Dr Robert London

The How-To of Relaxation Techniques

Clinical Psychiatry News - Volume 34, Issue 6, Page 20 (June 2006)

In many “Toolbox” columns, I have discussed assisting patients via the learning, philosophizing, and action technique I have developed over the last 25 years.

The LPA technique is my integration of various kinds of cognitive-behavioral therapy into a pragmatic approach to addressing many DSM disorders and many emotional situations that affect people but do not fit the DSM model.

When the learning and philosophizing aspects are either over or not necessary, I have often found that specific relaxation techniques can be adjunctively used to teach behavior modification strategies that can help patients develop skills to tackle specific problems.

Several readers have asked me to explain how to quickly get a patient into a relaxed state in which he or she would be receptive to a strategy that helps change certain thinking patterns and behaviors and develop new, more productive ones. In other words, what is the best way to set the stage for the action phase of the LPA technique?

For openers, note that not everyone is a candidate for a rapid (or any other)relaxation technique. One size does not fit all. Our strategies need to be tailored to people's needs and, of course, their capabilities.

The therapist must identify the problem and determine whether these methods are appropriate.

For example, among the problems I have helped patients with and treated them for are smoking cessation, weight control, insomnia, phobic responses, obsessive disorders, generalized anxiety disorders, stress-related disorders, psychosomatic conditions, chronic pain patterns (both physiological and psychological in origin), as well as many other habits and patterns of unwanted behaviors that patients have wanted to reprocess.

When the problem fits the criteria I use, I then go on to teach a quick relaxation technique, which allows the patient to focus on the strategy being taught. I still like, after all these years, the method developed by Dr. Herbert Spiegel and Dr. David Spiegel in “Trance and Treatment: Clinical Uses of Hypnosis.”

Now for the techniques I often use. Each allows patients to use projection and imagery to develop new thinking styles and behaviors:

? Screen or split-screen technique (sometimes modified to the blue-sky method).

? 20-steps technique.

? Balloon technique.

Split-Screen Technique

With the patient in a relaxed state, suggest that the patient imagine a large movie screen. As he sees this screen, get him to visualize a line right down the center of the screen, dividing it into a left side and a right side.

I use the left side of the screen to allow the patient to project and visualize his difficulties, worries, or anxieties. The point is that he sees these difficulties on the screen but does not experience them as he would in real life. Seeing the problem without experiencing it puts the patient on the first leg of the desensitization/relearning process. As the patient becomes comfortable with this approach, I have him switch over to the right side of the screen, where he sees himself drift into a pleasant and rewarding situation of his choosing.

This type of reciprocal inhibition of the unpleasant or troubling thoughts or behavior, coupled with a competing new pleasant set of thoughts, has been shown to be effective and long-lasting. Relaxation with the pleasant, non-anxiety-provoking images or thoughts is usually incompatible with stressful and anxiety-provoking experiences. Therefore, the screen technique is a good beginning to a rapid resolution of many disorders.

Once again, the need for the patient to know and understand this strategy, practice it, and modify it to suit his specific, ongoing needs is equally important in its success.

For those who find the screen technique not to their liking, I suggest the blue-sky method, in which they visualize a clear blue sky projecting the same concepts, moving from the left to the right in that sky, using the same reciprocal inhibition techniques.

20-Steps Technique

The 20-steps technique is excellent for general relaxation, and can be used to treat insomnia.

My approach has been to use the same quick relaxation technique and then have the patient imagine “20 heavily carpeted stairs,” preferably in his favorite color.

In this relaxed state, the patient is encouraged to walk slowly down those heavily carpeted stairs. As he descends those stairs—slowly—he finds himself becoming more relaxed. That is, his levels of stress and anxiety subside. If the treatment is aimed at insomnia, then, as the patient moves toward the 20th step, he often will fall into a restful sleep. This can be repeated many times as the patient attempts to resolve his problem. Again, the practice effect is important.

Balloon Technique

This strategy is unusual and has been very effective in treating a variety of anxiety disorders, phobic problems, and some chronic pain patterns.

After a relaxation technique is taught, I suggest that the patient imagine a great big red balloon. I like red, but any color or shade the patient may prefer would be effective. After that, I have the patient see this red balloon attached to a wicker gondola.

As the patient continues to see the red balloon attached to the gondola, I suggest that he place his anxieties, worries, phobic fears, or obsessive thoughts in that gondola. Then I have the patient let the red balloon lift off the ground and move into a blue, blue sky. In a slow process, I have the patient see the balloon float farther and farther away in this blue sky. The balloon becomes smaller and smaller. As the balloon gets smaller and farther away, so does the patient's problem.

Since the practice effect again is a key to success, I have the patient practice at least five to six times in the office setting. The length of these visits is usually one and half hours. For some problems or situations, I suggest or offer reenforcement visits.

Over many years, success with these techniques has been good. When a patient's problems persist, other, more time-consuming approaches may be necessary. However, they also follow a medical model and behavior modification/cognitive therapy techniques.

Many times, I find it effective to start with the action phase of my LPA technique for certain problems. If additional treatment is needed, the learning and philosophizing aspects of LPA become the focus of therapy and more in-depth, cognitive treatments follow. My experience is that the overgeneralized concept of symptom substitution is not applicable in most cases.

Let me know about your experiences with using these kinds of techniques to help patients. I will try to pass your ideas on to my readers.

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