Relaxation Training
(5-20-08)

Handouts

"Trophotropic state": generalized state of reduced physiological activity; awakened state of hypometabolic functioning

Anxiety control methods--Similarities (from Paul, 1969)

1. limited sensory intake
2. limited body activity
3. restricted (focused) attention
4. deliberately monotonous stimuli
5. altered body awareness
6. eyes closed
7. motivational instructions

Uses of relaxation training

1. reduce chronic tension level in emotional disorders

anxiety disorders
somatoform disorders
mood disorders

2. stress management/self-control--increased feeling of mastery

3. preparatory for additional therapy

systematic desensitization, covert techniques, guided imagery, other behavior and imagery therapies

4. general health education

Screening:

1. Purpose of training clarified
2. Sensory handicaps
3. Motor handicaps
4. Psychosis
5. Paranoid ideation
6. Fear of loss of control/relaxation sensations aversive
7. Previous training/experience
8. Athletic experience
9. Caution: headache
10. Caution: back pain
11. Caution: contact lenses

Rationale (from Bernstein & Borkovec, 1973):

1. procedure called progressive relaxation training
2. consists of learning to tense and release various muscle groups
3. essential part of learning to relax involves learning to pay close attention to the feeling of tension and relaxation in your body
4. learning relaxation is like learning other motor skills:

a. it is not done to you, you are taught a technique you can use
b. skill increases with practice

5. tension is used to produce relaxation

a. strong tension is more noticeable and will help you learn to attend to these feelings
b. initial production of tension produces some "momentum" that will carry muscles to deeper relaxation when released

6. questions?
7. demonstrate how to tense
8. release tension all at once when given the cue: "relax", "calm", "whatever", rather than gradually
9. Once a muscle group is relaxed do not move it unnecessarily (except to make yourself more comfortable)

10. Do not talk to me during the session. If I ask for a signal, lift little finger of hand nearest me
11. inform of length of session and invite to visit rest room
12. remove constraining items
13. explain dimming of lights

Physical Setting

1. lighting
2. body support
3. temperature
4. quiet

Procedural

1. sequence
2. number of groups
3. trials (two usually)
4. timing (5-7" tense, 30-40" relax, 45-60": relax)
5. patter
6. cues and instruction (signal system)
7. termination ritual

Evaluation

Inquiry: open ended to specific questions

Observations: behavior during training, initial response to termination, recovery time

clinician rating:

-3 refuses to participate, terminates session
-2 talks, moves, opens eyes, noncompliance, increased tension
-1 some movement, eyes open intermittently, tense
0 no change in tension
+1 some relaxation, breathing slows, compliant
+2 good response, breathing slowed, jaw opens, hips rotate
+3 deep relaxation, recovery phenomenon, time distortion

SUD's rating (Subjective Units of Disturbance) 0-100 or 0-10 (completely relaxed to panic attack), pre- post-ratings

Problems

1. difficulty producing tension
2. movement
3. falling asleep
4. finding feelings of relaxation distressing
5. intrusive thoughts

benign: mind wanders
disturbing: anxiety producing, sexual/aggressive content

6. emotional abreaction

Variations

Jacobson tension-release cycles
Relax Only ("passive relaxation")
Differential relaxation
Cue conditioned relaxation
Personal relaxing image
Thought stopping and Cautela's Self-Control Triad
Group training
Use of tapes and scripts