Some Factors Influencing the Effects of Relaxation Techniques

Dr K. Nespor, Czechoslovakia

Relaxation techniques are used in somatic medicine as well as in psychiatry. They have proved useful for the treatment of hypertension,^{*1, *2} bronchial asthma,^{*3, *4} insomnia,^*5 for pain treatment,^{*6, *7} as the prevention and therapy of ischaemic heart disease,^{*8, *9, *10} in hyperactive children,^*11 in gynaecology and obstetrics,^{*12, *13} for the treatment of migraine,^*14 as a measure of prevention and mental hygiene.^*15 After short periods of relaxation the decrease of blood pressure in patients with hypertension during twenty four hours was observed.^*16 Relaxation, which may be induced by various techniques, represents the physiological opposite of stress, which causes and/or aggravates many diseases (Fig. 1).

That is why preventive application of relaxation techniques is desirable for people with stressful professions and people undergoing rapid social, economic or cultural changes. Without these measures various psychosomatic diseases (headache and indigestion) and other diseases can result.

Relaxation techniques are usually without side effects, and relief is often felt immediately after practice. They can be combined with pharmacotherapy and/or psychotherapy, and are not very demanding on therapist's time and training. Some factors influencing the effects of relaxation techniques are described in this paper.

Factors on therapist's part

1. Therapist's own experience with relaxation technique and his ability to teach.
2. Therapist's relation to a patient.
3. Therapist's presence or absence. According to Tamez et al. relaxation with live therapist was more effective than relaxation according to tape recorded instructions (*17). But it may be possible that this finding is not relevant for people practising for a long time by themselves and knowing their technique very well. The mere physical presence of a therapist can have supportive effect, and this is useful when some strange or unpleasant feelings or thoughts appear. It is usually recommended to a client to remain relaxed and indifferent.

Factors on a client's part

1. Expectation. Placebo effect occurs during relaxation, and it is beneficial to use it clinically. Positive expectations also increase the motivation to practise regularly.
2. Personality. Some authors consider self-regulation relaxation techniques suitable for clients with 'sufficient ego-strength' but not for people with hysterical symptoms.^*18 Careful supportive approach and collaboration with a psychiatrist is advisable in people susceptible to psychotic attack. Neuroticism may also be an important consideration. People who discontinued the practice of Transcendental Meditation had higher neuroticism than those who continued to practise and those who did not start to practise.^*19 It is debatable if this finding is also relevant for other relaxation techniques. The ability to visualise is of importance in some techniques too. Simple relaxation techniques and longer training will probably be more convenient for people with low intellect.
3. Client's relation to a therapist influences positively or negatively the motivation to practise and results.
4. Belief system. This is the reason why some clients prefer or refuse certain techniques. It is better to clearly explain the mechanism, effects and benefits of technique before starting training.
5. Momentary state. To relax is easier after adequate body and/or mental activity. The combination of physical exercises and relaxation is very good, physical activity may decrease depression and anxiety^{*20, *21} and makes following relaxation deeper. Practitioners may also be able to perform their technique during stressful situations, e.g. during dentistry, before an important interview or examination, and be more comfortable.
6. Pleasant/unpleasant feelings. Compliance to practice may increase when the practice is pleasant, and decrease when unpleasant feelings appear.
7. Other factors. Compliance may be zero when treated disease brings material or psychological gains to a client, e.g. rent.

Factors related to technique

1. Frequency and length of practice. This factor is of course crucially important. Relaxation techniques are usually practised for 5-30 minutes once or twice daily, sometimes in addition short periods of relaxation are recommended during normal daily activities. A paper about testing if a client practises at home or not has been published.^*22
2. The choice of relaxation technique. There are many techniques bringing about relaxation: yogic techniques, autogenic training and modifications, progressive relaxation, biofeedback aided relaxation, hypnotic relaxation. A suitable technique can be chosen with regard to client's personality (further research is needed in this area; e.g. mental relaxation like autogenic training or meditation is efficient in bronchial asthma, but muscular relaxation is not)^{*3, *4}, to client's belief system, and perhaps also to his momentary state. The choice of technique is often limited; many therapists use only one technique, which they know well.

Factors related to training

1. The length of training. Usually after longer training the performance is better.
2. Environment. Relatively quiet environment is suitable. Later it is possible to practise e.g. during transport or waiting.
3. Time. Some consider late afternoon very suitable, or use relaxation techniques to induce sleep at night. According to yogic tradition the best time for meditation is early morning.
4. Group or separate training. Group training is less demanding on therapist's time, and a group can have supportive effect on a trainee. Later group or individual discussion about feelings etc. is possible.
5. Therapeutic milieu. The views of staff, relatives, friends, etc., may influence client's opinion about relaxation technique and his practice.

Conclusion

Detailed analysis of the factors influencing the effects of relaxation techniques is neither usual or necessary when these techniques are applied routinely. But such analysis may be very useful when training does not progress well. Influencing factors explain why different results are achieved with the same technique, and should be considered when relaxation techniques are compared mutually.

Relaxation techniques are the important components of the treatment of various psychosomatic diseases, the idea that relaxation creates the bridge between somatic medicine and psychotherapy is correct.

References

*1. Jacob, R. G., Kraemer, H. C., Agras, W. S.: Relaxation therapy in the treatment of hypertension. Arch. Gen. Psych., 34, 1977, No. 12, 1417-1427.

*2. Patel, C, North, W. R. S.: Randomised controlled trial of yoga and biofeedback in management of hypertension. Lancet, 2/7925, 1975, 93-95.

*3. Erskine-Milliss, J., Schonell, M.: Relaxation therapy in asthma: A critical review. Psychosomatic medicine, 43, 1981, No. 4, 365-372.

*4. Wilson, A. F., Honseberger, R., Chiu, J. T., Novey H. S.: Transcendental meditation and asthma. Respiration, 32, 1975. 74-80. -26-

*5. Shealy, R. C.: The effectiveness of various treatment techniques on different degrees and durations of sleep-onset insomnia. Behav. Res. Ther., 17, 1979, No. 6, 541-546.

*6. Kabat-Zin, J.: An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation. General Hospital Psychiatry, 4, 1982, 33-47.

*7. Varni, J. V.: Self-regulation techniques in the management of chronic arthritic pain in hemophilia. Behavior Therapy, 12, 1981, No. 2, 185-194.

*8. Tulpule, T. H., Tulpule, A. T.: Yoga- a method for relaxation for rehabilitation after myocardial infarction. Indian Heart J., 32, 1980, No. 1-2, 1-7.

*9. Patel, C: Coronary risk factor reduction through biofeedback-aided relaxation and meditation. J. of the Royal Coll. of General Practitioners, 27, 1977, No. 6, 401-405.

*10. Nespor, K.: Prevention of some cardio-vascular diseases from psychosomatic point of view. Cos. Lek. ces., 120, 1981, No. 35, 1055-1058 Orig Czech.

*11. Dunn, F. M.: Relaxation training and its relationship to hyperactivity in boys. Diss. Abstracts Int., 41, 1980, No. 1, 348-B.

*12. Halonen, J. S.: An examination of relaxation training and expectation variables in the treatment of postpartial distress. Diss. Abstracts Int., 41, 1981, No. 11, 4262-B.

*13. Poison, D. H.: Effects of biofeedback and autogenic training on symptoms of menstrual distress. Diss. Abstracts Int., 42, 1981, No. 6, 2545-B.

*14. Silver, B. V. et al.: Temperature biofeedback and relaxation training in the treatment of migraine headaches: One-year follow up. Biofeedback and Self Regulation, 4, 1979, No. 4, 359-366.

*15. Carrington, P., Collings, G.H., Benson, H. et al: The use of meditation-relaxation techniques for the management of stress in a working population. J. of Occupational Medicine, 22, 1980, No. 4, 221-231.

*16. Agras, W. S., Taylor, C. B., Kraemer, H. C., Allen, R. A.: Relaxation training. Twenty-four-hour blood pressure reductions. Arch. Gen. Psychiatry, 37, 1980, 859-863.

*17. Tamez, E. G., Moore, M. J., Brown, P. L.: Relaxation training as a nursing intervention versus pro re nata medication. Nursing Research, 27, 1978, No. 3, 160-165.

*18. Ikemi, l., ishikava, H., Goyeche, J. R. M., Sasaki, Y.: Positive and negative aspects of the altered states of consciousness induced by autogenic training, zen, and yoga. Psychotherapy and Psychosomatics, 30, 1978, No. 3-4, 179-186.

*19. Delmonte, M. M.: Personality characteristics and regularity of meditation. Psychological Reports, 46, 1980, 703-712.

*20. Griest, H., Klein, M. H., Eischens, R. R., Paris, J., Gurman, A. S., Morgan, W. P.: Running through your mind. J. of Psychosomatic Research, 22, 1978, 259-264.

*21. Bahrke, M. S.: Exercise, Meditation, and Anxiety Reduction: A Review. Amer. Con. Ther. J., 33, 1979, No. 2.

*22. Martin, J .E., Collinns, F. L., Hillenberg, J. B., Zabin, M. A., Katell, A. D.: Assessing compliance to home relaxation: a simple technology for a critical problem. J. of Behavioral Assessment, 3, 1981, No. 3, 193-198.