Relaxation Procedure
Relaxation training is a major
component in most behaviorallybased interventions for
* Anxiety Disorders
* Stress-related Disorders
* Pain Syndrome
Several Method Exists
Theories:
1. Unitary Theories:
A) Muscular Theory –
*Proposed by Edmund Jacobson
*He developed PMR and EMG method of
assessment
Relaxation is Decreased Skeletal Muscle
Activity as measured by EMG
Relaxation diminishes motoneuron output
and reduces proprioceptive input
This is evidenced as reduced magnitude &
increased latency of spinal motor
reflexes when person is relaxed
Reduced afferent and efferent activity
leads to decreased cortical arousal
Hence, it is effective in ‘Neurotic’ and
‘Emotional’ disorders
B) Autonomic Theory –
Proposed by Joseph Wolpe
Developed SD that opened the door for BT
in Anxiety-based Disorders
Emphasized autonomic rather than
muscular aspect of Relaxation
Involvement of autonomically innervated
visceral structures in emotional and
stress disorders provided the
evidence for this mechanism
Wolpe - the parasympathetic state of
Relaxation “reciprocally inhibits” the
sympathetic / anxiety responses
Benson who employed meditation also
came to similar conclusion
The denominator of all Relaxation
technique is RR of parasympathetic
dominance
Benson – Relaxation represents a shift in
autonomic activity away from
sympathetic arousal toward parasympathetic control
For example, a number of
parasympathetic mediated visceral
activities such as decreased HR,
respiratory rate, BP and oxygen
consumption is seen following
relaxation
2. Dualistic Theory:
Davidson and Smith - Relaxation has Two
components
a) Somatic (as outlined in unitary theory)
b) Cognitive
According them three Cognitive Processes
are necessary for Relaxation
a) Focusing
b) Passivity
c) Receptivity
Advocate use of self-report scales for
measuring cognitive component
They categorized PMR and exercise under
Somatic method, meditation and
hypnosis as Cognitive method (low
ratings of worry, disturbing thoughts,
mental state)
But, in general both procedures produce
changes in all measures (cognition
and physiological)
This has been interpreted as
“generalized relaxation response”
3. Three-Dimensional Theory:
Davidson & Schwartz added another
dimension to Dualistic theory
They termed it as “attentional” or opening
up of “awareness”
Features common to all procedures
1) Mental Device: A constant stimulus
such as their own breathing, BF
signal, trainer's voice, proprioceptive
sensations in their muscles
2) Passive Attitude: Ignoring distractions,
continuing observing the constant
stimulus, avoid evaluating one's
performance (not to judge success or
failure)
3) Decreased muscle tonus: Decreased
motoric behavior
4) Quiet environment: To minimize the
observation of distracting stimuli
In addition to above, providing the rationale,
latency of the effects, need to comply with
the instructions all helps
Methods: JPMR, BF (EEG, EMG, Temp, SCR,
HR) thermal feedback, autogenic training,
guided imagery, meditation, hypnosis)
Progressive Muscle Relaxation
Muscle tension is related to anxiety
PMR involves the successive tensing and
relaxing of voluntary muscles in an
orderly sequence
Indicated in a variety of conditions
Procedure:
Explain the rationale before and prepare
the patient and carry out steps
When a person is anxious 3 reaction seen 1. Physiological (Increased ANS)
2. Behavioral (Avoidance)
3. Cognitive (“I cannot cope”)
* Cue-controlled and *Differential Relaxation
Autogenic Training
Widely practiced in Europe (Schultz '59)
Involves repeated suggestions of
heaviness and warmth
Heaviness suggestions – “My arms are
heavy…… I am at peace” x 5 times
Then the subject repeats several times to
himself/herself
Warmth suggestions are incorporated
later
Heaviness = Relaxation
Warmth = Vasodilatation
Stress Inoculation (Meichenbaum, 1977)
Used in anxiety management
a) Discussion of anxiety reactions
b) Rehearsing coping skills
c) Testing these skills (in office setting)
d) In vivo application
Biofeedback
• Technique
• Physiological events
• Auditory or visual signals
• Manipulate these events
• Voluntary control of “involuntary” systems
• Based on Operant Conditioning
• Powerful Modality of Treatment (many
professionals employ)
• Conditions: Epilepsy, Tension / Migraines headache, Hypertension,
Neuromascular disorders, Anxiety disorders
etc.
• Concepts involves both Art and
Science
• Train to control or reverse Pathphysiological processes
• Based on information theory – “a variable
cannot be controlled
unless information
about the
variable is available to the
controller”
BF is additional external feedback loop of
homeostatic adaptive control system
Properties of feedback system are:
a) Feedback systems are closed loop system
b) Negative feedback promotes stability
positive feedback promotes instability
while
c) Feedback systems have steady state
dynamic descriptions
and
d) Feedback systems are limited by
their channel capacity
e) Feedback systems are affected by time delay
f) Feedback systems have linear and non- linear properties
Applications in psychiatric disorders is
only trial and error
Though BF meets operant condition requirements, it differs in
"valence" and learning is
influenced by their motivation
Patient's success depends on,
a) Clinician's success / belief system
b) When self-control is experienced
c) When belief of the client and clinician
are congruent
d) Acceptance of the living pattern by
client
Though being used since 1938 (EMG in
Hypnosis) only in 1974
Whatmore
and Kohli employed it in clinical
situation
(EMG in teaching muscle
relaxation)
Disorders in relation to BF can be grouped into four:
1. Obvious Direct Connection:
• Parameters used represent the
function of the body
damaged
• Most rationale and satisfying use of BF
• Example - Treatment of essential
hypertension
(Malfunction of BP
regulating mechanism and
BP - BF to remedy this)
2. Hypothetical Direct Connection:
• Parameters used are hypothesized (No
conclusive proof) to have a
direct
connection with the disorder treated
• Example - EMG BF for tension headache
3. Hypothetical Indirect Connection:
• Psycho physiological relationships involve conjecture, the
connections are hypothetical
• Example – Temperature BF in
Migraine
4. Connection through the General RR:
• Example - EMG BF for Anxiety / hyper• BF can be used in all of the following -
a) Stress syndrome
b) Temporary trauma (Eg. Fecal incontinence
following successful rectal surgery)
arousal
c) Functional derangement syndrome (Eg.
Headache)
Migraine or Tension
d) Neurological damage (Eg. In Stroke damage is present but, there
remains residual capacity which is unused.
Thus, EMG BF to
retrain the muscles)
e) Homeostatic imbalance & deregulation
Hypertension)
syndrome (Eg.
f) Broken control loop syndrome (Motor
control is normal, but
sensory inflow from the affected limb is damaged. BF will
substitute this, Eg. Stroke)