Relaxation Therapy

content provided by the Faculty of the Harvard Medical School

Relaxation Therapy

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

Background

Numerous relaxation techniques and behavioral therapeutic approaches exist, with a range of philosophies and styles of practice. Most techniques involve repetition (of a specific word, sound, prayer, phrase, body sensation or muscular activity) and encourage a passive attitude toward intruding thoughts.

Methods may be deep or brief:

• Deep relaxation methods include autogenic training, meditation and progressive muscle relaxation.

• Brief relaxation methods include self-controlled relaxation, paced respiration and deep breathing.

Other related techniques include guided imagery, passive muscle relaxation and refocusing. Applied relaxation often involves imagining situations to cause muscular and mental relaxation. Progressive muscle relaxation aims to teach people what it feels like to relax by comparing relaxation with muscle tension.

Relaxation techniques are taught by many types of health care professionals, including complementary practitioners, medical doctors, psychotherapists, hypnotherapists, nurses or sports therapists. There is no formal credentialing for relaxation therapy. Books, audiotapes or videotapes are sometimes used as teaching tools.

Theory

During stressful situations, the sympathetic nervous system increases activity, leading to the "fight-or-flight" response. Heart rate, blood pressure, breathing rate, blood supply to the muscles and dilation of the pupils often increase. It has been suggested that chronic stress may lead to negative effects on health such as high blood pressure, high cholesterol levels, upset stomach or gastrointestinal distress, and weakening of the immune system.

Harvard professor and cardiologist Herbert Benson, M.D., coined the term the "Relaxation Response" in the early 1970s to describe a state of the body that is the opposite of the stress response. The Relaxation Response is proposed to have the opposite effects of the stress response, including reduced sympathetic nervous system tone, increased parasympathetic activity, decreased metabolism, decreased blood pressure, decreased oxygen consumption and decreased heart rate. It is theorized that relaxation may counteract some of the negative long-term effects of chronic stress. Proposed relaxation techniques include massage, deep meditation, mind/body interaction, music- or sound-induced relaxation, mental imagery, biofeedback, desensitization, cognitive restructuring and adaptive self-statements. Rhythmic, deep, visualized or diaphragmatic breathing may be used.

One type of relaxation called Jacobson muscle relaxation, or progressive relaxation, involves flexing specific muscles, holding the tension and then relaxing. The technique involves progressing through muscle groups one at a time, beginning with the feet, up to the head, spending about one minute on each area. Progressive relaxation may be practiced while lying down or sitting. This technique has been proposed for psychosomatic disorders (those originating in the mind), pain relief and anxiety. The Laura Mitchell approach involves reciprocal relaxation, moving a part of the body in a direction opposite of an area of tension and then letting it go.

Evidence

Scientists have studied relaxation therapy for the following health problems:

Unproven Uses

Relaxation therapy has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using relaxation therapy for any use.

Potential Dangers

Most forms of relaxation therapy are considered safe in healthy adults, and severe adverse effects have not been reported. It has been theorized that relaxation therapy may increase anxiety in some individuals or that it may cause autogenic discharges (sudden, unexpected emotional experiences characterized by pain, heart palpitations, muscle twitching, crying spells or increased blood pressure). People with psychiatric disorders such as schizophrenia or psychosis should avoid relaxation therapy unless recommended by a qualified health care provider. Relaxation techniques that involve inward focusing may intensify a depressed mood, although this has not been clearly shown in scientific studies.

Jacobson relaxation techniques (flexing specific muscles, holding the tension, then relaxing the muscles) and similar approaches should be used cautiously by people with heart disease, high blood pressure or musculoskeletal injuries.

Relaxation therapy is not recommended as the sole treatment for potentially severe medical conditions. It should not delay diagnosis by a qualified health care provider and treatment with more proven techniques.

Summary

Relaxation therapy has been suggested for many conditions. Early scientific evidence suggests that relaxation may play a role in treating anxiety, although better studies are needed that identify which approaches are most effective. Research also reports possible effectiveness for pain, insomnia, premenstrual syndrome and headache, although this evidence is early and better studies are needed to form clear conclusions. Relaxation is generally believed to be safe when practiced appropriately, but it should not be used as the sole treatment for severe illnesses.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Resources

1. An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics

2. A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Relaxation Therapy

Natural Standard reviewed more than 150 articles to prepare the professional monograph from which this version was created.

Some of the more recent English-language studies are listed below:

1. Beck JG, Stanley MA, Baldwin LE, et al. Comparison of cognitive therapy and relaxation training for panic disorder. J Consult Clin Psychol 1994;62(4):818-826.

2. Blanchard EB, Appelbaum KA, Guarnieri P, et al. Five year prospective follow-up on the treatment of chronic headache with biofeedback and/or relaxation. Headache 1987;27(10):580-583.

3. Broota A, Dhir R. Efficacy of two relaxation techniques in depression. J Pers Clin Stud 1990;6:83-90.

4. Carroll D, Seers K. Relaxation for the relief of chronic pain: a systematic review. J Adv Nurs 1998;27(3):476-487.

5. Engel JM, Rapoff MA, Pressman AR. Long-term follow-up of relaxation training for pediatric headache disorders. Headache 1992;32(3):152-156.

6. Eppley KR, Abrams AI, Shear J. Differential effects of relaxation techniques on trait anxiety: a meta-analysis. J Clin Psychol 1989;45(6):957-974.

7. Good M, Stanton-Hicks M, Grass JA, et al. Relaxation and music to reduce postsurgical pain. J Adv Nurs 2001;33(2):208-215.

8. Goodale IL, Domar AD, Benson H. Alleviation of premenstrual syndrome symptoms with the relaxation response. Obstet Gynecol 1990;75(4):649-655.

9. 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.

10. Jacob RG, Chesney MA, Williams DM, et al. Relaxation therapy for hypertension: design effects and treatment effects. Ann Behav Med 1991;13(1):5-17.

11. Jacobs GD, Rosenberg PA, Friedman R, et al. Multifactor behavioral treatment of chronic sleep-onset insomnia using stimulus control and the relaxation response: a preliminary study. Behav Modif 1993;17(4):498-509.

12. Kohen DP. Relaxation/mental imagery (self-hypnosis) for childhood asthma: behavioral outcomes in a prospective, controlled study. Hypnos 1995;22:132-144.

13. Lichstein KL, Peterson BA, Riedel BW, et al. Relaxation to assist sleep medication withdrawal. Behav Modif 1999;23(3):379-402.

14. Mandle CL, Jacobs SC, Arcari PM, et al. The efficacy of relaxation response interventions with adult patients: a review of the literature. J Cardiovasc Nurs 1996;10(3):4-26.

15. Mastenbroek I, McGovern L. The effectiveness of relaxation techniques in controlling chemotherapy induced nausea: a literature review. Austral Occupat Ther J 1991;38(3):137-142.

16. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain 1999;80(1-2):1-13.

17. 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 1996;276(4):313-318.

18. Ost LG, Breitholtz E. Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behav Res Ther 2000;38(8):777-790.

19. Passchier J, van den Bree MB, Emmen HH, et al. Relaxation training in school classes does not reduce headache complaints. Headache 1990;30(10):660-664.

20. Rankin EJ, Gilner FH, Gfeller JD, et al. Efficacy of progressive muscle relaxation for reducing state anxiety among elderly adults on memory tasks. Percept Mot Skills 1993;77(3 Pt 2):1395-1402.

21. Renzi C, Peticca L, Pescatori M. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results. Int J Colorectal Dis 2000;15(5-6):313-316.

22. Seers K, Carroll D. Relaxation techniques for acute pain management: a systematic review. J Adv Nurs 1998;27(3):466-475.

23. van Dixhoorn JJ, Duivenvoorden HJ. Effect of relaxation therapy on cardiac events after myocardial infarction: a 5-year follow-up study. J Cardiopulm Rehabil 1999;19(3):178-185.

24. Walker LG, Walker MB, Ogston K, et al. Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy. Br J Cancer 1999;80(1-2):262-268.

25. Wynd CA. Relaxation imagery used for stress reduction in the prevention of smoking relapse. J Adv Nurs 1992;17(3):294-302.

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Last updated:	August 21, 2006