationships were markedly improved at ERT termination (Andreoli,
Casolari, & Rigatelli, 1995).
to be effective in the treatment of test anxiety and significantly better
than no-treatment controls. However, cognitive methods seem to be
more effective than relaxation (Lehrer & Woolfolk, 1993).
appears to be effective in the treatment of social phobias.
Treatment comparisons showed that either exposure, relaxation, or CT are
effective in the treatment of social phobias (Heimberg, 1989).
Anger, Hostility and Aggressive
Relaxation techniques, such as PMR, meditation,
and AT seem to be equally effective as CT in reducing symptoms of
hostility (Deffenbacher, McNamara, Stark, & Sabadell, 1990).
However, the combination of CT and relaxation therapies are particularly
effective in treating excessive anger in children and adults (Kendall
& Braswell, 1986; Meichenbaum & Novaco, 1985; Novaco, 1975). A
combination of cognitive-relaxation compared with relaxation coping skills
was measured to show which proved more useful in treating general anger.
It was shown that some measures slightly favored the cognitive-relaxation
method. The two methods also showed reductions in clinically meaningful
general anger and maintenance of anger and anxiety after a one year
follow-up period at a somewhat equivalent rate (Deffenbacher & Stark,
techniques are useful in treating adults (Primavera & Kaiser, 1992)
and children's (Mehta, 1992; Sartory, Mueller, Metsch, & Pothmann,
1998) headaches. Relaxation or biofeedback training helps between
40% and 80% of tension headache sufferers (Blanchard, Ahles, & Shaw,
1979). Greater improvements are reported at follow-up than
immediately after treatment. Autonomically focused techniques (e.g.,
TBFK, AT) are used for migraine headaches (Lisspers & Ost,
1990). Somatic techniques (e.g., PMR) are used for the
treatment of migraine headache (Blanchard, Appelbaum, Radnitz, Morrill,
Kirsch, Hillhouse, Evans, Guarnieri, Attanasio, Andrasik, Jaccard, &
Dentineer, 1990). CT appears to be a particularly potent method for
treating tension headaches (Murphy, Lehrer, & Jurish, 1990). A
combination of CT and relaxation therapy has been shown to be more
effective than relaxation alone (Tobin, Holroyd, Baker, Reynolds, &
Holm, 1988). No systematic differences have been found between CT
and relaxation for migraine headache (Sorbi, Tellegen, & du Long,
1989). Use of PMR and restricted environmental stimulation therapy
showed a significant decrease in headache reports (Wallbaum, Rzewnicki,
Steele, & Suedfeld, 1991). The active treatment group improved
significantly more than the control group, as well as showed continuing
improvement during follow-up periods, while the control group had
deteriorated by 34% since the end of the treatment.
PMR is an effective
treatment for idiopathic insomnia (objective insomnia, Borkovec,
1979). Knapp, Downs, and Alperson (1976) suggests that the majority
of the relaxation training significantly reduces the latency to sleep
onset and the number of awakenings. There is some evidence that PMR
also improves pseudoinsomnia (self-reported insomnia) (Greeff &
Conradie, 1998). Because cognitive rather than physiological arousal
is critical to the cause and/or maintenance of insomnia, several
researchers recommend a combination of CT and PMR methods (Lacks, 1987). A
recent study has also found that self-administered treatment of
progressive relaxation training is highly effective in treating insomnia.
After a one year follow-up period, patients had learned to relax to an
average of 83%, and also learned to achieve a state of calmness which
improved their overall sleeping patterns by 86%. (Gustafson,
of alcoholics suffer panic-related anxiety disorder, and 10-20% of anxiety
disorder clients abuse alcohol or other drugs (Cox, Norton, Swinson, &
Endler, 1990). Relaxation and self-management techniques
significantly reduce anxiety and tension in alcoholics (Parker &
Gilbert, 1978; Parker, Gilbert, & Thoreson, 1978). Relaxation seems to
be highly recommended for anxious alcoholics (Kushner, Sher, &
Beitman, 1990) who drink to avoid experiencing stress or in response to
stress. Relaxation training effects could substitute for alcohol
Recent studies have
found that the use of relaxation imagery in smoking cessation programs to
be effective. The study targeted smokers aged 18-60, and showed quit rates
to be 69%, and abstinence rates of 55%. These findings suggest that
relaxation imagery can be a useful tool to deter smoking (Wynd,
Relaxation Therapies with Children
Children are as good or better able than adults to learn relaxation
techniques (Zaichkowsky & Zaichkowsky, 1984; Hiebert, Kirby, &
Jaknovorian, 1989). Most of the studies show that relaxation can be
beneficial in treating anxiety-related academic difficulties and pain
(Heitkemper, Layne, Sullivan, & David, 1993). Relaxation therapy
can also be a positive addition to improving psychosomatic disorders
(Richter, 1984), and hyperactive children's impulsivity, disruptive
behavior, academic performance, and self-concept (Omizo & Williams,
Hypertension and Heart Disease
Relaxation training is more effective in controlling mild essential
hypertension than no-treatment, delayed-treatment, and control procedures
(Agras, Southam, & Taylor, 1983). This training alone, however,
is not as effective as antihypertensive medications in reducing blood
pressure (Jacob, Shapiro, Reeves, Johnson, McDonald, &
Coburn,1986). Some studies of relaxation therapy for hypertension
have reported highly significant effects for relaxation therapies (Jacob,
Chesney, Williams, Ding, & Shapiro, 1991). In 1988, the joint
National Committee on Detection, Evaluation, and Treatment of High Blood
Pressure recommended that relaxation be used for treatment of mild
hypertension, and as an adjunct to medication for treatment of more severe
hypertension. There is evidence that stress management techniques
can decrease the doses of anti-hypertensive medications needed (Glasgow,
Engel, & D'Lugoff, 1989). Where blood pressure is significantly
elevated, however, it should not be considered safe to maintain
hypertensive patients on relaxation treatment alone.
Relaxation-based interventions also have a prophylactic effect against
heart disease (Dath, Mishra, Kumaraiah, & Yavagal, 1997, Patel,
Marmot, & Terry, 1981; van-Dixhoorn, 1998). A combination of
thermal biofeedback and PMR training administered to those suffering from
essential hypertension has produced satisfactory results. A significant
decline in systolic and diastolic blood pressure was observed in the
treatment group, as opposed to an increase in both for the control group.
(Hahn, Ro, Song, & Kim, 1993).
techniques such as PMR, AT, and TBFK are effective for treating Raynaud's
disease (Pinkerton, Hughes, & Wenrich, 1982; Rose & Carlson, 1987;
Surwit, 1982). TBFK seems to be the more effective technique,
especially when cold stress is added to treatment (Freedman, Lynn, lanni,
& Wenig, 1983).
Relaxation techniques have been used to treat those
suffering from fibromyalgia. Studies have compared the effectiveness
of relaxation, exercise, and a combination of the two. It was found
that all three treatment groups produced improvements in self-efficacy for
physical function, which was best maintained by the combination group
after a two year follow-up period (Buckelew, Conway, Parker, et
Applied Relaxation was tested on individuals who suffered
from postmenopausal hot flushes. The number of flushes was measured from
one month before to six months after treatment was applied, and was found
to reduce the frequency by an average of 73% (Wijma, Melin,
Nedstrand, & Hammar, 1997).
Irritable Bowel Syndrome
Studies combining relaxation and CT have shown positive results in
the treatment of irritable bowel syndrome (Neff & Blanchard, 1987;
Blanchard & Schwarz, 1988). Progressive Muscle Relaxation administered
to those suffering from Irritable Bowel Syndrome has been shown to
significantly alleviate symptoms associated with the condition (Blanchard,
Greene, Scharff, & Schwarz-McNorris, 1993). Fifty percent of the group
was clinically improved by the end of the treatment, and results also
indicate that relaxation training alone can be a useful treatment for
Irritable Bowel Syndrome.
have been shown to produce significant improvement in asthma (Vazquez
& Buceta, 1993), Facial muscle EMG BFK appears to successful in
decreasing parasympathetically mediated bronchoconstriction.
(Kotses, Harver, Segreto, Glans, Creer, & Young, 1991). After
reviewing the emotional precipitants of asthma, Kotses (1998) recommends
the use of procedures that promote relaxation and reduce stress.
A recent study tested
the hypotheses that persons with diabetes mellitus treated with twelve
sessions of biofeedback-assisted relaxation would decrease blood glucose
compared with untreated controls. Treatment consisted of EMH biofeedback,
thermal biofeedback, relaxation therapy, and diabetes education. The
results confirmed the stated hypotheses, as well as an earlier study,
which concludes that biofeedback-assisted relaxation can be an adjunct to
conventional therapy for insulin-dependent diabetes. (McGrady, Graham,
& Bailey, 1996).
have been used to treat side effects of cancer therapy. Relaxation
training has been successful in decreasing the duration and severity of
post treatment nausea (Morrow, 1986); and secondary insomnia (Cannici,
Malcolm, & Peek, 1983). Recent studies have also shown relaxation to
be effective in increasing immune effects during chemotherapy treatment
for ovarian cancer . It is suggested that relaxation can positively affect
immune parameters in cancer patients. (Lekander, Fuerst, Rostein, Hursti,
& Fredrickson, 1997). Relaxation combined with imagery and
cognitive-behavioral training have been used to reduce pain during cancer
treatment with substantiated success. (Syrjala, Donaldson, Davis, &
PMR, EMG BFK,
TBFK, cognitive restructuring, time scheduling, and non-directive therapy
has been shown to be effective in the treatment of dysmenorrhea (Balick,
Elfrier, May, & Moore, 1982; Sigmon & Nelson, 1988).
relaxation given as a treatment for frequent occurrences of genital herpes
outbreaks has been shown to produce reduction in outbreak frequency
(Koehn,, Burnette, & Stark 1993).
relaxation has shown to be quite effective in treating symptoms associated
with HIV. Conditions such as anxiety, mood, self-esteem, and t-cell count
were measured after a stress management program consisting of 20 bi-weekly
sessions of progressive muscle relaxation was implemented. Analysis showed
significant improvements on all measures, and suggests that using stress
management to reduce arousal of the nervous system would be an appropriate
component of treatment for HIV infection (Taylor 1995). Studies have also
compared the effectiveness of guided imagery and PMR on HIV symptoms.
Results have shown that imagery reduced depression and fatigue, while PMR
increased CD4+T lymphocyte count and also reduced depression (Eller
relaxation has been shown to be highly effective in the reduction of
seizures (Whitman, Dell, Legion, & Eibhllyn, 1990). Frequency of
seizures was monitored over an eight-week interval, and three subsequent
follow-up periods after the therapy was implemented. During the third
eight week follow-up interval, seizures were shown to reduce by over
focusing on PMR for 34 patients with Alzheimer’s have successfully shown
significant decreases in behavioral disturbances, as well as improved
performances on measures of memory and verbal fluency, from baseline
to two month follow-up testing (Suhr, Anderson, & Tranel,
Live versus Taped Training
Live and taped training techniques work equally well within
training sessions (Stefanek & Hodes, 1986). However, only live
relaxation training seems to provide clients with skills that enable them
to lower their physiological arousal outside the training session (Lehrer,
1982; Lehrer & Woolfolk, 1984).
Problems Associated with Relaxation
For some clients, especially those suffering generalized anxiety,
the level of tension increases instead of decreases when practicing
relaxation, an experience they find unexpected and stressful (Borkovec
& Grayson, 1980; Lazarus, 1965; Ley, 1988). Unpleasant side
effects of relaxation may include dizziness, unpleasant sensations of
warmth, fear of losing control, and panic attacks (Lazarus & Mayne,
1990; Ley, 1988). The following two adverse consequences of
relaxation training have been documented:
Autogenic discharges (Schultz & Luthe, 1969) are emotional or
physical experiences that can include pain, anxiety, palpitations, muscle
twitches, and crying. These AT events, which are not necessarily
counter-therapeutic, are sometimes experienced as unpleasant, leading the
client to abandon treatment. They may also produce effects that are
medically dangerous (e.g., increases in blood pressure among
hypertensives). Therefore, clients must be carefully monitored to
prevent any deleterious effect of autogenic training.
Relaxation-induced anxiety (Heide & Borkovec, 1983, 1984) is the
heightened physiological arousal and physiological reactivity that are
experienced sometimes during meditation. This type of detrimental
anxiety has been observed more frequently during meditation than during
PMR. This suggests that meditation produces more negative side
effects than PMR (Carrington, Collings, Benson, Robinson, Wood, Lehrer,
Woolfolk, & Cole, 1980; Heide & Borkovec, 1983; Norton, Rhodes,
Hauch, & Kaprowy, 1985).
Autogenic discharges and relaxation-induced anxiety occur more
frequently with AT and in meditation than in PMR (Heide & Borkovec,
1983; Lehrer, Atthowe, & Weber; 1980). Fewer patients report
sensations of transient anxiety during the practice of PMR suggesting that
this technique is easier to tolerate. Because of its direct focus in
lowering somatic tension, the anxiety reactions may be less common in
Although some (e.g., Smith, 1988) suggest that the
symptoms of relaxation-induced anxiety can be therapeutic if subjects can
learn to relax through the experience, there is data showing that this
type of experience predicts poor treatment prognosis (Borkovec, Mathews,
Chambers, Ebrahimi, Lytle, & Nelson, 1987), and it may even contribute
to high dropout rate in relaxation therapies. When clients
experience AT or meditation-induced anxiety, clinicians should consider
using PMR methods. PMR is an effective method to minimize physiological
tension prior to meditating (Girdano, Everly, & Dusek, 1990).
Relaxation is not recommended for clients with certain types of
respiratory or gastrointestinal disorders (Kinsman, Dirks, Jones, &
Dahlem, 1980; Luthe & Schultz, 1969).
Due to the complexity of selecting the appropriate method for each
client and the potential side effects (e.g., relaxation-induced anxiety)
of relaxation, training with a health professional is reasonably
warranted. There is also research evidence supporting the notion that
administration of relaxation therapy by competent professionals is
necessary for their success (Carey & Burish, 1987). Professionally
administered PMR, but not paraprofessionally or audiotaped administered
training, reduced emotional distress and physiological arousal and
increased food intake in cancer patients undergoing chemotherapy.
Clients may consider the following types of professionals for relaxation
training: behavioral medicine specialists, physicians, psychologists,
psychiatrists, professional counselors, school counselors, and social
workers (Miller, Smith, & Rothstein, 1993).
(adapted from Edmund Jacobson)
When my patients ask me why is it so important
to learn to relax I explain to them that tension is incompatible with
relaxation. Yes! We either do one or the other. When we relax our body and
our mind, we automatically exclude the tension that tightens our muscles.
This is one of the major reasons why learning to relax reduces
stress and anxiety, and produces a feeling of well-being.
Once you've learned how your muscles should feel
when they're relaxed, it becomes a matter
of practice to bring them into that relaxed state. This
process is called self-regulation.
Using the following muscle relaxation technique,
you can learn to induce deep muscular
relaxation by tensing and releasing tension from various
parts of your body one part at a
Please lean back in your chair.
Make yourself comfortable. Place both feet flat on the floor. Rest your
hands comfortably in your lap. Follow the instructions on your
Begin by stretching your legs as
far as they can go...Relax. Stretch your legs, again. Move your feet up,
towards you, hold...turn your feet down, away from
Now, tighten the muscles in your
calves and those in your thighs. Tight. Hold it, hold it...and
Let your legs go back, slowly,
down to their original position and relax all the muscles in your feet,
all the muscles in your calves, all the muscles in your thighs. Let your
leg be completely relaxed. And now, feel that wonderful relaxation coming
up from your toes, up your calves and your thighs. Feeling nicely relaxed,
very calm...and...very relaxed. Calm and relaxed. Take some time to take
your attention away from the screen. Focus on your legs and feel your
Now, stretch out your arms. Make
two fists, tighten the muscles in your fingers. Feel the tightness...Hold
it, hold it...and relax. Let your arms go down to their resting position.
Feel that relaxation. Now stretch your arms again. Tighten the muscles in
your wrists, in your lower arms, in your upper arms...Hold it, hold
it...And, let go, just let go, let your arms go down to their original
position. Stop for a second, and take your time to notice that quieting
feeling of relaxation through your fingers, your hands; through your lower
arms, and upper arms. Let your arms go completely limp. Take your time to
increase that feeling of relaxation. Very relaxed, very calm, very relaxed
Now, arch your back backwards,
raise your chest. Tighten the muscles in your chest, your abdomen, your
back, and your neck. Hold it...hold it...Let go of the tension. Just let
go of the tension. Notice your muscle relaxation. Take time to feel the
muscles relax in your chest, in your abdomen, in your neck, all over your
back. All your muscles feel nicely relaxed.
Now, tighten the muscles in your
face, first the muscles around your forehead, then the muscles around your
eyes. Make them tighter. Hold it...hold it...and relax. Now, tighten the
muscles of your cheeks, the muscles around your mouth, the muscles of your
chin. Make them tighter...Hold it, hold it...and relax. Let all the
muscles in your face relax, first the muscles of your chin, then the
muscles around your mouth, the muscles of your cheeks, the muscles around
your eyes, the muscles of your forehead. Let all the tension drain from
your face. Let your chin sag if that feels good. Take your time to enjoy
the feeling of relaxation. Very relaxed and very calm. Relaxed and
Now, breathe in through your nose,
slowly, and deeply. Breathe the air down into your abdomen first, then
your chest, and your throat. Hold it, hold it...and slowly breathe it out
through your nose. Feel the relaxation. Breathe in, tense up...Breathe
Once again, take a very deep
breath, hold it...hold it and slowly let it out. Let go of all your
tension, your frustrations, your anxieties, feeling more and more relaxed.
Relaxed and calm.
Now, take some time to scan your
body. If you notice any tensional spot, take your time to release that
tension. Very good, very relaxed.
Now, take time to breathe in and
out; stretch your body; focus on your surroundings. Be ready to continue
your day. Relaxed and calm. Focused and attentive.
This is a series of relaxation techniques that you can
do almost any where and any time. They do not take very long to
do. Do not force yourself to relax - just let it happen.
2-Step breath - Fill the bottom of your lungs first,
then add the top as you breathe through your nose. Breath out
slowly. Feel the tension flowing out.
Tighten the muscle that
you want to relax. Focus on and feel the tension where you have tighthen.
Now let the muscle become loose and limp. Feel the relaxation flow into
With your mind briefly scan every muscle in your body
from the tips of your toes to the top of your head. If you sense a tight
muscle, just let it become limp and relaxed.
LIMP RAG DOLL:
Do the 2-step breath two times.
With your mind imagine that you are a limp rag doll.
Feel your mind and body become limp and relaxed.
*** You may use whatever image you like best
To quiet your mind first, focus on your breathing. As
you breathe in say slowly to yourself "I am" and as you breathe out, say
slowly to yourself "calm". When your mind feels calm you may focus only on
your breathing, with no thoughts at all.
SHOULDERS, ARMS AND HANDS HEAVY
Put your mind into your
shoulders, arms and hands - imagine and experience them becoming heavy,
relaxed and warm.
- A Holistic Approach to Preventing Stress Disorders. K. Pelletier
(1984). New York: P. Smith.
- Autogenics: A Clinical Guide. W. Linden (1990). New York:
- Beyond the Relaxation Response. H. Benson (1984). New York: Times
- Principles and Practice of Stress Management, 2nd edition. P. M.
Lehrer and R. L. Woolfolk (Eds.)(1993). New York: Guilford Press.
- Progressive Relaxation Training: A Manual for the Helping
Professions. D. A. Bernstein and T. D. Borkovec (1973). Champaign, IL:
- Relaxation and Imagery: Tools for Therapeutic Communication and
Intervention. R. P. Zahourek (Ed.)(1988). Philadelphia, PA: W. B.
- The Relaxation Response, 2nd edition. H. Benson & M. Z.
Klipper (1975). New York: Avon.
- The Relaxation and Stress Reduction Workbook, 4th edition. M.
Davis, E. R. Eshelman, and M. McKay (1995). Oakland, CA: New
- The Three Minute Meditator. D. Harp (1990). San Francisco: Mind's
- Clinician's Complete Reference to Complementary & Alternative
Medicine. D. Novey (Ed.)(2000). New York: Mosby
- Sultanoff, B. and Zalaquett, C. (2000). Relaxation Techniques. In
D. Novey, Clinician's Complete Reference to Complementary &