The relaxation response

Maximization of biofeedback following cognitive stress preselection in generalized anxiety

53 subjects, who scored high on an anxiety check list, were evaluated for their responsiveness to relaxation exercises and biofeedback. Each subject was cognitively stressed prior to the training phase by imagining anxiety-provoking situations. Analysis was done on pertaining/posttraining anxiety scores and physiological parameters (galvanic skin response, differences in finger temperature, and frontalis muscle activity). Subjects given feedback corresponding to that physiological parameter which changed the most when stressed, maximized that feedback more than subjects receiving nonrelevant or no feedback. All groups reported significant reductions in anxiety symptoms. Follow-up analysis 15 mo. later showed 76% of the subjects were still symptom-free for anxiety regardless of type of feedback received.

Biofeedback and relaxation-response training in the treatment of pediatric migraine

To assess the efficacy of electromyographic biofeedback, relaxation-response training and pain behavior management as a treatment for pediatric migraine, we studied 18 children between the ages of eight and 12 years (mean = 10 X 1) in a prospective, randomized, controlled investigation. Six patients received all three treatment procedures, six received relaxation-response training and pain behavior management, and the remaining six constituted a waiting-list control group. All patients kept a record of their headaches for the 15-week study period and then for four weeks one year later. Following four weeks of baseline, the treatment groups completed nine one-hour treatment sessions in 11 weeks. Both treatment groups experienced a significant reduction in headache symptoms and were significantly improved compared to the waiting-list control group by the end of treatment. The treatment groups did not differ from each other in any of these comparisons. The reduction in headache symptoms in the treatment groups was maintained one year after treatment ended. These results suggest that relaxation-response training, with or without biofeedback training, combined with pain behavior management, is an effective alternative treatment for pediatric migraine.

Alternative treatments for withdrawing the long-term benzodiazepine user: a pilot study

Anxiolytic therapy with benzodiazepines and their potential for dependence are reviewed. Relaxation training and biofeedback have been used for chemically dependent anxious patients. These techniques have been recommended for benzodiazepine-dependent patients, but not investigated. Previous withdrawal studies offer only limited follow-up data. Stress management treatment was based on a successful case study. Recruitment difficulties were encountered. However, seven patients were randomly assigned to stress management or brief psycho-therapy. All showed improvement, but three of four patients available for 1 year follow-up had returned to pretreatment dependence. These withdrawal difficulties suggest the need for more effective treatments and more adequate follow-up studies.

Pain and pain control in children

Focused research on pain and pain control in children has developed primarily in the last 10 years and even now is woefully inadequate in relation to the magnitude of the problem. The available research, inferences from the adult literature, and anecdotal information all indicate the elusive nature of pain. Pain is not solely a fixed neurophysiologic response to a noxious stimulus but a product of the interaction of many variables such as age, cognitive set, personality, ethnic background, and emotional state. These factors exert a tremendous influence on the suffering which surrounds the pain message. Technology exists at present to eliminate or substantially reduce pain in almost all cases. There remains, however, a tendency, which is even more pronounced with respect to children, to underestimate or ignore pain. In an overall approach to pain in children, the following points should be considered: A high index of suspicion is necessary to determine if children are experiencing pain since they may have difficulty verbalizing their discomfort. In infants, physiologic variables should be considered (increased heart rate, palmar sweating, increased respiratory rate), and in preschoolers, time should be taken to ascertain that the child actually understands the word "pain" if it is used in questioning them. Some method of continuous monitoring, such as a visual analogue scan, should be considered as part of the treatment plan. Adequate analgesia should be provided. The appropriate dose should be administered at the appropriate pharmacokinetic time. Too little medication may cause obsessive attention to medication-related issues. Too much medication may cause sedation and lack of mental clarity, which is often anxiety-producing for both the parents and the child. The usefulness of p.r.n. medication has been seriously questioned and a time-contingent as opposed to pain-contingent strategy should be applied. Fears of addiction are generally unwarranted. Adjunctive medication may increase the value of offered narcotics and counteract some of their side effects. Although this monograph has focused more attention on pharmacologic than on nonpharmacologic approaches to pain, this is merely a reflection of available data and not necessarily of relative importance. The importance of distraction from pain by nursing, medical, or child life personnel using play techniques cannot be overestimated. Every attempt should be made to relax the child by using creative strategies. Preparation of the child for procedures is often helpful as some of the fear of the unknown is eliminated.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrocortical activity and related phenomena associated with meditation practice: a literature review

The state effects of meditation appear to include decreased electrocortical arousal. There is also evidence that meditators more readily demonstrate alpha and theta activity than nonmeditators, even when not meditating. It is not clear whether prospective meditators as a group already possessed this characteristic, or whether the state effects of meditation practice eventually generalize to become traits. However, certain individuals, namely the psychologically "healthy" and those with a capacity for relaxed absorbed attention, appear to be more favourably disposed to meditation. Meditators appear to show both stronger orienting and recovery responses to stressors while meditating than controls. Meditation practice may begin with left hemisphere type activity, which gives way to functioning more characteristic of the right hemisphere. However, it appears that during advanced meditation ("no thought") both left and right hemisphere activity are largely inhibited or suspended. Depending on the individual, inexperienced meditators may report sleep, hypnogogic reverie, trance or abreaction during practice. The evidence to date does not support the notion of unique state effects associated with the practice of meditation.

Physiological responses during meditation and rest

Forty nonmeditators and 12 experienced transcendental meditators were randomly assigned to four experimental cells devised to control for order and expectation effects. All 52 (female) subjects were continuously monitored on seven physiological measures during both meditation and rest. Each subject was her own control in an abab experimental paradigm comparing meditation to rest. Analyses of variance on change scores calculated from both initial and running (intertrial) baselines revealed small but significant conditions effects for all variables except diastolic BP. The same subjects (both experienced meditators and those meditating for the first time) showed lower psychophysiological arousal during the meditation than during the rest condition for systolic BP, HR, SCL, digital BV, digital ST, and frontalis EMG. The experienced meditators showed only marginally more conditions effects than the novices practicing "noncultic" meditation. For the nonmeditators, deliberately fostering positive expectations of meditations was associated with lower physiological arousal in terms of diastolic BP, HR, and SCL. These findings suggest that both cultic and noncultic meditation are associated with lower physiological activation than eyes-closed rest. The meditators, however, tended to become more relaxed over meditation trials, whereas the nonmeditators showed the opposite trend.

Health behaviors of psychotherapists

Examined the health behaviors practiced by psychotherapists (N = 86) themselves and the extent to which they focus on these behaviors with their clients during the course of psychotherapy. The specific health behaviors investigated were dietary habits, physical exercise, relaxation practices, sleeping, alcohol consumption, and smoking. Results indicate that psychotherapists are at this time actively engaged in both evaluating and making recommendations to their clients in the areas of diet, physical exercise, and relaxation practice. In addition, 51% of those who participated in this study evaluate health practices of their clients and make recommendations with regard to their physical health. While only 47% agreed that it is important for the psychotherapist to assess the typical client's physical health status, 72% of this group frequently inquire about chronic illness during an intake session.

The influence of two different sets of information and suggestions on the subjective effects of relaxation

The study compared the subjective effects of different relaxation techniques and their susceptibility to influence by information and suggestions provided by the trainers. Two groups of twelve subjects each were trained in autogenic training and in progressive relaxation successively. On three occasions during their training, each group was given one of two contrasting sets of information and suggestions concerning the subjective effects to be expected. At the end of training, differences in the subjective effects accompanying the two relaxation techniques were found but no significant effect of the contrasting sets of information and suggestions emerged. These results suggest that the subjective effects of relaxation were resistant to simple suggestions and, being more robust and real than often thought, could constitute a basis for differential indications of various relaxation methods.

Stress management training and relaxation imagery in the treatment of essential hypertension

The present study compared the effectiveness of three procedures in the treatment of 34 individuals with essential hypertension: (1) stress management training plus relaxation imagery, which consisted of an adaptation of existing stress management techniques in conjunction with extensive relaxation training using relaxation imagery; (2) relaxation imagery alone; and (3) weekly blood pressure checks. The relaxation imagery technique involved visualization of a relaxing image along with concentration on suggestions of relaxation, heaviness, and warmth. Treatment was individualized and lasted 8 weeks. Results indicated stress management plus relaxation imagery and relaxation imagery alone were significantly more effective than blood pressure checks in reducing systolic and diastolic blood pressures during treatment and in maintaining diastolic blood pressure reductions during follow-up. However, no significant differences were found between the two treatment procedures. Clinical implications of these findings are discussed.

Neuromuscular control of childbirth-prepared women during the first stage of labor

To evaluate the neuromuscular control of Lamaze-prepared women during the first stage of labor and to identify the factors which influenced control, 94 women were studied. The women were categorized into two groups: class-taught and self-taught. A tool was devised to evaluate neuromuscular control. The study revealed that class-taught women exhibited a significantly higher degree of neuromuscular control, more frequent practice patterns, and a greater ability to make goal-directed statements about their labor than the self-taught women. The data also demonstrated an association between practice and control and goal directedness and control.

Paced abdominal breathing and EMG responsivity

5 subjects participated in a within-subjects design to determine the effect of paced abdominal breathing on EMG levels. After training in thoracic and abdominal breathing, each subject's respiration performance and EMG levels were assessed in both breathing modes via a counterbalanced A-B-A-B reversal design. Reliable effects of respiration training were observed in both breathing modes. No effects were observed on EMG measures. The results were discussed in relation to literature on approaches to respiration training which may target specific arousal indices other than electromyogram activity. The utility of dovetailing complementary treatment techniques such as respiration training and relaxation training which are specific to particular arousal indices was discussed.

An evaluation of progressive muscle relaxation on stress related symptoms in a geriatric population

Ten highly anxious women, between the ages of sixty-nine and eighty-four, participated in a five month study designed to test the hypothesis that progressive muscle relaxation would reduce psychosocial stress in a group of high risk senior citizens. The women, who had lost their husbands within the last five years, responded to an offer extended to nervous senior citizens to participate in a relaxation study. Five women were assigned to the treatment group and five to a control group. The treatment group received two weeks of baseline evaluation, ten weeks of one hour in vivo relaxation training, and ten weeks of home practice using taped instructions. The control group had an identical schedule except instead of progressive relaxation training they received a pseudorelaxation procedure and had no home practice. All participants were evaluated prior to training, at the end of training, and ten weeks after training. Participants were also measured on the following factors: 1) state and trait anxiety, 2) self-report muscle tension, 3) hours to fall asleep, 4) number of nocturnal awakenings, and 5) headaches. Results indicate significant differences on all five measures between the experimental and control group. With the exception of trait anxiety, the experimental group manifested significant improvements on the remaining five measures from baseline to end of training. For state anxiety, a significant improvement continued during the ten weeks of home practice following the end of training.

Heart rate decrease: a comparison of feedback modalities and biofeedback with other procedures

Sixty subjects were divided into six groups in a comparison of heart rate (HR) decreases obtained with (1) visual feedback, (2) auditory biofeedback, (3) combined visual and auditory biofeedback, (4) instructions to decrease HR without biofeedback, (5) sitting quietly, (6) abbreviated relaxation training, and, as a comparison, a group of 10 experienced mediators were also studied. Biofeedback stimuli were pulsed signals generated by the R-wave of the heartbeat. The results indicated that (a) there was no differential advantage on a HR decrease task to subjects receiving visual, auditory or combined biofeedback; and (b) all groups showed evidence of some decline in HR over the testing session. The mediation group showed the greatest overall decline.

Reduced sympathetic nervous system responsivity associated with the relaxation response

Sympathetic nervous system activity was assessed in experimental and control subjects who were exposed to graded orthostatic and isometric stress during monthly hospital visits. After the first session, the experimental subjects practiced a technique that elicited the relaxation response. Their concentrations of plasma norepinephrine during subsequent graded stresses were significantly higher. No such changes were noted in the control group. These results were than replicated in the control group in a crossover experiment. The groups did not differ in their heart rate and blood pressure responses. These observations are consistent with reduced norepinephrine end-organ responsivity after regular elicitation of the relaxation response.

Managing desperate emotional behaviour with hypnosis

When no other psychotherapy or pharmacotherapy could prevent debilitation or institutionalization consequent to longstanding frequent repeated maladaptive behaviour, hypnosis has been observed to be effective in suitable patients. A documentation, three cases of such chronic severe behaviour which have been encountered by the author are described; each had been regarded as hopelessly unmanageable by the primary physician at the time of referral for hypnotherapy. Relevant to their suitability for hypnosis, all three patients were able to understand normal speech with difficulty, were able to concentrate well, and were agreeable to using hypnosis.

A comparison of somatic relaxation and EEG activity in classical progressive relaxation and transcendental meditation

Oxygen consumption, electroencephalogram (EEG), and four other measures of somatic relaxation were monitored in groups of long-term practitioners of classical Jacobson's progressive relaxation (PR) and Transcendental Meditation (TM) and also in a group of novice PR trainees. All subjects (1) practiced relaxation or meditation (treatment), (2) sat with eyes closed (EC control), and (3) read from a travel book during two identical sessions on different days. EEG findings indicated that all three groups remained primarily awake during treatment and EC control and that several subjects in each group displayed rare theta (5-7 Hz) waveforms. All three groups demonstrated similar decrements in somatic activity during treatment and EC control which were generally of small magnitude (e. g., 2-5% in oxygen consumption). These results supported the "relaxation response" model for state changes in somatic relaxation for techniques practiced under low levels of stress but not the claim that the relaxation response produced a hypometabolic state. Despite similar state effects, the long-term PR group manifested lower levels of somatic activity across all conditions compared to both novice PR and long-term TM groups. We concluded that PR causes a generalized trait of somatic relaxation which is manifested in a variety of settings and situations. Two likely explanations for this trait were discussed: (1) PR practitioners are taught to generalize relaxation to daily activities, and/or (2) according to a "multiprocess model," PR is a "somatic technique," which should produce greater somatic relaxation than does TM, a "cognitive technique." Further research is required to elucidate these possibilities.

A relaxation technique in the management of hypercholesterolemia

Chronic sympathetic nervous system overactivity has been implicated as a factor capable of elevating and maintaining high serum cholesterol levels independent of dietary measures. We conducted a controlled trial to determine the effect of a relaxation technique. Transcendental Meditation, on serum cholesterol levels in hypercholesterolemic subjects. Serum cholesterol levels were measured at beginning and end of an 11-month period in 12 hypercholesterolemic subjects who regularly practiced meditation. Eleven hypercholesterolemic controls who did not practice the technique were similarly followed up for 13 months. Paired comparisons showed a significant (p less than 0.005) reduction in fasting serum cholesterol levels of those subjects who practiced meditation. These results suggest that the regular practice of a relaxation technique may contribute, most likely through a reduction in adrenergic activity, to the amelioration of hypercholesterolemia in certain subjects.

Skin conductance conditioning with dyshidrotic eczema patients

Thirty-three patients with dyshidrotic eczema were trained either to decrease or to increase the electrical conductivity of the skin. Skin conductance has been found to be related to epidermal water content as well as emotional variables, both of which have suggested links to eczema. Subjects trained to decrease skin conductance showed clinical improvement more often than the controls who were trained in the opposite direction. They also showed a significant decrease in measured conductance and anxiety. The controls showed increased anxiety and no significant changes in skin conductance level.

Altered states of consciousness during psychotherapy: a historical and cultural perspective

This paper reviews the frequent phenomenon of altered states of consciousness in disparate cultural psychotherapeutic contexts. The historical antecedents of contemporary Western psychodynamic psychotherapy are examined and the central importance of altered states in the therapeutic effects of religious institutions such as the Dionysian rite and the Asclepia is illustrated. The continued presence of this phenomenon in Western psychotherapy from Mesmerism to psychoanalysis is shown. The use of trance states in the healing rituals of non-Western societies is culturally variegated therapeutic settings. The ubiquitous nature of the altered state phenomenon in such widely varied cultural contexts suggests the possibility of its being a universal component of psychotherapy.