The information provided in this website complements the chapter on relaxation techniques written by Dr. Sultanoff and myself. The chapter was included in Dr. Novey's Clinician's Complete Reference to Complementary & Alternative Medicine.

Reference: Sultanoff, B. and Zalaquett, C. (2000). Relaxation Therapies. In D. Novey (Ed.), Clinician's Complete Reference to Complementary & Alternative Medicine, 2000, pp. 114-129. New York: Mosby.

Introduction

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 response.

Note: PMR = progressive muscular relaxation; CT = cognitive therapy; EMG BFK = electromyographic biofeedback; T BFK = thermal biofeedback.

The Specific Effects Model
The 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 tension headaches.

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 arousal.

Integrative Model
Schwartz, 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.
 A 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 particular modality.

Jacobson's Method versus Modified Jacobsonian Procedures
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).

*adapted from Lehrer, Woolfolk, & Goldman, 1986.

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 Therapy
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.

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, & Sergerson, 1986).

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 Meditation
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 Techniques
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 technique separately.

Cognitive Effects of Autogenic Training and Progressive Relaxation
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.

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.

ANXIETY
Relaxation techniques 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).

Panic Disorder
Several studies 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 & Westling, 1995). 

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).

Test Anxiety
Relaxation seems 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). 

Social Phobia
Relaxation 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 Behavior
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, 1992). 

Headaches
Relaxation 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. 

Insomnia
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, 1992). 

Substance Abuse
Between 10-40% 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 effects.

Smoking
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, 1992). 

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, 1982).

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).

Raynaud's Disease
Self-control 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).

Fibromyalgia
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 al., 1998).

Menopausal Symptoms
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. 

Asthma
Relaxation treatments 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.

Diabetes
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).

Cancer
Relaxation techniques 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, & Kippes, 1995).

Dysmenorrhea
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).

Genital Herpes
Applied 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).

HIV
Progressive muscle 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 1995).

Seizures
Progressive 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 fifty  percent. 

Alzheimer’s Disease
Studies 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, 1999). 

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).

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

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

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 PMR.
 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).

Other Contraindications

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).

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
time. 

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 screen.

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 you...Hold...Relax.

Now, tighten the muscles in your calves and those in your thighs. Tight. Hold it, hold it...and relax.

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 relaxation.

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 and calm.

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 calm.

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 out, relax.

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.

BREATHING:
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.

TENSE-RELAX MUSCLES:
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 the muscle.

BODY SCAN:
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:

MIND QUIETING:
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 AND WARM:
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: Guilford Press.
• Beyond the Relaxation Response. H. Benson (1984). New York: Times Books.
• 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: Research.
• Relaxation and Imagery: Tools for Therapeutic Communication and Intervention. R. P. Zahourek (Ed.)(1988). Philadelphia, PA: W. B. Saunders.
• 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 Harbinger.
• The Three Minute Meditator. D. Harp (1990). San Francisco: Mind's i press. 

• 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 & Alternative Medicine.

 




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