RELAXATION THEORY AND PRACTICE RELAXATION THEORY AND PRACTICE1 DIANA ELTON, G. D. BURROWS AND G. V. STANLEY University of Melbourne SUMMARY This paper reviews the theoretical aspects of clinical use of relaxation and the pr.oblems inherent in its applicatio..n in a h03pital setting. It discusses, the relative usefulness of relaxation procedures in va.rious conditions. 1'his includes the advantages versus the disadvantages of group practice, the use of audio casettes, specificity of instructions and inteTdisciplinary aspects 01 patient care. Some guidelines are p\Tovided for the practice of relaxation by physiotherapists. INTRODUCTION of relaxation in treatment of many conditions. We live in an anxiety provoking world. Generally the medical profession has been Each individual may daily face challenges, slow in adopting these approaches. for which there may be little or no solution. In recent times, there has been a growing Mechanization may rob pride of work and interest in relaxation, as a means of dealing individuality. A person could become a slave with tension and anxiety and of generally to the clock, in a constant rush to keep abreast improving the patients' well-being. It has of commitments: "the inability to relax is attracted the attention of several professions: one of the most widely spread diseases of our 1. Psychiatrists are using it more fre­ time and one of the most infrequently recog.. quently in dealing with conditions where the nized" (Jones, 1953). predominant component is anxiety. Those who .A.nxiety often presents in a variety of practise hypnotherapy often adopt relaxation bodily, behavioural and psychological ways. as a standard induction procedure. Every day doctors see tense patients whose 2. Psychologists, and particularly the be­ anxiety may he <manifested by many com.. havioural scientists (Wolpe, 1958 & Rachman, plaints, such as tension headaches, arthritis, 1965), use relaxation as a part and as an ulcers, spastic colon, neurasthenia.. A busy adjunct to the systematic desensitization in doctor may be rushed to prescribe medication the treatment of phobias, other neuroses, and having insufficient time to establish the ante.. behaviour disorders. Lomont & Edwards cedent causes of these complaints. (1967) stated that "relaxation is crucial The use of relaxation in treatment of to systematic desensitization". medical conditions -is not new. In former days 3. Recently the popularity of hypnosis and doctors prescribed "rest" which could be bio-feedback has led some general practition­ variously interpreted, but which basically in­ ers to use these methods to train their patients cluded relaxation. The difference here is that in relaxation. Other medical practitioners are "rest" involved passive use of relaxation, while still oriented mainly to chemotherapy. modern approaches prefer a dynamic, self.. regulating approach to relaxation. Jacobson 4. Occupational therapists in the psychiat.. (1938) attempted to place relaxation on a ric field often use group relaxation treatment scientific basis and to make it a standard to handle a variety of disorders, such as form of medical treatment" He has shown anxiety, cardio-vascular problems, gastroin.. clinically and experimentally the usefulness testinal problems and !o forth. Although they treat mainly neuroses, some patients suffering 1Received March, 1977 .. from psychoses may occasionally be included Aust.l.Physiother., XXIV, 3, September, 1978 144 THE AUSTRALIAN JOURNAL OF PHYSIOTHERAPY in the group4 Many occupational therapists resides entirely in the brain and the nervous insist on detailed assessment of their patients system. There are muscular tensions associ­ prior to admission to a relaxation group4 ated with all mental processes, such as 5.. Physiotherapists have used relaxation imagery, attention, cognition and so on. When principles for years. They employ them in the an ·organ is active, the muscles which control practice of obstetrics when teaching their it are also active. The sensations from con­ trolling muscles evidently play a useful part patients the "natural childbirth" methods 4 They also use relaxation as a standard form of in mental processes. Without a faint tenseness treatment of asthma and other respiratory neither imagery nor thought would be sus­ conditions, since it is believed to help pre.. tained. There is a reciprocal interaction be­ vent bronchial constriction. Some physio.. tween the tonus in skeletal muscles and in the therapists employ relaxation methods also in smooth muscles of the viscera. This tonus orthopaedic, thoracic and neurological fields, affects the higher nervous system and therefore as an adjunct to other forms of treatment. the tension is associated with emotion. This practice is not followed by other uses Emotional processes cannot exist unless they of physiotherapeutic techniques. That is re.. are accompanied by muscular tension. Relax­ grettahle, since, "relaxation should be the ation, that is, the diminution of the tension, keystone of all physiotherapeutic treatment" must bring with it a diminution of emotional (Jones op. cit.). or mental processes. Jacohson has demon.. strated, both clinically and experimentally, Interest in relaxation is shared by many evidence for his theory. Further evidence to different professions, all dealing with similar support his views comes from the behavioural patient populations.. This is of particular scientists. Wolpe (op. cit) showed that relax.. importance to the physiotherapist, who may ation was an essential part of systematic be called upon in the future to offer more desensitization, because it was antithetical to widespread services, involving relaxation tension states. Hay and Madders (1971) dem.. training, to a variety of patients. As the onstrated that relaxation therapy coupled appreciation of the use of relaxation techni­ with a discussion group was successful in re.. ques grows, so will the demand for its lieving migraine headaches (presumably practitioners. To meet that demand the partly due to tension) in 69 out of 98 physiotherapist may require greater knowledge patients. of the theories underlying the practice of re.. laxation, the variety of methods of its use, Jacohson's theory may be criticized: and of the possible reasons for its effectiveness 1. He 'focused only on the neuro..musculo.. as well as the need for selectivity in acceptance sensory interaction, and did not consider of patients into such training. This paper dis.. mental relaxation, which to him was the cusses some of these issues. obvious outcome of the physical relaxatioD4 Rachman (Opr. cit.) opposed this and argued THEORETICAL CONCEPTS that therapeutically the most useful component While the empirical usefulness of relaxation of relaxation was the resultant "mental calm.. techniques seems obvious, they are more ness". Mental calmness can he achieved even difficult to explain conceptually. Various without muscular relaxation, by the use of factors require consideration: pleasant imagery, or by concentration on words such as "calm, calm" or "relax, Relaxation and Neuromuscular Control relax". Further evidence of the importance of Jacobson (op. cit.) stated that neuro.. mental relaxation comes from the studies of muscular patterns are an essential part of the Yoga, Transcendental Meditation and other mental and emotional activities of an individ­ forms of mental self·controL ual. The energy expended in a neuromuscular 2.. Lader and Wing (1966) demonstrated activity is identical with and not a transform­ that there were occurrences of bursts of ation of the energy of the corresponding electromyographic activity in muscles during mental and emotional activity. Jacobson a relaxation session, although the subject re· argued that it is a fallacy that human ideation ported himself to be quite relaxed. Aust.J.Physiother., XXIV, 3, September, 1978 RELAXATION THEORY AND PRACTICE 145 3. Davison (1966) has shown that sub­ anxiety. This was supported by Shor (1962) jects who were injected with curare, a sub­ and others. The other important features of stance which produces complete relaxation of hypnosis are the use of suggestion and all the skeletal muscles, experienced a great imagery, alteration of attention and dissoci" deal of anxiety during this procedure. ation. These components are also used to a degree in relaxation training. Although re· 4. Jacobson did not consider the import­ laxation may he part of hypnosis, it is difficult ance of suggestion in the relaxation pro­ to determine when the relaxation ends and cedures, yet it is vitally important, as shown hypnotic trance state occurs, since many of studies of hypnotic analgesia (Hilgard, by the techniques used to achieve both are similar. 1969) . Some of the patients, particularly those who Relaxation and the Placebo Effect are good hypnotic subjects, may enter into a hypnotic trance just the use of relaxation It is difficult to consider any form of by training. It is useful to observe certain signs psychological approach to patients without of the hypnotic trance, such as the acknowledging the "placebo effect". The sur­ eyelid flutter, change in breathing, muscular relax­ prising effectiveness of placebos in relief ation, to determine what happens to each from pain is well known. Beecher (1959) individual in a "relaxed" state. showed that 35% of pain patients received relief from placebos and only 65% of pain In summary, when considering theories -of patients received relief from morphine. relaxation, variables include: neuromuscular