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Relaxation Therapy

Relaxation therapy  

Natural Standard Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified health care professional before making decisions about therapies and/or health conditions.

Related Terms

  • Abbreviated progressive muscle relaxation therapy, APRT, autogenic training, behavioral techniques, Benson's "relaxation response", biofeedback-assisted relaxation, breath therapy, chosen relaxation, cognitive behavioral therapy (CBT), conscious relaxation, functional relaxation, guided relaxation, hypnotic music, imagery, J. H. Schultz, Jacobson's progressive, Laura Mitchell approach, meditation passive relaxation, mind-body medicine, muscle relaxation techniques, musical relaxation therapy, progressive muscle relaxation, progressive relaxation, psychomotor therapy programs, Qi gong, relaxation coping, relaxation exercises, self-hypnosis, Soong (Mandarin), visualization.

Background

  • Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually nondirected relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), using a passive attitude towards intruding thoughts, and return to the focus.
  • Deep and brief methods exist. Deep methods include autogenic training, progressive muscle relaxation (PMR), and meditation (although meditation is sometimes distinguished from relaxation based on the state of "thoughtless awareness" that is said to occur during meditation). Brief methods include self-control relaxation, paced respiration, and deep breathing. Brief methods generally require less time and often represent an abbreviated form of a deep method. Other relaxation techniques include guided imagery, deep breathing, breathing control, passive muscle relaxation, and refocusing. Applied relaxation involves imagination of relaxing situations with the intention of inducing muscular and mental relaxation. Another popular technique is progressive relaxation, in which the individual is taught what it feels like to relax by comparing relaxation with muscle tension. Progressive muscle relaxation (PMR) is said to require several months of practice at least three times per week in order to be able to evoke the relaxation response within seconds. Relaxation technique instruction is available in many hospitals, in the community, in books, or on audiotapes or videotapes.
  • The term "relaxation response" was coined by Harvard professor and cardiologist Herbert Benson, MD in the early 1970s to describe the physiologic reaction that is the opposite of the stress response. The relaxation response is proposed to involve decreased stimulation of the nervous system, as well as increased parasympathetic activity (urination, digestion, and other activities that occur when the body is at rest) characterized by lowered heartbeat, muscle, and skeletal function, and altered interactions between the nervous and endocrine systems.
  • Relaxation techniques may be taught by complementary practitioners, physicians, psychotherapists, hypnotherapists, nurses, clinical psychologists, or sports therapists. There is no formal credentialing for relaxation therapies.
  • Clinical studies suggest that relaxation techniques may be beneficial in patients with anxiety, although these approaches do not appear to be as effective as psychotherapy. For conditions with a strong psychosomatic element, relaxation may be beneficial, although it is not clear if the effects are long-term. Relaxation techniques may be used for stress management using self-regulation (self-control). There is not enough evidence to form firm conclusions about the effectiveness of relaxation for any condition. However, relaxation has been studied with respect to depression, pain, behavior, blood pressure lowering, etc. It has also been studied in patients with irritable bowel syndrome. Relaxation techniques are sometimes used by people with insomnia or other sleep disorders.

Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • In situations of stress, there is increased activity of the sympathetic nervous system, which leads to the "fight or flight" response. Physiologic changes include increased heart rate, blood pressure, rate of breathing, blood supply to the muscles, and dilation of the pupils. It has been proposed that frequent stressful situations may lead to negative effects on health, such as high blood pressure, raised cholesterol levels, gastrointestinal distress, or depression of the immune system.
  • In contrast to the stress response, relaxation is characterized by decreased stimulation of the nervous system, as well as increased parasympathetic activity (urination, digestion, and other activities that occur when the body is at rest). This may include decreased metabolism, blood pressure, oxygen consumption, and heart rate, as well as a feeling of calmness. Increased brain wave slow-wave activity (measured on EEG) has been reported. Alterations in the immune system may also play a role.
  • It has been theorized that by learning how to self-initiate the relaxation response, the negative effects of chronic stress may be counterbalanced. There are some reports that, with practice, states of relaxation can be achieved after several seconds. Massage, deep meditative states, mind-body interactive techniques, and certain types of music and sounds have been suggested as means of establishing a state of relaxation. Rhythmic, deep, visualized, or diaphragmatic breathing may be practiced. Mental imagery, biofeedback, desensitization, cognitive restructuring, and adaptive self-statements may also be included in such techniques.
  • Jacobson muscle relaxation, or "progressive relaxation," involves flexing specific muscles, holding that position, then relaxing the muscles. This technique often involves progressing through the muscle groups of the body one at a time, beginning with the feet, spending approximately one minute on each area. Progressive relaxation may be practiced while lying down or sitting. This approach has been suggested for psychosomatic disorders, for pain relief, to ease physical tension, or to relieve "inner unrest."
  • The Laura Mitchell approach involves reciprocal relaxation, moving one part of the body in the opposite direction from an area of tension, and then letting it go.
  • No formal credentialing or licensure exists for these relaxation techniques. Courses are offered at institutions such as the National Institute for Clinical Applications of Behavioral Medicine (NICBM), the American Holistic Medical Association (AHMA), and the Center for Mind-Body Medicine (CMBM).
  • According to Dr. Herbert Benson, who coined the term "the relaxation response," relaxation has been shown to decrease oxygen consumption and carbon dioxide output, to decrease the rate of breathing, to slightly increase oxygen levels in the blood, to decrease blood lactate levels (an indicator of stress), and to increase oxygen consumption during sleep.

Evidence

 

Uses based on scientific evidence 

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare professional.

Grade* 

Aggression 

One study failed to demonstrate any effects of relaxation therapy on aggression. More well-designed trials are needed.

C 

Angina (chest pain) 

Early research in patients with angina has reported that relaxation may reduce anxiety, depression, the frequency of angina episodes, the need for medication, and physical limitations. Large, well-designed studies are needed to confirm these results.

C 

Anxiety/stress 

Numerous human studies have reported that relaxation techniques (for example, using audiotapes or group therapy) may moderately reduce anxiety, particularly in individuals without significant mental illness. Relaxation may be beneficial for phobias (such as agoraphobia), panic disorders, work-related stress, and anxiety (due to serious illnesses, prior to medical procedures, or during pregnancy). However, because there are many types of relaxation techniques used in studies, and because many trials do not clearly describe design or results, a strong recommendation cannot be made without better human evidence.

C 

Asthma 

Preliminary studies of relaxation techniques in individuals with asthma have reported a significant decrease in asthma symptoms, anxiety, and depression, along with improvements in quality of life and measures of lung function. Further large trials in humans are needed to confirm these results.

C 

Attention-deficit hyperactivity disorder (ADHD) 

One study failed to demonstrate any effect of relaxation therapy on attention-deficit hyperactivity disorder. More well-designed trials are needed.

C 

Cardiovascular conditions 

Early research of relaxation techniques in people who have had a heart attack suggests that fewer future heart attacks may occur when relaxation is regularly practiced. Relaxation techniques have been associated with reduced pulse rate, systolic blood pressure, and diastolic blood pressure; lower perception of stress; and enhanced perception of health. Further research is needed to confirm these results.

C 

Chronic fatigue syndrome 

One study failed to show that relaxation techniques may be helpful in treating chronic fatigue syndrome. More research is necessary before a firm conclusion can be drawn.

C 

Chronic obstructive pulmonary disease (COPD) 

Early human trials report that relaxation techniques may be helpful in treating chronic obstructive pulmonary disease. Better-quality research is necessary before a firm conclusion can be drawn.

C 

Depression 

There is conflicting evidence from human trials supporting the use of relaxation to reduce symptoms of depression. Better-quality research is necessary before a firm conclusion can be drawn.

C 

Dyspepsia 

Early human trials report that relaxation techniques may be helpful in treating dyspepsia. Better-quality research is necessary before a firm conclusion can be drawn.

C 

Epilepsy 

Early human trials report that relaxation techniques may be helpful in treating epilepsy. Better-quality research is necessary before a firm conclusion can be drawn.

C 

Fatigue 

Relaxation therapy has been investigated as a treatment for radiation-induced fatigue and for aviation-induced fatigue. More well-designed trials are needed.

C 

Fibromyalgia 

Relaxation has been reported to reduce fibromyalgia pain. However, results from studies are conflicting, and therefore further research is needed before a clear recommendation can be made.

C 

Headache 

Preliminary evidence suggests that relaxation techniques may be helpful for the reduction of migraine headache symptoms in adults. Many adults reportedly supplement traditional treatments with relaxation therapy. Research on relaxation in children with headaches has yielded unclear results. Relaxation therapy has been suggested as being helpful in special populations (children, the elderly, pregnant or nursing women) where more traditional migraine prevention medications may not be appropriate. Additional research is necessary before a firm conclusion can be drawn.

C 

HIV/AIDS 

Mental health and quality-of-life improvements have been seen in preliminary studies of HIV/AIDS patients. These findings suggest the need for further, well-controlled research.

C 

Huntington's chorea/disease 

Preliminary research in patients with Huntington's disease has evaluated the effects of either multisensory stimulation, using relaxation activities as a control. Results were unclear. Further research is necessary before a conclusion can be drawn.

C 

Insomnia 

Several human trials suggest that relaxation techniques may be beneficial in people with insomnia, although the effects appear to be short-lived. Research suggests that relaxation techniques may produce improvements in some aspects of sleep, such as sleep latency and time awake after sleep onset. Cognitive forms of relaxation, such as meditation, are reported as being slightly better than somatic forms of relaxation, such as progressive muscle relaxation (PMR). Well-conducted research is necessary before a firm conclusion can be drawn.

C 

Irritable bowel disease 

Early research in humans suggests that relaxation may aid in the prevention and relief of irritable bowel disease symptoms. Large, well-designed trials are needed to confirm these results.

C 

Menopausal symptoms 

There is promising early evidence from human trials supporting the use of relaxation techniques to reduce menopausal symptoms, although the effects appear to be short-lived. Better-quality research is necessary before a firm conclusion can be drawn.

C 

Myocardial infarction (heart attack) 

Limited numbers of well-designed trials have examined the effects of relaxation on myocardial infarction outcomes, and the results are mixed. More research is needed.

C 

Obesity 

A small number of studies on psychotherapy-related approaches, e.g., relaxation therapy, have failed to demonstrate any decisive positive outcomes. Additional research is needed.

C 

Osteoarthritis 

In an early study, Jacobson relaxation was reported to lower the level of subjective pain and reduce the need for pain medication in osteoarthritic patients. Further well-designed research is needed to confirm these results.

C 

Pain 

Early research suggests that massage is more effective than relaxation therapy for pain, including postoperative pain and low back pain. Also, the quality of most studies in this field is poor. Better research is necessary before relaxation techniques can be recommended either alone, or as an addition to other treatments, for acute or chronic pain.

C 

Post-traumatic stress disorder (PTSD) 

Limited studies have examined the effects of relaxation for post-traumatic stress disorder. More research is needed.

C 

Premenstrual syndrome (PMS) 

There is early evidence that progressive muscle relaxation (PMR) training may improve physical and emotional symptoms associated with PMS. Further research is necessary before a conclusion can be drawn.

C 

Prevention of pregnancy complications 

Studies suggest that relaxation therapy may have positive effects on preventing premature labor and hypertension. More well-designed trials are needed.

C 

Rheumatoid arthritis 

Limited preliminary research reports that muscle relaxation training may improve function and well-being in patients with rheumatoid arthritis. Additional research is necessary before a conclusion can be reached.

C 

Skin conditions 

Limited research has been conducted examining the effects of relaxation therapy alone in improving skin conditions. Well-designed trials are needed.

C 

Temporomandibular joint disorder (TMJ) 

Early research suggests that use of an occlusal appliance is more effective than relaxation therapy for relief from temporomandibular disorders. More well-designed trials are needed.

C 

Tinnitus (ringing in the ears) 

Relaxation therapy has been associated with benefits in preliminary studies of tinnitus patients. Further research is needed to confirm these results.

C 

Tourette's syndrome 

Limited evidence suggests a lack of benefit for relaxation therapy in Tourette's syndrome. More well-designed trials are needed.

C 

Upper respiratory tract infection (children) 

There is a lack of evidence reporting the effects of relaxation therapy on upper respiratory tract infections in children. Well-designed trials are needed.

C 

Well-being 

Studies assessing relaxation to improve psychological well-being and "calm" in patients have reported positive results, although the results of most trials have not been statistically significant. Although this research is suggestive, additional work is merited in this area before a firm conclusion can be drawn.

C 

 

*Key to grades: 

A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

For full grading rationale, click here.

Uses based on tradition or theory 

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified health care professional

Abdominal pain, addiction, adjustment disorder, aging, alcohol abuse, Alzheimer's disease, amnesia, anti-spasm (pelvic floor spasms), arrhythmia (abnormal heart rhythm), balance, cancer pain, cognitive disorders (neurogenic), communicative disorders (neurogenic), coronary artery disease, drug abuse, dysmenorrhea, emotional distress, exercise performance, gastritis, gastroesophageal reflux disease (GERD), gastrointestinal disorders, hemiplegia, herpes virus, high cholesterol, immune system stimulation, increasing breast milk, infertility, ischemic heart disease, longevity, migraine, multiple sclerosis, obsessive compulsive disorder (OCD), ostomy care, panic disorder, Parkinson's disease, peptic ulcer disease, pregnancy, preparation for surgery, psoriasis, psychiatric disorders, psychosomatic conditions, quality of life, reflex sympathetic dystrophy, repetitive strain injuries, rosacea, warts, wound healing.


Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

  • Most relaxation techniques are noninvasive and are generally considered safe in healthy adults. Serious adverse effects have not been reported. It is theorized that anxiety may actually be increased in some individuals using relaxation techniques and that autogenic discharges (sudden, unexpected emotional experiences, including pain, heart palpitations, muscle twitching, crying spells, or increased blood pressure) may occur rarely. Scientific evidence is limited in these areas. People with psychiatric disorders such as schizophrenia or psychosis should use relaxation techniques only when recommended by their primary psychiatric healthcare provider. It is sometimes suggested by practitioners that techniques requiring inward focusing may intensify depressed mood, although scientific evidence is limited in this area.
  • Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously by people with illnesses such as heart disease, high blood pressure, or musculoskeletal injury.
  • Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven techniques.

Authors

Selected References

Natural Standard developed the above evidence-based information based on a systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Andrasik F, Grazzi L, Usai S, et al. Pharmacological treatment compared to behavioural treatment for juvenile tension-type headache: results at two-year follow-up. Neurol Sci 2007 May;28 Suppl 2:S235-8.
  2. Boyce PM, Talley NJ, Balaam B, et al. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol 2003;98(10):2209-2218.
  3. Dickinson H, Campbell F, Beyer F, et al. Relaxation therapies for the management of primary hypertension in adults: a Cochrane review. J Hum Hypertens. 2008 Dec;22(12):809-20. Epub 2008 Jun 12.
  4. Engel JM, Rapoff MA, Pressman AR. Long-term follow-up of relaxation training for pediatric headache disorders. Headache 1992;32(3):152-156.
  5. Fichtel A, Larsson B. Relaxation treatment administered by school nurses to adolescents with recurrent headaches. Headache 2004 Jun;44(6):545-54.
  6. Gavin M, Litt M, Khan A, et al. A prospective, randomized trial of cognitive intervention for postoperative pain. Am Surg 2006 May;72(5):414-8.
  7. Irvin JH, Domar AD, Clark C, et al The effects of relaxation response training on menopausal symptoms. J Psychosom Obstet Gynaecol 1996;17(4):202-207.
  8. Janke J. The effect of relaxation therapy on preterm labor outcomes. J Obstet Gynecol Neonatal Nurs 1999;28(3):255-263.
  9. Kearney DJ, Brown-Chang J. Complementary and alternative medicine for IBS in adults: mind-body interventions. Nat Clin Pract Gastroenterol Hepatol. 2008 Nov;5(11):624-36. Epub 2008 Sep 30.
  10. Larsson B, Carlsson J, Fichtel A, Melin L. Relaxation treatment of adolescent headache sufferers: results from a school-based replication series. Headache 2005 Jun;45(6):692-704.
  11. Medlicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther 2006 Jul;86(7):955-73.
  12. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. JAMA 7-24-1996;276(4):313-318.
  13. Ramaratnam S, Baker GA, Goldstein LH. Psychological treatments for epilepsy. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD002029.
  14. Siev J, Chambless DL. Specificity of treatment effects: cognitive therapy and relaxation for generalized anxiety and panic disorders. J Consult Clin Psychol 2007 Aug;75(4):513-22.
  15. Yu DS, Lee DT, Woo J. Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure. J Psychosom Res 2007 Apr;62(4):427-37.
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