Dr Robert London

Relaxation Techniques: Adjuncts to Therapy

Clinical Psychiatry News - Volume 34, Issue 12, Page 22 (December 2006)

In a recent column, I wrote about the psychiatric/psychological assistance we can offer in treating TMD (“Stress-Related Temporomandibular Dysfunction,” The Psychiatrist's Toolbox, October 2006, p. 60).

As I examined the techniques that I have found most useful in helping patients with TMD, I briefly mentioned Jacobson relaxation techniques. Much to my surprise, several people responded to the reference, wanting to know who Jacobson was and what he did.

The questioners, all relatively young clinicians, had never heard of either Dr. Jacobson or his techniques. Because of this intense interest—and given the scores of people who seek relief from stress and tension using these techniques—I decided to use the toolbox to further examine the topic.

In 1929, Dr. Edmund Jacobson developed a technique called Progressive Relaxation. He observed that an individual who is relaxed in an ordinary manner does show tension. Respiration may be irregular, pulse may be increased, and even some reflexes may be hyperactive, showing restless movements.

With this in mind, Dr. Jacobson went on to teach a specific type of relaxation in which the patient would begin to learn to isolate various muscle groups by putting them under tension—Dr. Jacobson used the word “tenseness”—to get a sense of the muscle group. As patients understood that they were in control of the muscle group, they could reverse this tense process. Dr. Jacobson used 50 sessions in this learning process and more to achieve a result.

This long-term process was not inconsistent with talk therapy of the 1920s, ‘30s, ‘40s, and even ‘50s. In those days, psychoanalysts promoted long treatments—that is, four to five visits a week for years in some cases. What Dr. Jacobson did not realize is that there may be a biological substrate in the ability of different people to enter relaxation, hypnosis, or even trance phenomenon. The work I've done suggests that some people have few problems shifting gears and getting into these states. Others, however, rarely or never get into these altered states of concentration.

In the 1940s and ‘50s, Dr. Joseph Wolpe demonstrated that relaxation can be induced within 20 minutes. In my experience, certain people can achieve this response in 2–5 minutes.

I also have found that relaxation techniques, including hypnosis, can be used broadly to help patients with many types of disorders. My approach often has been to use the concepts of relaxation and the hypnotic phenomenon interchangeably.

I think of hypnosis and relaxation as adjuncts in the treatment of a problem. For me, the hypnotic or relaxation experience can be used to focus concentration or attention so that a specific therapeutic goal can be reached through a behavior modification or cognitive strategy. I have developed this for numerous problems and disorders I've treated using my learning, philosophizing, and action technique.

The question that remains is this: Why do so many people use relaxation models as problem-solving techniques? Many people remark that “I did yoga or relaxation, and I really felt better.” I ask, “Better from what?” There is no real answer. They were not addressing a specific problem but essentially got a release of stress and tension through the relaxation exercise. I discussed the situation with a colleague, Mark Harren, who is program coordinator at Lutheran Medical Center, New York, and has been using and teaching relaxation techniques for more than 25 years.

After talking with him, I felt as if I had been schooled by an encyclopedia of relaxation techniques. After an hour I needed him to slow down.

He believes that the relaxation process is therapeutic by itself. He and I agree that the various techniques probably tap the same substrate that people possess in shifting gears to get into a different state. We went through the various types of meditation—transcendental meditation, using the various mantras, verbal and visual—which, according to Mr. Harren, help relax and release thoughts that may be blocking certain emotional freedoms. He also covered various types of yoga, which he believes can assist in stress control.

After speaking with Mr. Harren, I realized that the techniques that can be used to promote relaxation probably number in the hundreds. My commitment in using these techniques, however, aims toward specific problem resolution using the relaxation experience as an adjunct to help focus concentration and attention in treating clearly defined DSM-IV disorders.

If people are able to employ relaxation techniques, as I believe they are, the operator is simply tapping into natural abilities. This helps demystify the power of the operator, which is good.

What I worry about is who is doing the operating. Too many are neither psychiatrists nor psychologists. Obviously, my colleague Mr. Harren, who works on an inpatient psychiatric unit, knows and understands psychopathology. But the knowledge of these techniques by gurus with little knowledge about mental health worries me. I'm also concerned about the possible harm that might be done when people with mentally illness are treated for problems in which relaxation models are not therapeutic and even may be harmful.

Which is better: meditation or yoga? Relaxation or hypnosis? As Mr. Harren says: “Insisting one is better than the other is like religious intolerance.” As I see it, different ceremonies tap into the same human potential to shift gears into a state of alert, intense concentration. When that state is achieved, I think we can use behavior modification or cognitive therapy strategies to treat disorders or problems.

Tell me about your experiences with relaxation techniques, and I'll try to pass them along to my readers.

PII: S0270-6644(06)71957-9


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