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Relaxation Training
Abstract
• If the demonstrated effects of relaxation training on blood pressure (BP) occur only during relaxation practice, then little effect on the morbidity and mortality of essential hypertensives would be expected. This question was addressed by inpatient monitoring of five hypertensive patients' BP for 24 hours during six experimental days, including a no-treatment baseline, three days of relaxation training, and one day of recovery. Lowering of both systolic and diastolic pressures persisted beyond the end of the training sessions. Moreover, systolic BP was significantly lower during relaxation training days than during either baseline or recovery days, a difference particularly noticeable at night when patients were sleeping. The BPs of the three patients showing the largest initial effects of training averaged 12.5/7.3 mm Hg less during nights following relaxation sessions than during nights following no treatment.
... Although relaxation training is nonspecific to the major, competing psychological theories of depression, it has been noted as an effective technique for the reduction of symptomatology associated with depression (Agras, 1983;Biglan & Dow, 1981). Furthermore, relaxation training has been used as a treatment condition (albeit viewed by the investigators as an attention control) in at least one therapy outcome study (McLean & Hakstian, 1979), where it was found to be as effective as psychotherapy and pharmacotherapy. ...
... Given that depression is associated with increased anxiety and adrenalcortical activity (Klerman, 1983), it may be that relaxation training either directly or indirectly enhances the production of endorphins. Agras (1983) noted that relaxation training has a direct effect on catecholamines and results in the blocking of noradrenergic receptors. The case for noradrenergic involvement in stress as it relates to depression has been made by Katz (1983). ...
This investigation examined the efficacy of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents. Thirty moderately depressed adolescents were randomly assigned to either cognitive-behavioral treatment, relaxation training, or a wait-list control condition. Treatment subjects met in small groups for ten 50-min sessions over 5 weeks in a high school setting. Outcome measures included self-report and clinical interviews for depression as well as measures of self-esteem and anxiety. The cognitive-behavioral and relaxation training groups were superior to the wait-list control group in the reduction of depressive symptoms at both posttest and 5-week follow-up assessments. There was no significant difference between active treatments in their effectiveness for reducing adolescents’ depression. Subjects in the cognitive-behavioral and relaxation training conditions went from moderate levels of depression at pretest to nondepressed levels at posttest, and they maintained these levels at follow-up. Improvements in anxiety and academic self-concept were also demonstrated by the active treatments. The findings demonstrate that these short-term group-administered therapies are effective in significantly decreasing depression in adolescents.
... Although relaxation training is nonspecific to the major, competing psychological theories of depression, it has been noted as an effective technique for the reduction of symptomatology associated with depression (Agras, 1983;Biglan & Dow, 1981). Furthermore, relaxation training has been used as a treatment condition (albeit viewed by the investigators as an attention control) in at least one therapy outcome study (McLean & Hakstian, 1979), where it was found to be as effective as psychotherapy and pharmacotherapy. ...
... Given that depression is associated with increased anxiety and adrenalcortical activity (Klerman, 1983), it may be that relaxation training either directly or indirectly enhances the production of endorphins. Agras (1983) noted that relaxation training has a direct effect on catecholamines and results in the blocking of noradrenergic receptors. The case for noradrenergic involvement in stress as it relates to depression has been made by Katz (1983). ...
30 moderately depressed high school students were randomly assigned to either cognitive-behavioral treatment, relaxation training, or a wait-list control condition. Treatment Ss met in small groups for 10 50-min sessions over 5 wks in a high school setting. Outcome measures included a modified Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the State-Trait Anxiety Inventory. The cognitive-behavioral and relaxation training groups were superior to the wait-list control group in the reduction of depressive symptoms at both posttest and 5-wk follow-up assessments. There was no significant difference between active treatments in their effectiveness for reducing depression. Ss in the cognitive-behavioral and relaxation training conditions went from moderate levels of depression at pretest to nondepressed levels at posttest, and they maintained these levels at follow-up. Improvements in anxiety and academic self-concept were also demonstrated by the active treatments. Findings demonstrate that these short-term group-administered therapies are effective in significantly decreasing depression in adolescents. (48 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Distinguished control of parasympathetic nervous system over sympathetic nervous system was noticed during relaxation techniques (lazar et al.,2000).Review suggests that relaxation training has been a vital inclusion in numerous psychotherapeutic treatments for depression (Blaney ,1981) and hyperactivity disorder. Some of the classic work pertaining to relaxation training suggests it as an effective training for reduction of depression symptoms (Agras ,1983 ;Biglan & Dow, 1981). Relaxation training was found to be effective in lowering the impulsivity scores and improving attention in hyperactive male children (Rivera & Omizo, 2006).Short term psychological therapies based on relaxation training for moderately depressed adolescents, were capable in attaining non-depressed levels at post intervention stage (Reynolds &Coats, 1986). ...
Humans follow 'preparation' during number of general instances such as during exams or an interview. Preparedness for any process can be explained as the readiness to adapt or absorb involved information. Generally in order to attain efficient results. Preparedness, in terms of cognition is the adequacy of arousal state in order to procure efficient session learning. Cognitive Preparedness may be regarded as a crucial stage in the direction of progression in counselling and psychotherapy. The relationship between level of arousal and relaxation (sleep or without sleep) is a well known concept in understanding behavioural efficiency in individuals. This interrelationship is implied as cognitive preparedness training for childhood depression. This research paper outlines the process and relevance of cognitive preparedness training for psychotherapy administered on subjects with depression.
One purpose of this conference is to bring various disciplines together. Thus for those scientists who are not yet too familiar with the behavioral sciences a number of basic data are included. For those who are acquainted with this discipline, a number of important areas for future research and practice of relaxation therapy with hypertensive patients are outlined. Since several good reviews have appeared (Seer, 1979; Agras & Jacob, 1979; Vaitl, this volume), the literature is not reviewed extensively. Rather, a few investigations are mentioned by way of illustration. Throughout the different sections ╌ the description of results, the section on the active ingredients of the techniques, méthodologie considerations and trends for the future ╌ a central idea is that relaxation training is not an isolated procedure. The presence and clinical attention of the trainer, together with other factors such as lifestyle and adherence to medication or diet, are important for the results. The individual characteristics of the patient must also be considered. It is strongly suggested that future work should take into account data from psychophysiological investigations, in the search for criteria that will predict which patients will benefit from a particular relaxation program.
Although mortality from heart disease in the United States has been declining in the past decade, it still accounts for more deaths than all other diseases combined (U.S. Department of Health, Education and Welfare, 1979). Elevated blood pressure is the single biggest contributory cause in the form of strokes, heart attacks, and renal failure (National Institutes of Health, 1979). It is estimated that 60 million people suffer from elevated blood pressure (140/90 mmHg or greater). Of these 60 million people, 35 million have definite hypertension (160/95 mmHg or greater) and another 25 million have borderline hypertension (140/90 to 159/94 mmHg). Epidemiological findings from the Fra-mingham study (Kannel, 1977) confirmed that hypertension is a major risk factor for coronary heart disease (CHD). In over 90% of the cases of hypertension, classified as “primary” or “essential” hypertension, the etiology is unknown. In such cases, symptoms (elevated blood pressure) are treated with diuretics, alpha and beta blockers, vasodilators, and/or combinations of the above in a stepped-care approach. Behavioral interventions as either alternatives or adjuncts to medical treatment are increasingly being utilized in efforts to prevent sustained high blood pressures which increase morbidity and mortality from cardiovascular and renal complications.
Blood pressure (BP) is maintained by cardiac output and peripheral vascular resistance that, in turn, are modified by stroke volume, pulse rate, total blood volume, blood viscosity, elasticity of blood vessels, and humoral and neurogenic stimuli. Changes in one or more of these variables by pharmacological, behavioral, physiological, or environmental means normally affect BP only transiently because a variety of homeostatic reflexes, responding to the change, act to maintain a relatively stable mean arterial BP. When a homeostatic mechanism chronically maintains BP at abnormally high levels, it is sometimes due to a surgically or medically correctable condition (e.g., coarctation of the aorta, primary hyperaldosteronism, Cushing’s syndrome, pheochromocytoma, or unilateral renal disease). However, more than 90% of all cases of chronically elevated BP are not secondary to one of these correctable conditions, and are therefore referred to as primary, or essential, hypertension (Whelton & Russell, 1984). The nature of essential hypertension (HBP) has been a topic of controversy for some time (Laragh, 1965). The tendency for an individual to develop HBP often runs in families, and population studies have demonstrated a familial resemblance at all levels of the BP continuum. Environmental stimuli also seem to play a significant role in most cases of HBP (Whelton & Russell, 1984). Predominantly environmental factors that have been implicated in the genesis of HBP are increased ingestion of sodium, excessive caloric intake, and emotional stress. Although BP has been demonstrated to rise in response to diets extremely high in sodium and to fall in response to diets extremely low in sodium, a relationship between dietary salt and HBP still has not been clearly established. Similarly, although weight reduction is often associated with BP reduction, even when dietary sodium and potassium are held constant, obesity is rarely the primary cause of HBP. Acute responses of BP to emotional stress also have not been shown to have a role in the etiology of chronic HBP. The role of other environmental factors (eg., alcohol consumption, cigarette smoking, heavy metal intake, and calcium content of water intake) is also unclear although there is evidence that some role exists in each case (Whelton & Russell, 1984). Because these environmental factors are not mutually exclusive in their influence on BP, the view that HBP has a multifactorial etiology is now gaining wide acceptance.
Conceived in the 1970s, behavioral medicine has since outgrown its original conceptual foundations of learning and conditioning; it has assimilated aspects of cognitive therapy, behavioral family therapy, and social skills training and also blended these approaches, to some extent, with pharmacotherapy It has also extended its scope from assessment and therapy to prevention and rehabilitation (Kaptein & Rooijen, 1990). Despite this increase in scope and diversity, behavioral medicine has adhered to essential principles of behavior therapy, insisting on quantitative measures of observables, emphasis on performance and action, and the priority of manifest current functioning over inferred psychological processes (Bellack & Hersen, 1990; Wixted, Bellack, & Hersen, 1990). Operational, objective, and quantitative characteristics of these principles seem to be promising candidates for computer-based procedures of one kind or another. A few innovative and forward looking clinician-investigators had already recognized this during the formative stages of behavioral medicine. Yet, despite fairly consistent reports of satisfactory results, current health-care practitioners have not applied computer-based approaches in behavioral medicine as widely as seems warranted by the apparent match between the tasks and the computer’s potential as assistive tool. Agras (1987) addressed this issue in his Presidential Address to the 20th Annual Meeting of the Association for Advancement of Behavior Therapy; in his discussion—“Where Do We Go from Here?”—he drew attention to the desirability of building on already existing, successful computer applications, and stressed the potential of developing promising new applications.
This review is intended to critically evaluate research on relaxation techniques used in physical and rehabilitation medicine. Literature searches were undertaken using the Medline, Cinahl, Bids/Embase, and Cochrane Library databases. The main criteria for inclusion were randomization into groups and the inclusion of a control condition. However, some original articles and reviews were included. Studies were categorized generally into 'physical' and 'nonphysical' approaches to relaxation. Physical approaches included Jacobson's Progressive Relaxation, Mitchell's Simple Physiological Relaxation, Massage, and the Alexander Technique. A section on comparative studies, using Jacobson's Progressive Relaxation as a 'gold standard', was also included. Nonphysical approaches included Benson's Relaxation Response and Hatha Yoga. Outcome measures included heart rate, respiration rate, blood pressure, galvanic skin response, electromyography, and electroencephelography as physiological indicators of relaxation, and measures of anxiety and depression as psychological indicators of relaxation. Male and female subjects, of a variety of age ranges, who fell into the categories of normal healthy subjects, and patient/client groups with both pathological and psycho-social disorders participated in the trials. In general, all techniques reviewed demonstrated the potential to reduce both the physiological and psychological indicators of stress, in all subject groups, suggesting increased relaxation. Some studies demonstrated inconsistent findings, which may suggest differential responses between male and female groups, between normal subjects and patient/client groups, and between physiological and psychological responses. Further research is required to confirm these differential responses.
Stress is a cognitive or emotional response made by the individual towards any situation, which demands adjustment. When the demands of the situation exceed the ability of the individual distress results, which may manifest in mental and physical symptoms of abnormality. The practice of Yoga nidra helps in building up the coping ability. The practitioner of Yoga nidra slowly becomes aware of the inherent dormant potentialities and thus prevents himself from becoming a victim of distress. As well as relaxation of yoga nidra relaxes the physical as well as mental stresses as it relaxes the whole nervous system.
Stress-related disorders evolve gradually through four stages. In the first stage, psychological symptoms like anxiety and irritability arise due to over activation of the sympathetic nervous system.
Yoga nidra can be consider as a highly effective practice for reducing stress on the basis of the present study as Yoga nidra releases the stress of the students of higher classes. Practice of Yoga Nidra also reduces the Anxiety of male and female subjects both. It may have positive results for the other age groups and occupations also.
This article describes some of the practical aspects of stress management and methods of implementing management techniques and coping strategies. It is designed to complement the article on ‘Stress in occupational therapy: how to cope’ (Craik1), which reviews the themes and proposed strategies in the literature on stress management.
Changes in the diagnostic criteria for essential hypertension and the development of effective behavior change approaches to its treatment raise new issues concerning the place of nonpharmacologic approaches in the management of high blood pressure.
Aim of this study was to see any effect on autonomic functions in menstrual disturbances patients after Yoga Nidra practice. The subjects for the study were 150 females with menstrual irregularities, 28.08 +/- 7.43 years of mean age, referred from department of Obstetrics and Gynecology CSMMU, UP, Lucknow. Subjects were divided randomly in to two groups' intervention and in control groups -seventy five (75) in each group. Out of these, one hundred twenty six (126) completed the study protocol. The yogic intervention consisted of 35-40 minutes/day, five days in a week till six months. An autonomic function testing was done in both the groups at zero time and after six months. A significant positive effect was observed when yoga therapy was used as an adjunct in the patients of menstrual disturbances. There were significant improvements in the blood pressure, postural hypotension and sustained hand grip, heart rate expiration inspiration ratio and 30:15 beat ratios of the subjects after yogic practice.
The possible physiological significance of individual control over environmental/occupational stressors has not been discussed systematically in relation to cardiovascular disease. In this paper we review associations between stressors and control in the work situation and endocrine, metabolic, and cardiovasclar activity, using the categories “anabolic” and “catabolic” to organize the findings in relation to the development of ischemic cardiovascular disease. We propose a comprehensive hypothesis, related to existing stress models which incorporates potential physiological regenerative or ameliorating—as well as pathologic—effects of stressor exposure. Regenerative processes are hypothesized to occur in circumstances where equilibrium or a match exists between environmental demands and possibilities for individual control over those demands, whereas pathologic consequences would occur when demands exceed control. This theory is further proposed to account for cardiovascular pathophysiologic differences found between occupational groups. Finally, empirical testing of the validity of this theory is discussed.
In order to test its effect on compliance with recommended practice of relaxation training, patients in anxiety management training groups were provided with additional information about the procedure and its rationale. After an introductory training session all subjects were provided with audiotaped relaxation instructions to use for three weeks until the second group meeting. Additional information was provided either as an audiotaped message at the end of the relaxation instructions ('Message') or as a printed leaflet ('Leaflet'). In a 2 x 2 factorial experiment 32 subjects were randomly assigned to one of four conditions: Message, Leaflet, Message and Leaflet, Basic Programme alone. Neither manipulation had an effect on self-reported frequency of practice during the three was (which ws high), but both increased subjects' knowledge of the treatment and also their satisfaction with it. Subjects receiving the message were significantly less likely to drop out of treatment during the remainder of the 16-weeks group programme. Compliance was predicted by subjects' perceptions of the severity of their condition but not by their knowledge, satisfaction or state anxiety.
This study explores the relationship of chronic stress to hypertension. The study included 127 hospitalized and 134 outpatients of a stress treatment program and 129 “normal” persons in the general population. All subjects were matched for age, sex, and race. After three days of hospitalization, there was a 17.3% incidence of hypertension in the hospitalized patients when hypertension was defined as blood pressure levels greater than 140/90 mmHg. These data compare with a 5% and 13% incidence of hypertension in the outpatient stress and “normal” groups, respectively. The National Health Survey of 1962 indicated that 18% of the population were hypertensive. Our data indicate that the incidence of hypertension was no greater in a diagnostically established group of hospitalized stress patients than in the less stressed outpatient or an otherwise “normal” group. The frequently expressed notion that tension and chronic stress predispose a population to essential hypertension is not confirmed by this analysis.
Stress management and relaxation training lower the blood pressure of many mild hypertensives substantially through mechanisms
that are as yet unclear but may include behavioral and cognitive change. It is almost certain that the reduction of weight
in the obese, drinking in heavy drinkers, and increased exercise in the sedentary also reduces pressure usefully in hypertensives,
and opportunites exist for the application of behavioral principles to improve the effectiveness of programs to alter these
behavioral risk factors. It is fortunate that behavioral methods for the control of hypertension exist and are making progress
since there are increasing doubts about the effectiveness of pharmacological solutions for mild hypertension.
Complaints of anxiety, often meetingDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III), criteria for anxiety disorder, are among the most common problems presenting to health practitioners. In spite of the frequency of anxiety and anxiety disorders, little is known about the basic psychopathology of these conditions that would lead to the development of more efficient and effective treatments and possible preventive efforts. Recently, there has been an increase in research on the psychopathology of anxiety disorders from biological, psychological, and social perspectives. The National Institute of Mental Health's Clinical Research Branch sponsored a 2-day workshop of investigators representing diverse research approaches to discuss emerging issues and research practices within the anxiety disorders. Discussions centered on a review of the general areas of classification, phenomenology, and etiology. A selective summary of this workshop is presented along with recommendations for specific research directions.
One-hundred and forty-eight patients, hospitalised for myocardial (MI) infarction, were asked to list those factors which they believed contributed to their present illness episode and then rank them according to their perceived pathogenic potency. Additionally, they were asked to then rate each cited causal factor for degree of control that they perceived themselves as having.One-hundred and two subjects successfully completed the task. Twenty discreet causal categories were identified from a total of 321 causes supplied.The most frequently perceived cause of myocardial infarction in these patients was Overwork. This was followed by Smoking, Worry, Lack of Exercise, Stress, Lifestyle, Overweight and Diet. Lifestyle was seen as the most potent cause for some but for most subjects, Smoking was perceived as the most potent cause. The standard risk factors of smoking, hypertension and serum cholesterol accounted for 20.25% of all cited items with a combined mean potency of 8.7. By contrast, Overwork, Worry and Stress combined to account for 43.0% of all cited causes with a mean potency of 8.6 on a scale of 0–10.Overwork, Worry and Stress together were perceived as significantly less controllable (P < 0.05) than Smoking, Lifestyle, Lack of Exercise, Overweight and Diet.Implications of these data for information giving and treatment compliance where health care workers focus on smoking cessation, dietary control and hypertension control are discussed.
This study aimed to compare the short-term physiological effects of Mitchell's simple physiological relaxation and Jacobson's progressive relaxation.
Twenty-four normotensive subjects, 14 men and ten women, participated in the six-week study. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), respiratory rate (RR) and heart rate (HR) were monitored by conventional methods. Each subject underwent a baseline period to ascertain pre-study parameter values, following which subjects were randomly assigned to three groups. Each group received two 25-minute sessions of each of the relaxation techniques, and two sessions of the control condition of 25 minutes supine lying. The sequence of intervention differed among the three groups. Physiological parameter measurements were taken immediately before and after intervention.
Following intervention with simple physiological relaxation, there were significant reductions in SBP and HR (both p < 0.001), and DBP and RR (both p < 0.01); following intervention with progressive relaxation, there were significant reductions in SBP, DBP and HR (all p < 0.01), and RR (p < 0.001). There were no significant differences between the two interventions. Following the control condition of supine lying, there were significant reductions in HR (p < 0.05) and RR (p < 0.001) only. Both relaxation techniques reduced SBP to a significantly greater extent than supine lying (p < 0.05), and progressive relaxation reduced RR to a significantly greater extent than supine lying (p < 0.05). The order in which the intervention was received had no confounding effect on the results. Recommendations are made for further research.
Several studies have produced results suggesting that thermal biofeedback treatment is effective in lowering the blood pressure (BP) of individuals with both mild and moderate essential hypertension. This study used thermal biofeedback to treat 9 unmedicated individuals with mild hypertension. Subjects underwent 24-hour ambulatory BP monitoring both prior to and following the thermal biofeedback treatment regimen. Four of the subjects were considered treatment successes using standard office blood pressure assessments as the success-fail criteria. However, 24-hour ambulatory BP measures showed a markedly different pattern of results, with several subjects who were considered successes under conventional assessment techniques showing an increase in 24-hour ambulatory BP from pre- to posttreatment. There was a significant decrease in diastolic blood pressure for all subjects as measured by the ambulatory method. There was also a significant decrease in systolic and diastolic standing home blood pressure. The implications of these results are discussed.
1. Ability to alter blood pressure (BP) acutely with continuous systolic (SBP) BP biofeedback was assessed in volunteers using a new non-invasive finger BP monitor.
2. Reliability of finger BP measurement was demonstrated in six hypertensive subjects (21–60 years), by beat-to-beat comparison with brachial intra-arterial BP over 90 min. Wide variation of BP was achieved by physiological manoeuvres. Mean error of finger BP was -3.0/-2.2 mmHg with intra-subject s.d. of 7.2/5.4 mmHg.
3. Thirteen normotensives (21–51 years) were paid to undergo 30 trials of SBP biofeedback in six sessions over 3 weeks. The SBP trend was displayed on a monitor with appropriately ‘shaped’ targets; each trial consisted of BP-raising and -lowering periods of 45 and 90 s respectively with intervening 45 s baselines.
4. Nine subjects raised BP, on analysis of the last 10 trials, by an average of 18.8 mmHg while five of the 13 successfully lowered BP by an average of 10.0 mmHg. BP lowering was best achieved by diminishing respiratory rate and depth, and muscular relaxation.
5. Demonstration of large BP reductions in five of 13 normotensives using strategies applicable to longer training sessions warrants further investigations in hypertensive subjects, focusing on mediating mechanisms and transfer of effect beyond the laboratory.
In groups of hypertensives blood-pressure (BP) reductions after relaxation training (RT) are generally moderate. One possibility to explain this relative weakness of RT follows from the observation of large interindividual differences in BP response after RT. In a first study we observed this same variability of BP response after RT in normotensives. Subsequently a method was developed to predict individual BP response after RT. The validity of this method was then established in three samples of normotensives: both systolic and diastolic BP changes appear to be predictable after progressive relaxation as well as after autogenic training.
Relaxation and meditation are widely used psychological treatments, but their effectiveness has been questioned, and the mechanism of their therapeutic effect is not well-understood. It has been suggested that the subjective effect of regular practice of relaxation may lead to changes in cognition and behaviour. To investigate this possibility, the effects of relaxation on affect and cognition were compared with those of an equally plausible placebo in normal Ss. In the presence of the therapist, both ‘treatments’ were equally effective in reducing arousal and distress, but when practising alone, Ss who were taught relaxation techniques achieved similar effects, while Ss in the placebo group did not. Arousal reduction was associated with a decrease in the accessibility of negative cognitions in both groups. Although no unequivocal treatment differences in the recall of positive and negative words emerged, the superior consistency of relaxation training as a means of achieving subjective arousal reduction during solo practice might support the hypothesis that changes in cognition and behaviour could result from regular practice of relaxation. Relaxation techniques also moderated the increase in arousal brought about by watching a stressful film.
A six-month multifocal behavioral treatment program was compared to clinic blood pressure monitoring only. Subjects were 50 men and women with blood pressures in the borderline hypertensive or upper normotensive range. The behavioral treatment combined relaxation therapy, reduction of salt intake, and weight reduction. After six months, both groups showed a significant decline of systolic pressure (5.7 and 6.1 mm Hg, respectively), but there was no difference between the groups. There was no significant change in diastolic pressure in either group. There was a significantly larger decline of weight in the behavioral group. At the one-year follow-up, there was a significant decline of diastolic pressure in both groups, and systolic pressures remained significantly below baseline levels. Again, the changes were equivalent in both groups. Thus both interventions were associated with decrease of blood pressure, but there was no advantage of the behavioral treatment over clinic blood pressure monitoring.
This study investigated the relationship of relaxation practice to blood pressure reduction in 31 hypertensive subjects who participated in an 8-week treatment program. Subjects achieved significant post-treatment reductions in systolic and diastolic blood pressure, which were maintained at 5 months follow-up and were found to generalize to the subjects' home environment. Subjects who practiced relaxation with their spouses showed significantly better treatment adherence than those who practiced relaxation alone. No differences were found in blood pressure reduction between the two groups, however, due to the fact that pressure reduction was only modestly correlated with degree of relaxation practice. A significant, inverse relationship was found between blood pressure reduction and two measures associated with the Type A behavior pattern. Results of this study provide further evidence that relaxation training is effective in the treatment of some persons with mild, essential hypertension; however, further efforts are needed to identify predictors of treatment response.
The effects of progressive muscle relaxation on blood pressure of hypertensive clients were examined. After collection of baseline data, 22 clients received group relaxation training followed by individual monitoring sessions over a 6-week period. The 22 persons in the control group did not receive relaxation training. The group instructed in relaxation had a lower mean systolic blood pressure than the nontrained group at 4-month follow-up. While the relaxation-trained group showed a significant decrease in diastolic pressure from baseline to follow-up, the difference between trained and non-trained groups at follow-up was not significant. Relaxation, taught initially in group with individual follow-up visits, resulted in continued practice of relaxation and subsequent lowering of blood pressure in subjects with essential, uncomplicated hypertension.
An ongoing study demonstrates that systematic training in relaxation can produce prolonged reductions in clinically significant hypertension. The results support the theory that hypertension often has a large functional component.
Despite the enormous gains made in the variety and specificity of antihypertensive agents, much hypertension remains uncontrolled. It is important to understand how psychosocial and behavioral factors interact with pathophysiologic and regulating mechanisms to produce hypertension, and how behavioral and other interventions may be used to reduce blood pressure. The author surveys pathophysiologic and psychologic mechanisms, examines the role of the nervous system, and presents treatment recommendations, including the roles of medication, rest and relaxation, biofeedback, and diet.
Controlled studies have demonstrated that relaxation training can lead to significant in-clinic blood pressure (BP) reductions in patients with essential hypertension. We examined the BP-lowering effect of relaxation training during the working day. Forty-two patients being treated for essential hypertension with diastolic BPs greater than 90 mm Hg were randomized into either a relaxation training program or no treatment. Multiple BP measurements were made during the working hours, using an ambulatory monitoring device, before and after training. Significant work-site differences between groups were evident after treatment both for systolic and diastolic pressures. These results suggest that relaxation therapy leads to a reduction in BP that is evident in the natural environment, providing new evidence that the procedure is a useful adjunct to the treatment of hypertensive patients.
A meta-analysis of 102 studies was conducted to determine the effects of psychoeducational care on blood pressure (n = 89), knowledge about hypertension (n = 30), medication compliance (n = 23), weight (n = 16), compliance with health care appointments (n = 11), and anxiety (n = 6). Small- to medium-sized statistically significant beneficial effects were found on blood pressure for several types of psychoeducational care (education only, behavioral monitoring only, and relaxation). However, in the better controlled studies, the effect of relaxation on blood pressure was much smaller and not statistically significant. Statistically significant large treatment effects were obtained on knowledge, medication compliance, and compliance with health care appointments. Threats to validity limited conclusions about the effects of psychoeducational care on the weight and anxiety of adults with hypertension.
Psychological, emotional, and behavioral events result in physiologic changes. By appropriate use of behavioral interventions, desirable physiologic alterations may be made. For example, use of certain simple behavioral techniques lead to elicitation of the relaxation response and its corresponding decreased sympathetic nervous system activity. Organic diseases may be treated by such non-pharmacologic interventions, linking the traditionally separate disciplines of psychiatry and internal medicine.
Six patients, with surgically implanted tantalum myocardial markers, were trained in deep muscle relaxation therapy. Analysis of individual responses and group means of blood pressure and ventricular dimensions during relaxation showed a decrease in plasma norepinephrine levels and indices of myocardial contractility compared to the control state. Heart rate changes in individuals during relaxation were directly correlated with changes in plasma norepinephrine levels, although group means for heart rate did not change significantly between control and relaxation periods. Base-line plasma norepinephrine levels were directly correlated with systolic blood pressure and were inveresly correlated with a measure of myocardial contractility. These data suggest that physiological changes during relaxation may be mediated through the sympathetic nervous system.