Relaxation TechniquesFrom Rakel RE (ed): Principles of family practice, ed 6, Philadelphia, 2002, WB Saunders.Relaxation TechniqueSummaryFurther ResourcesBreathing exerciseThis is the foundation of most relaxation techniques. Have patients place one hand on the chest and the other on the abdomen. Instruct them to take a slow, deep breath, as if they were sucking in all the air in the room. While doing this, the hand on the abdomen should rise higher than the hand on the chest. This promotes diaphragmatic breathing that increases alveolar expansion in the bases of the lungs. Have them hold the breath for a count of 7 and then exhale. Exhalation should take twice as long as inhalation. Repeat this for a total of five breaths, and encourage patients to do this three times a day.Conscious Breathing by Gay Hendricks is one of many good resources on using breathing for relaxation and health.MeditationTranscendental/The relaxation responseTo prevent distracting thoughts, the subject repeats a mantra (a word or sound) over and over again while sitting in a comfortable position. If a distracting thought comes to mind, it is accepted and let go, with the mind focusing again on the mantra.www.mindbody.harvard.edu or The Relaxation Response by Herbert Benson; www.tm.org for information on transcendental meditation.Mindful meditationThis represents the philosophy of living in the present or in the moment. The body scan is one technique where the subject uses breathing to obtain a relaxed state while lying or sitting. The mind progressively focuses on different parts of the body, where it feels any and all sensations intentionally but nonjudgmentally before moving on to another part of the body. A patient with back pain may focus on the quality and characteristics of the pain as if to better understand it and bring it under control.Full Catastrophe Living by Jon Kabat-Zinn describes this technique in full and the program for stress reduction at the University of Massachusetts Medical Center.Centering prayerThis is a form similar to transcendental meditation that has a more religious foundation. The subject repeats a “sacred word” similar to a mantra. As thoughts come to mind, they are accepted and let go, clearing the mind to become more centered on the spirit within, as if the mind’s preoccupied thoughts are the layers of an onion that are peeled away, allowing better understanding of the spirit at the core.www.Centeringprayer.com; look under “method of centering prayer” for a nondenominational discussion.Progressive muscle relaxation (PMR)A form of relaxation in which the subject is attuned to the difference in feeling when the muscles are tensed and then relaxed. In a comfortable position, start by tensing the whole body from head to toe. While doing this, notice the feelings of tightness. Take a deep breath in and as you let it out, let the tension release and the muscles relax. This is then followed by progressive tension and relaxation throughout the body. One may start by clenching the fists and then tensing the arms, shoulders, chest, abdomen, hips, legs, and so on, with each step followed by relaxation.www.uaex.edu/publications/pub/fshei28.htm is a good review of PMR as well as other relaxation exercises. It is sponsored by the University of Arkansas.You Must Relax is a book by the founder of this technique, Edmund Jacobson.Visualization/Self-hypnosisThe subject uses visualization to recruit images that create a relaxed state. For example, if a person is anxious, visualizing images of a place and a time that were peaceful and comforting would help induce relaxation. This is best used in conjunction with a breathing exercise.There are many audiocassettes that can guide people through a visualization “script” that can result in relaxation. Emmett Miller is one well-known author.Autogenic trainingThis induces a physiologic response by using simple phrases. For example, “My legs are heavy and warm” is meant to increase the blood flow to this area, resulting in relaxation. This is done progressively from head to toe with the use of deep breathing and repetition of the phrase. After completing this, focus attention on any body part that may still be tense, and then focus the breath and phrase to that area until the whole body is relaxed.The British Autogenic Society at www.autogenictherapy.org.uk is a good resource for more information.Exercise/MovementAerobicWhile performing an aerobic exercise, focus attention on a phrase, sound, word, or prayer and passively disregard other thoughts that may enter the mind. Some may focus on their breathing, saying to themselves, “In” with inhalation and “Out” with exhalation, or repeating “one-two, one-two” with each step they take with jogging. Doing this will help the mind focus, preventing other thoughts that may cause tension.Beyond the Relaxation Response by Herbert Benson includes discussion of his research on inducing the relaxation response while exercising.YogaThis has been practiced for thousands of years in India. In America, it has been divided into three aspects: breathing (pranayama yoga), bodily postures or asanas (hatha yoga), and meditation to maintain balance and health. Regular practice induces relaxation.For the following therapies, it is best to encourage patients to take a class at a local community center or gym and to pick up an introductory book at a library or bookstore.T’ai chiAn ancient Chinese martial art that uses slow, graceful movements combined with inner mindfulness and breathing techniques to help bring balance between the mind and body.See above.Qi gongA traditional Chinese practice that uses movement, meditation, and controlled breathing to balance the body’s vital energy force, Qi.See above.

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