Smith (2021) views relaxation as a component of a more expansive relaxation/meditation/mindfulness (RMM) construct. Relaxation, meditation, and mindfulness overlap.
There is a bit of relaxation in all of meditation and mindfulness. There is a bit of meditation and mindfulness in all of relaxation. Nearly all texts and training programs teach blends of RMM. Although different techniques clearly have a different pattern of effects, all can be placed on the same psychological map. All can evoke experiences from the same lexicon (Smith, 2017, 2019; pp. 39-40).
He states, "My definition is based on popular use; relaxation is what most professionals call relaxation" (p. 39). Examples of relaxation exercises are autogenic training, paced breathing, progressive muscle relaxation, tai chi, visualization, and yoga (Smith, 1985, 1986, 1990, 1999, 2001, 2005, 2017, 2019).
For Smith, the core element of meditation is "sustaining quiet, simple focus (Smith, 2017, 2019)" (p. 39). Focused attention (FA) meditation (Lutz et al., 2015) concentrates on one stimulus (e.g., breathing sensations). Mindfulness meditation "involves quietly attending to the flow of all stimuli (or restricted domain of stimuli, such as sounds) as a neutral observer" (p. 39).
Biofeedback is not relaxation; it is information about your body and its performance.
Although consumers and clinicians sometimes conflate biofeedback with relaxation, they can be completely separate.
In biofeedback-assisted relaxation training (BART), clinicians combine biofeedback with relaxation exercises to teach clients to relax. BART can use individual or combined biofeedback modalities to reinforce relaxation exercises like Autogenics, guided imagery, mindfulness meditation, paced breathing, and Progressive Relaxation (Moss, 2020).
"a high percentage of biofeedback treatment follows a stress-relaxation model, in which the purpose of biofeedback training is to cultivate a relaxed state and counteract the effects of chronic situational and personal stress (Moss, 2020)."
Relaxation practices are diverse and vary in their degree of structure. Discover the relaxing activities your client already enjoys and build on them.
This unit addresses Relaxation methods: Procedures, indications and contraindications (VII-B), and The effects of exercise on mood, physiological functioning, and presenting symptoms (VII-F).
This unit covers Relaxation Myths, Two Road Maps for Self-Relaxation, Procedures That Produce Deep and Moderate Relaxation, Autogenic Training, Progressive Relaxation, Visualization, Meditation, Hypnosis, the Quieting Response, Nutrition, and Physical Exercise.
Please click on the podcast icon below to hear a full-length lecture.
Relaxation Myths
Both clients and therapists share misconceptions about relaxation. These include:
1. Relaxation is like being deeply asleep,
2. All relaxation procedures produce the same relaxed state,
3. You must make yourself relax.
4. We've administered "autogenic training"
Correcting these misconceptions is crucial for effective treatment.
Relaxation training should teach clients to achieve a state of
calm
alertness instead of drowsiness. Relaxation practice should improve your performance when
driving, presenting a talk, or hitting a golf ball.
All Relaxation Procedures Produce the Same Relaxed State
When we administer a psychophysiological profile to a new client, we
often see some systems within normal limits and others one or more
standard deviations outside clinical norms. Each client has a
personalized response stereotypy (unique psychophysiological response
pattern): blood pressure and heart rate might be elevated while skin
conductance level and upper trapezius muscle contraction are normal.
Mild and moderate stressors do not produce unidimensional physiological
changes. Stressors will trigger changes in some systems but not others:
blood pressure and heart rate may rise while skin conductance and upper
trapezius EMG do not change. This illustrates the concept of response
fractionation in which body systems react independently to stressors. Stress responses are
multidimensional.
If your client's response to stressors is unique and multidimensional,
their response to a relaxation procedure will also be unique
and multidimensional. For example, a progressive relaxation exercise
(focus on the tension in your forearm and then let it go) may lower blood
pressure and heart rate and not change skin conductance and upper
trapezius EMG. In contrast, a visualization exercise ("imagine yourself
lying on warm sand") may lower state anxiety and not change blood
pressure, heart rate, skin conductance, or upper trapezius EMG.
Relaxation procedures produce complex changes in each client; there is
no generic relaxed state.
You Must Make Yourself Relax
A client's strategy during relaxation practice can result in clinical
success or failure. When we introduce a relaxation exercise to lower
blood pressure, clients should not practice it in a way that
triggers vagal withdrawal, paradoxically raising their blood pressure.
Although active
volition (instructing muscles to contract) can play a valuable role in progressive muscle relaxation procedures, excessive effort can backfire. Shaffer et al. (2002) reported that high effort in
autogenic training (AT) and progressive muscle relaxation (PMR) procedures caused unwanted
physiological changes. Effort can trigger overbreathing and suppress the parasympathetic branch, producing vagal withdrawal (Khazan, 2019).
Therapists should remind their clients that relaxation is a state of
calm alertness and that you cannot be calm when you force yourself to
relax. Instead, therapists should encourage their clients to use
passive
volition, where they visualize a desired change and then allow their
bodies to make the change at their own pace.
We've Administered "Autogenic Training"
Researchers often administer abbreviated versions of AT and PMR and then draw
conclusions about the effectiveness of these techniques. They may leave out crucial elements of the original
procedure, provide significantly less training time in session length and the number of sessions, lack
expertise in teaching the method, and play recorded relaxation instructions instead of offering live
interactive training.
There are three issues. First, they should not be surprised when "crippled" versions of procedures originally taught over months or years do not produce the profound changes reported by their developers. Second, relaxation training success is greatly influenced by trainer skill and personality
(Taub's "person effect"), just like athletic coaching success. Don't blame the tools. Third, recorded
instructions have less impact than live instructions and cannot be adjusted to help clients overcome difficulties
during a training session.
TWO ROAD MAPS FOR SELF-RELAXATION
Smith (2016) proposed two self-relaxation road maps, self-stressing theory and psychological relaxation theory.
Self-Stressing Theory
Self-stressing theory proposes that we initiate and perpetuate a "fight-or-flight" response in six ways: stressed posture and position, skeletal muscles, breathing, body focus (rapid breathing), emotion (anxiety), and attention (worrying about a threat).
Smith (2016) argued that the diverse self-relaxation strategies attempt to remedy these forms of self-stressing. A single family group may address more than one self-stressing mechanism.
The table below is reproduced from Smith (2016).
Psychological Relaxation Theory
Based on 31 published factor analytic studies and surveys of over 40 RMM techniques,
Smith (2021) grouped 25 relaxation states
(RMM states) into 6 levels. Several RMM exercises may produce the same subjective state. We recommend that professionals purchase Lehrer and Woolfolk's authoritative Principles and Practice of Stress Management (4th ed.) and read Smith's Overview of Stress and Stress Management in its entirety.
Smith
characterized RMM theory this way:
My approach is not narrow-spectrum; it does not focus on a homogenous, static outcome state or trait (e.g., the relaxation response, focused awareness, or nonjudgmental acceptance). Instead, my approach is broad-spectrum and based on four ideas: (1) RMM has many defining effects, (2) these effects inform and influence each other, (3) they change over time, and (4) this change is not random or circular but evolves in a direction that is decreasingly self-referential and increasingly deep and encompassing. Simply, my broad-spectrum model is multidimensional, interactive, dynamic, and directional (for an elaboration, see Smith, 2017, 2019) (pp. 40-41).
The table below is reproduced from Smith (2021).
Smith (2021) argued that RMM states powerfully reinforce the initiation and maintenance of relaxation practice and are
crucial to positive relaxation experiences. They enable clients to communicate their relaxation goals and experiences and incorporate relaxation into their daily lives.
Procedures That Produce Deep and Moderate Relaxation
Relaxation training combines deep relaxation and abbreviated relaxation
procedures. We can categorize relaxation procedures in terms
of subjective and physiological change, degree of sensory restriction,
and length of practice.
Autogenic
training (AT), progressive muscle relaxation (PMR), visualization, transcendental meditation (TM), clinically
standardized meditation (CSM), and hypnosis can help clients achieve deep relaxation. They
produce moderate-to-strong subjective and physiological changes, involve moderate-to-high sensory restriction, and are practiced for intermediate-to-long periods.
Abbreviated relaxation procedures like the Quieting Response (QR) produce mild-to-moderate subjective and physiological change, involve minimal sensory restriction, and are practiced for very brief periods.
Deep relaxation exercises
may help counter allostatic load and reset
body setpoints for blood pressure, muscle contraction, and stress hormone
levels. Finally, the belief that relaxation practice has been successful
may increase your clients' perception of self-efficacy (personal
effectiveness) and result in an internal shift in their locus of control
(perceived cause of individual outcomes like health and illness).
These exercises may create a relaxation template, help clients develop an automatic relaxation response, help clients counter changes produced by distress and reset body setpoints, and increase perceived self-efficacy and internally shift their locus of control.
Abbreviated relaxation procedures help clients transfer relaxation
skills to their environment by making relaxation automatic. A stress
response is a habit that has become automatic after months to decades of
practice.
Although you should protect your initial relaxation practice from disruption by environmental stimuli (e.g., noise), generalization requires that you gradually expose yourself to mild distractions like TV, the calico kitten.
A relaxation skill is also a habit, but it is so new that its practice initially requires conscious supervision. The more clients
practice a relaxation skill, the stronger this habit becomes. After about
6 months, clients may automatically replace a fight-or-flight response
with relaxation when they encounter stressors (traffic slowdown).
Abbreviated relaxation exercises may complement deep relaxation exercises
in countering cumulative changes produced by distress. These exercises may also help reset body setpoints, increase perceived self-efficacy, and internally shift your clients' locus of control.
To summarize, abbreviated relaxation exercises may help clients transfer relaxation skills to their environment, develop an automatic relaxation response, counter changes produced by distress and reset body setpoints, and increase perceived self-efficacy and shift their locus of control internally.
The Relationship of Biofeedback to Relaxation Training
There can be a remarkable synergy between biofeedback and relaxation
training. In BART, biofeedback helps clients refine their relaxation skills by
guiding their practice with knowledge of results. Feedback immediately
shows clients when relaxation strategies succeed or fail. Biofeedback
provides objective, quantifiable evidence of
performance success. Clients often trust physiological measurements more than
their perception of improvement. Measurements in microvolts seem more
real to them. This information can reassure clients that they have made
progress, increase their motivation to practice, and help them
continuously refine their relaxation skills.
Relaxation training, in turn, helps clients transfer self-regulation
skills learned through biofeedback to their environment. Forty minutes a
week of biofeedback training cannot change client stress responses by
itself. These 40 minutes must counter the stressors encountered during
about 10,000 waking minutes each week. Biofeedback training does not have
a chance of changing clients' stress responses without weekly relaxation
practice. Biofeedback research has consistently shown that successful
clinical and performance outcomes require regular—but not daily—relaxation practice.
Autogenic Training
Johannes Schultz (1884-1970), a German neurologist and Nazi, developed AT during the 1920s based on clinical hypnosis research (Schaefgen,
1984). Schultz described clinical applications of AT to
the Medical Society in 1926 and published his first book, Das Autogene
Training, in 1932.
Wolfgang Luthe, a German-born psychiatrist who was
Schultz's student and collaborator, introduced AT to
English-speaking professionals. Luthe translated Das Autogene Training
into English in 1959 and co-authored a six-volume English series on
AT from 1969 to 1973 (Suter, 1986).
Schultz observed that deep relaxation and falling asleep are
associated with sensations of limb heaviness and warmth. AT assumes that this process is bidirectional. Passively imagining
heaviness and warmth can produce a deeply relaxed state. AT requires passive concentration, free of effort or
goal direction.
Luthe believed that visualization is crucial to achieving self-regulation in AT.
From Luthe's perspective, passive concentration reduces cortical
interference with maintaining homeostasis by subcortical structures.
The transition to a passive, pre-sleep, hypnagogic autogenic state is
called autogenic shift. The challenge is to maintain the autogenic state
without falling asleep. A client walks a tightrope between active
attention and sleep (Luthe, 1979). Check BodyMindPower video Autogenic Training - A Guided Relaxation for a Deep and Restful Sleep.
Autogenic Therapy
AT is a sequence of six standard
exercises, autogenic modification, and autogenic meditation. Therapists
often use complete or abbreviated versions of the standard exercises. They frequently dispense with autogenic modification and autogenic meditation. Training
can be individual or in a group setting. The environment should be
comfortable with minimal distraction. A client should sit or lie
comfortably with good neck and leg support. The ideal position is
lying supine on a couch since this minimizes muscle tension and promotes
drowsiness. The room should be slightly darkened (Linden, 1990).
Six Standard Exercises
The six standard exercises focus on physiological changes. A therapist
prepares the client for the first exercise by reviewing its rationale,
the learning process, common experiences, and the mechanics of autogenic
training. Each standard exercise consists of a relaxation theme
("heaviness") a client subvocally repeats while visualizing that they are lying or sitting in a comfortable environment like a beach or a
meadow (Schultz & Luthe, 1969). A passive attitude is the most crucial
element. A relaxed position, conducive environment, and visualization are
also important.
AT consists of six relaxation themes.
AT's heaviness and warmth standard exercises (themes 1-2) are divided
into
seven parts.
The remaining standard exercises (themes 3-6) consist of only one relaxation
component. In total, the six standard exercises consist of 18
components. The European practice of 1-2 sessions per component requires
almost 6 months to complete these exercises (Lichstein, 1988). American
clinicians sharply abbreviate autogenic exercises (Pikoff, 1984), often
providing less than one hour of training.
Each training session starts with the formula, "I am at peace." The initial
practice may be as brief as 30 seconds per relaxation component (for a
total of 9 minutes for one standard exercise). A client may extend
performing a component to over 30 minutes as their skill increases.
Standard exercises end with taking back procedures: vigorously flexing
the arms, deep breathing, and opening the eyes: "Arms firm, breathe
deeply, open eyes" (Linden, 1990).
Autogenic Modification
Autogenic modificationprocedures are used when a
symptom like low back
pain does not respond to the practice of the six standard exercises.
Following a client's mastery of the standard exercises, a therapist may
introduce organ-specific formulae or intentional formulae.
Organ-specific
formulae modify standard exercise themes (heaviness, warmth, calm and
regular heartbeat, and coolness) to treat client symptoms ("My back is
warm"). Intentional formulae, which may be reinforcing or neutralizing,
increase or decrease behaviors. Reinforcing formulae motivate
action ("I am energetic and will practice harder"). Neutralizing formulae
reduce self-defeating statements ("My job frustration does not matter").
Autogenic Meditation
Seven autogenic meditation exercises improve visual imagery
skills after a client has mastered the six standard exercises. These
exercises are designed to assist clients who find visualization hard.
The exercise sequence is arranged in increasing difficulty. The client
should follow the established order and only advance after
mastering an exercise.
A client's visualization skills determine their rate of mastery.
Moderate-ability clients may master all seven exercises in one or two
sessions; others may require a month per exercise (Lichstein, 1988).
Physiological Effects
Eighty studies have demonstrated that autogenic training increases skin temperature and peripheral blood flow.
Vasodilation becomes apparent during the "heaviness" phrases and
increases during the "warmth" exercises. The temperature increases often followed the anatomical focus
of the "warmth" exercises (Lichstein, 1988).
These studies challenged Freedman and colleagues' (1983) conclusion
that AT does not produce hand-warming. The authors assigned Raynaud's clients to listen to 3
minutes of tape-recorded instructions followed by the repetition of the phrase, "My hands are warm and heavy"
for 13 minutes over 10 biweekly sessions. These clients did not increase their hand temperature.
Freedman and colleagues' conclusion was indefensible for two reasons. First, they did not use traditional
AT. Instead, they used a crippled version that had failed to produce hand-warming in a previous
study by Surwit and colleagues (1978). Second, their findings can't be generalized to all individuals since they
were based on Raynaud's clients, who suffered from compromised peripheral blood flow.
AT Efficacy
Quantitative, meta-analytic findings indicated that AT was associated with medium-sized pre-to posttreatment effects ranging from d = –0.43 for biological indices of change to d = –0.58 for psychological indices in the Linden (1994) review, and d = –0.68 (biological indices) and d = –0.75 (psychological outcomes) in the Stetter and Kupper review (2002). The pooled effect size estimates hide considerable variability in behavioral/psychological effects for individual target problems; moderately sized improvements were reported for tension headache and migraine, hypertension, coronary heart disease rehabilitation, asthma, somatoform pain disorder, Raynaud’s disease, and anxiety and sleep disorders (Linden, 2021, p. 546).
Progressive Relaxation
Edmund Jacobson (1888-1973) received training as a research
physiologist and physician. Jacobson started using PMR
in clinical cases about 1918 and published case histories in two 1920s
articles (Jacobson, 1920, 1924). His most significant research productivity was
between 1925 and 1940, when he studied the psychophysiology of progressive
relaxation. During this period, he published the classic texts Progressive
Relaxation (Jacobson, 1929) and You Must Relax (Jacobson, 1934).
PMR was not widely used until Wolpe incorporated an
abbreviated version of this procedure in systematic desensitization. Wolpe
designed this behavior therapy procedure to treat phobic disorders. Wolpe
(1958) and Goldfried (1971) condensed Jacobson's standard
procedure, which covered 50 muscle groups in 3-6 months of training. Wolpe's version trains about 15 muscle groups
in 20 minutes (Lichstein,
1988).
Jacobson observed that clients maintain tension not required to perform
a task (clenching teeth when writing a check) and are often
unaware of that tension. He also discovered using electromyography that
muscles usually do not relax even when we lie down. Jacobson theorized that
unconscious muscle bracing wastes energy, disrupts performance, and
produces stress disorders (Jacobson, 1929). He also asserted that anxiety
is correlated with muscle tension, so muscle relaxation reduces
anxiety.
Research has shown that the relationship between muscle tension, stress disorders, and anxiety is complex. Muscle tension may be a
byproduct of an underlying disease instead of the cause (Suter, 1984).
Jacobson's original procedure trained clients to relax 2 or 3 muscle
groups each session until 50 groups were trained. Several sessions might
focus on a single difficult muscle group before moving to successive
groups. Jacobson's approach was time-intensive, requiring 50-60 sessions
in the clinic and 1-2 daily one-hour practice sessions (Suter, 1984).
Studies do not show a difference in outcome between Jacobson's original
PMR protocol and modern condensed versions (Snow,
1977; Turner, 1978).
In contrast to current protocols in which clients tense and relax muscle
groups, Jacobson only asked clients to produce minimal muscle tension
early in training. Jacobson's clients mainly employed passive relaxation
in which they simply focused on muscle sensations (Lichstein, 1988). For
Jacobson, the objectives of progressive relaxation were the development of
muscle sense (awareness of muscle tension) and the reduction of useless
residual tension. After eliminating residual tension, Jacobson encouraged his clients to develop differential relaxation skills, inhibiting unneeded muscle groups during routine activities. Check out the YouTube video Progressive Muscle Relaxation.
Popular PMR protocols are no more standardized than
their autogenic counterparts. There are significant procedural differences (Lichstein, 1988). Watch the University of Toledo video Progressive Muscle Relaxation.
As in AT, clients may be trained individually or in
groups. Also, a client reclines or sits in a slightly darkened room
with eyes closed. For a conventional protocol covering 16 muscle groups,
a client might tense for 7 seconds and relax for 45 seconds. The
training sequence may be revised to accommodate a client's needs. Before training, a therapist should question each client to exclude already relaxed muscle groups and identify problem groups. Spastic or strained
muscle groups may be skipped, or the tension level may be passively
observed (without additional tensing). A therapist may repeat the
tense-relax cycle two or three times for difficult muscle groups
(Lichstein, 1988).
PMR Efficacy
Jacobson’s clinical applications of progressive relaxation are impressive indeed. However, there apparently are no experimental (vs. clinical) data that validate the method, probably because of the extensive methodological difficulties in conducting an experiment...Although the literature on various forms of relaxation therapy is impressive, descriptions of the length and nature of training indicate either that the research has not used Jacobson’s progressive relaxation procedure or that this procedure has been confounded with other methods (McGuigan & Lehrer, 2021).
Visualization
Kenneth Pelletier's (1977) classic text Mind as Healer, Mind as Slayer proposed that mental imagery can produce harmful or beneficial physiological changes. Negative imagery can increase blood
pressure, heart rate, muscle contraction, and pain.
Visualization, in which a client
generates mental imagery that can be somatosensory and visual, is a common element in interventions ranging
from autogenic training to behavior therapy. The vivid images created during visualization can help relaxation (standard autogenic exercises), prepare an individual to cope with stressful situations (mental rehearsal), and reduce symptoms such as anxiety, back pain, headache, hypertension, and ulcers. There are marked individual
differences in visualization ability, and this capacity may overlap with
hypnotic susceptibility. High-hypnotizable individuals who are gifted visualizers may achieve the best results using this strategy (Moss,
2004). Watch the University of Houston at Clear Lake White Cloud Visualization video.
Transcendental meditation (TM) is a
form of mantric meditation in which an individual repeats Sanskrit
syllables that have been assigned by an instructor based on age or
personality.
Benson (1975)
identified four components that TM shares with other deep relaxation
procedures: a "quiet environment, mental device, passive attitude, and
comfortable position" (pp. 112-113). Benson developed a secularized
version of TM, called the Relaxation Response, that incorporated these four
elements and recommended that
clients practice 1-2 times daily for 10-20 minutes. Watch the Relaxation Response: Dr. Herbert Benson Teaches You The Basics video.
Early TM
hypertension studies lacked control groups, involved single-group
pre-test-post-test designs, and yielded mixed results. Controlled trials
of Benson's meditative procedure have not demonstrated
clinically significant blood pressure changes in hypertensive
individuals (Lichstein, 1988). Check out the 5 min Mantra Meditation for Beginners - Easy Guided Meditation.
Clinically Standardized Meditation (CSM)
Clinically standardized meditation (CSM)
is a systematic secular meditative procedure incorporating
components from meditative techniques like TM. A meditator selects or
creates a mantra (soothing sound), repeats it aloud with the instructor
and then alone, whispers it, and then mentally (silently) repeats it
with eyes closed. Both the instructor and trainee meditate seated with
eyes closed for 10 minutes, after which the trainee gradually returns to ordinary consciousness over 1-2 minutes. An instructor answers the
student's questions about using this meditative technique and then
instructs them to meditate alone for a specified period
(10-20 minutes) after the instructor leaves the room. The student
completes a questionnaire following meditation which is reviewed with
the instructor. Then the instructor teaches the following week's
meditative exercise and reviews how to control negative side effects.
Meditation practice is prescribed twice daily for about 20 minutes and
may be shortened if the student experiences adverse side effects
(Lehrer & Carrington, 2003).
Mantric Meditation Efficacy
Several meta-analyses of the data have been reported (Ooi, Giovino, & Pak, 2017;
Park & Han, 2017; Shi et al., 2017), and these reviews generally confirm the earlier findings that mantra meditation is of decided value for health and emotional stability. These studies frequently call for more rigor in the design of studies and ask for larger samples. This is sound advice, except for the fact that funding for research on meditation is not easy to come by due to its seemingly esoteric nature, which still marks it as somewhat outside of the commonly accepted parameters. For this reason, research funds for more elaborate studies may not be readily obtainable. Hopefully, adequate support will bring forth such larger studies in the future.
PTSD is a notoriously difficult area to study due to the difficulties in pinning down the diagnosis and acquiring a suitable population for study, for follow-up, and for obtaining reliable outcome measures. Despite such difficulties, however, the general conclusion that mantra meditation can be highly effective in the treatment of many components of PTSD has been repeatedly confirmed (Kang et al., 2018; Metcalf et al, 2016; Cushing & Braun, 2018; Lang et al., 2012; Park & Han, 2017; Harne & Hiwale, 2018), and anxiety remains a major area in which mantra meditation seems to offer considerable clinical help (Cooney Roxbury, 2018; Travis et al., 2018) (Carrington & Lehrer, 2021, p. 403).
Mindfulness Interventions
Mindfulness is "preverbal awareness of the present moment with acceptance" (Germer, 2009). Clinicians have developed a family of mindfulness interventions over four decades, including Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Stress Reduction (Khazan, 2019). These interventions teach clients to be in the moment without action or judgment. Mindfulness is not relaxation but can enhance relaxation training as clients nonjudgmentally experience emotions, physical sensations, and thoughts. Check out the Comfort Care Mindfulness Meditation video.
Physical Changes
Lazar and colleagues (2005) used magnetic resonance imaging (MRI) to compare the thickness of the prefrontal cortex and right anterior insula in Buddhist Insight meditators and matched nonmeditators. They found that meditators had greater prefrontal cortical gray matter volume than the controls. This difference was greatest for older meditators and suggested that meditation may protect aging brains from apoptosis. Prefrontal cortex and right anterior insula volumes were positively correlated with years of meditation.
A systematic review (Gard et al., 2014) of 12 studies, including 6 randomized controlled trials, concluded that various types of meditation might protect against age-related cognitive decline.
Hölzel and colleagues' (2009) used MRI to measure gray matter changes in the amygdala. The investigators randomized participants to an 8-week mindfulness-based stress reduction (MBSR) intervention or a wait-list control condition. They measured amygdala volume and perceived stress scale (PSS) scores before and after the intervention. Participants who received MBSR training reported significant stress reductions correlated positively with decreased right basolateral amygdala gray matter volume.
However,
Kral et al. (2022) conducted an RCT that failed to replicate whole-brain or region-of-interest structural changes previously reported for an 8-week mindfulness-based stress reduction (MBSR) course in 218 meditation-naive participants. The authors highlighted the low statistical power of previous studies with sample sizes of 20 or less.
Mindfulness-Based Intervention (MBI) Efficacy
By mid-2013, a meta-analysis of MBIs drew on 209 studies (Khoury, Lecomte, Fortin, et al., 2013), showing comparable effects of MBIs to CBT and psychopharmacology and greater effects in comparison to other control conditions. Other meta-analyses are now showing effects for stress reduction in healthy individuals (Khoury, Sharma, Rush, & Fournier, 2015), in primary care (Demarzo et al., 2015), in older adults (Hazlett-Stevens, Singer, & Chong, 2018), and in the prison population (Shonin, Van Gordon, Slade, & Griffiths, 2013). An inclusive meta-analysis of psychiatric disorders (Goldberg, Tucker, Greene, Davidson, et al., 2018) examined efficacy by five types of control groups (from wait-list to evidence-based intervention), finding significant improved value both immediately after intervention and at follow-up for most comparisons, with MBIs being comparable to evidence-based alternatives. There are now enough meta-analyses in core areas for a meta-analysis of the meta-analytic studies (Gotink et al., 2015). With the focus primarily on MBSR and MBCT, results show significant improvement in depressive symptoms, anxiety, stress, quality of life, and general physical functioning (Kristeller, 2021, p. 423).
Hypnosis
The American Psychological Association's Division of Psychological
Hypnosis cautions that hypnosis "is not a type of therapy" but instead
"a procedure that can be used to facilitate therapy" (Kirsch et al.,
1999, p. 3). Instead of hypnotherapy,
which connotes an independent treatment like cognitive behavior therapy
(CBT), we should use the term "hypnotically-assisted psychotherapy"
(Moss, 2004, p. 37).
Researchers disagree on the clinical efficacy and nature of
hypnosis.
Barber (1996) views hypnosis as an altered state of
consciousness and contends that analgesia involves
negative hallucination where normal perception is
suppressed. Hilgard (1978)
hypothesized that the process of hypnotic
induction produces an altered state of consciousness in
susceptible individuals that allows them to create physiological
changes. Barber (1982)
conceptualizes hypnosis as a trait or relatively permanent
predisposition to respond to suggestion and believes that the hypnotic
process is not simply relaxation. He challenges the need for
hypnotic induction (promotion of a hypnotic state) and argues that individuals respond equally well
to suggestions without a trance state. Most hypnotherapists agree that
all hypnotic procedures involve
self-hypnosis (self-suggestion).
Hypnotic suggestibility
(responsiveness to suggestion) was measured originally by instruments like the
Stanford Hypnotic Susceptibility Scale and the Harvard Group Scale of Hypnotic Susceptibility. Clinicians can administer the recent Elkins Hypnotizability Scale more briefly than the hour required for the Stanford and Harvard scales while achieving relatively strong concurrent validity
with the older scales (Kekecs et al., 2016).
Moss and Willmarth (2019) described hypnotic ability as a relatively stable trait when measured over a lifetime. A study of monozygotic and dizygotic twins estimated that hypnotic susceptibility has a heritability index of 0.64 (Morgan, 1973). A heritability index estimates the percentage of variation due to genetic influences. Values close to 1.0 indicate strong genetic influence.
A 25-year longitudinal study (Piccione et al., 1989) reported test/re-test correlations of 0.64, 0.82, and 0.71 for measurements at 10, 15, and 25 years, respectively.
The distribution of this trait in the population is relatively normal, which means that there are individuals with very low and very high hypnotic ability. Moss and Willmarth (2019) caution that about 20% of patients may be poor candidates for medical hypnosis applications due to low hypnotic ability. Interventions to increase suggestibility do not help most of these individuals (Lynn et al., 2015). For this reason, therapists should measure client
suggestibility to determine whether to use a hypnotic procedure.
The Role for Biofeedback
Hypnosis can be effectively combined with biofeedback/neurotherapy (Moss, 2004). Wickramasekera (2003) proposed different roles for biofeedback with highly hypnotizable and medium-to-low hypnotizable individuals. He argued that highly hypnotizable clients will best respond to hypnotic procedures and that biofeedback can help illustrate the connection between mind and body. In contrast, medium-to-low hypnotizable clients are often better candidates for more intensive biofeedback training, which may increase their hypnotic susceptibility.
The Promise of Hypnosis in Integrative Healthcare
Most patients show moderate-to-high hypnotic ability and achieve comparable outcomes to validated medical interventions. Moss and Willmarth (2019) advocate inclusion of adjunctive hypnosis in integrative healthcare programs where its addition enhances treatment outcomes:
For this to happen, it is critical that the patient’s complaint be one for which there is a strong research base supporting the value of hypnotic treatment. There is good research support for the application of hypnosis for anxiety disorders, depression (including major depression), post-traumatic stress disorder, stress management, sleep disorders, smoking cessation, weight management and eating disorders, and the addictions. There is also strong research support for the use of hypnosis for acute and chronic pain, IBS, colitis, diabetes mellitus, hypertension, skin conditions including psoriasis, chemotherapy induced nausea, and pediatric problems such as anxiety, school phobia, and recurrent abdominal pain (Elkins, 2017; Nash & Barnier, 2008). (p. 500)
Hypnosis for Chronic Pain
Hypnotic treatment is more effective than placebo in producing
analgesia (insensitivity to pain) in highly
suggestible clients (Jacobs et al., 1995). However, clients
with low suggestibility respond to analgesic suggestions at the same
rate as they respond to placebos (Miller et al., 1991).
While researchers disagree about the mechanisms responsible for hypnotic
analgesia, there is convincing clinical evidence that hypnosis can
effectively treat acute and chronic pain.
A meta-analysis
(Montgomery et al., 2000) revealed that analgesic suggestions
reduced pain in about 75% of subjects and comparably reduced clinical
and experimental pain. Hypnotic procedures have been successfully used
in burn pain, cancer pain in children, childbirth discomfort, dental
pain, headache, low back pain, pain from sickle cell disease, and
surgical pain. These techniques are underutilized due to misconceptions
such as "hypnotized clients are unaware of their surroundings" (Brannon, Feist, & Updegraff,
2022).
Moss and Willmarth (2019) summarized
Patterson's review of hypnosis for chronic pain:
Similar to his table related to acute pain, Patterson (2010) presented a table related to chronic pain that included 14 controlled studies of hypnosis (12 randomized), in chronic conditions including fibromyalgia, headaches, cancer-related pain, back pain, and irritable bowel syndrome (IBS)-related pain. Again, all studies found that hypnosis was equal to or better than standard care treatments which included group support, biofeedback, medication, relaxation, Autogenic training, attention control and CBT. (p. 499)
Hypnosis for Surgical Patients
Moss and Willmarth summarized meta-analyses by Montgomery et al. (2002, 2007) on surgical applications of hypnosis:
Montgomery et al. reviewed 20 well-controlled research studies, using meta analytic techniques, and concluded that hypnosis is an effective adjunctive treatment for patients undergoing surgery.
The meta-analysis showed a broad beneficial impact of hypnosis with surgical patients, across outcome categories. Subjective measures such as anxiety and pain, objective measures such as analgesia use, physiological measures, recovery time, and treatment time, all showed comparable beneficial outcomes for patients in the groups receiving hypnosis. The patients in the hypnosis groups showed better medical and psychological outcomes than 89% of the patients who did not receive hypnosis. Later research by Montgomery et al. (2007) showed that not only could hypnosis reduce patients suffering, enhance healing, and optimize recovery time, but that the savings to the hospital were substantial, mainly in reduced time in surgery. (pp. 499-500)
Hypnosis as an Adjunct to CBT for Stress
Clinicians do not have to choose between CBT and hypnosis. Kirsch et al. (1995) reported compelling evidence that hypnosis can improve CBT efficacy.
The 18 studies that were analyzed in the Kirsch et al. (1995) report comprised 20
comparisons of hypnotic with nonhypnotic CBT groups, with a total of 90 effects and 577 participants. Larger positive effects tended to occur in larger samples. The average weighted effect was 0.66, so the average person receiving CBT in a hypnotic context did as well as the person at the 75th percentile or so of those receiving CBT without hypnosis.
Of these studies, Kirsch et al. (1995) identified 14 in which the only difference
between hypnotic and nonhypnotic conditions was the use of the word hypnosis during relaxation instructions and training. The average weighted effect size for interventions labeled hypnotic, compared with the same intervention without the label hypnosis, for these 14 studies was d = 0.63. Thus labeling an intervention as hypnotic increases its efficacy by more than half a standard deviation (Karlin, p. 560).
The Quieting Response
Stroebel developed the
Quieting Response (QR) abbreviated relaxation
exercise to counteract the fight-or-flight response.
The 6-second fight-or-flight response consists of four stages.
The 6-second QR consists of four corrective stages.
Stroebel recommended that clients learn the QR in eight
learning sessions scheduled about one week apart. The activities for each
session were described in QR: The Quieting Reflex (Stroebel, 1982). He
advised clients to initially practice the QR whenever
they experience annoyances, as many as 50-100 times a day. He cautioned
that it would take about 6 months for the QR to become
automatic. While 100-times-a-day practice might seem excessive, it only
involves 600 seconds or 10 minutes per day. Stroebel estimated that 80%
of clients practicing the QR achieve this level of
proficiency and continue using this technique after two years.
Stroebel explained that the 80% compliance rate was due to the minimal time
commitment required by the QR and the fact that clients
do not have to disrupt daily activities to perform this 6-second
exercise. "They controlled the technique; the technique did not control
them." (p. 82)
Relaxation Training Issues
Causes of Deep Relaxation Training Failures
No one knows the average quality of instruction in AT and
PMR when delivered as part of biofeedback
training. There are many reasons that deep relaxation training fails.
Recorded Relaxation Exercises
The professional can benefit from recorded relaxation exercises because
they conserve training time, increase flexibility regarding when and
where the client can practice, reduce the professional's burnout from
the repeated presentation of relaxation scripts, and standardize relaxation
script language.
There are many practical benefits of recorded exercises. The cost of
therapy may be lower due to fewer sessions. The therapist may schedule more clients.
Therapist credibility and client enthusiasm may increase as the exercises
produce desired results. Finally, client practice shortens the time to achieve mastery.
From a client's perspective, recorded exercises are desirable because
they increase comprehension and retention, improve client satisfaction,
motivation, and compliance, provide more consistent instructions and
standardize exercises, provide information that family members can
understand, allow for practice with fewer distractions, and help the
client learn to pace relaxation exercises.
Schwartz (2003) recommended several steps when recording relaxation
instruction.
Therapists should consider teaching clients to record exercises in their
voices to increase client skills and promote an internal locus of
control. We want clients to perceive relaxation as a skill they can
refine through practice. We don't want them to use recordings as
substitutes for medication. In Wickramasekera's language, we want to
promote "skills, not pills."
Research suggests that live instructions may be more effective than taped
instructions. A therapist's physical presence may produce more motivating demand
characteristics than a recording. The
advantage of live instructions may also be due to a therapist's ability
to adjust relaxation training to the client's immediate experience and
progress. For example, a therapist might suggest changes in sitting
position or reduced effort during practice, observing psychophysiological
measurements. Finally, a therapist can adjust pacing to an individual
client's performance.
Negative Side Effects of Relaxation Training
Striefel (2004) cautioned that
BART could produce negative reactions in any
client.
Most negative reactions to BART are due to its relaxation component.
While Budzynski (1994)
suggested that a thorough psychological history can identify clients with
an elevated risk of adverse reaction, therapists must be prepared to
respond to problems in clients without diagnosed disorders.
Schwartz, Schwartz, and Monastra (2016) advised that while significant severe adverse reactions are rare, mild-to-moderate adverse responses can interfere with training, possibly end promising therapy, and reduce client practice of assigned relaxation exercises.
Caption: Mark Schwartz
When clients experience adverse reactions like anxiety, muscle spasms,
tics, and increased sympathetic activation, a biofeedback
therapist can reassure the individual and adjust biofeedback therapy and
home practice assignments. In the rare case of a severe adverse
reaction that exceeds the therapist’s expertise, they may need to
consult with or obtain supervision from a more experienced professional. If they cannot effectively
treat their client, they may
refer them to another clinician. Nash
and colleagues (2001) contend that biofeedback therapists who
are not licensed mental health professionals should not treat clients
with a DSM diagnosis without licensed supervision.
Deep relaxation procedures like autogenic training and progressive
relaxation can result in negative experiences.
Intrusive thoughts are among the most common adverse reactions to BART or relaxation exercises by themselves.
A survey by
Edinger and
Jacobsen (1982) of 116 psychologists who used a relaxation procedure
revealed that relaxation side effects are common. For example, 15% reported intrusive thoughts, and 9% fear of losing control.
The adverse reactions experienced during relaxation training can be
grouped as follows.
Adverse reactions can interfere with or lead to the termination of
relaxation training. Based on 17,542 clients seen by 116 clinicians,
3.5% experienced adverse reactions that interfered with relaxation
therapy, and 3.8% experienced negative side effects that confounded
therapy, requiring discontinuation of relaxation. In all, 7.3%
experienced significant adverse reactions.
An experienced therapist can reduce client distress through reassurance,
positive reframing (reconceptualizing) these experiences, and slowing the training
pace. These sensations often fade in weeks or become more
pleasant (Lichstein, 1988).
During relaxation training, relaxation-induced negative reactions (RINRs) may be characterized by increased anxiety, including increased perspiration, shivering, trembling, pounding heart,
and rapid breathing (Carrington, 1977). Relaxation training, and not
biofeedback, appears to cause these reactions.
Diverse causes produce RINRs.
Schwartz, Schwartz, and Monastra (2016) recommended several preventative strategies.
Finally, they cataloged common problems and practical strategies for dealing with them.
A biofeedback therapist should obtain their client’s agreement to consult with the healthcare
provider before reducing dosage or discontinuing a drug (Schwartz,
2003).
Nutrition
Acute and chronic stress disorders may deplete B-complex vitamins (50-100
mg/day), calcium (1,000 mg/day), and magnesium (400 mg/day), requiring
their increased intake through dietary sources or supplements (University
of Maryland Medical Center Complementary Medicine Program, 2005).
Clients should avoid or minimize caffeine consumption due to its
activation of the sympathetic nervous system and potential to disrupt
sleep. They should also restrict alcohol intake due to the risk of abuse and physical dependency,
interaction with prescription medication, and potential interference with
sleep. Check out the YouTube video Bill Nye The Science Guy & Nutrition.
In a paradigm shift, researchers increasingly focus on how producers process food in addition to calories, food pyramid position, and nutrients (O'Connor, 2022).
At their core, they are industrial concoctions containing a multitude of additives: salt, sugar and oils combined with artificial flavors, colors, sweeteners, stabilizers and preservatives. Typically they’re subjected to multiple processing methods that transform their taste, texture and appearance into something not found in nature. Think Frosted Flakes, Hot Pockets, doughnuts, hot dogs, cheese crackers and boxed macaroni & cheese.
These hyper-palatable products combine artificial flavors, fat, sodium, and sugar to hijack the mesolimbic reward system, increase craving, and trigger overeating. The National Institutes of Health compared the effects of 2 weeks of ultra-processed meals with homemade meals. The meals contained identical fat, fiber, sodium, and sugar. When participants received ultra-processed meals, they ate 500 more calories per day and rapidly increased body fat and weight. The same individuals lost weight and reduced cholesterol when eating meals made from scratch. Appetite-suppressing PYY hormone levels rose and hunger-producing ghrelin levels fell (Hall et al., 2019; O'Connor, 2022).
Yet in dozens of large studies, scientists have found that ultra-processed foods are linked to higher rates of obesity, heart disease, hypertension, type 2 diabetes, and colon cancer. A recent study of more than 22,000 people found that people who ate a lot of ultra-processed foods had a 19 percent higher likelihood of early death and a 32 percent higher risk of dying from heart disease compared with people who ate few ultra-processed foods.
Chrono-Nutrition
Research on the timing of meals suggests that we should consume the majority of our calories earlier, frontloading with a large breakfast and middle-sized lunch. Dinner should be the smallest meal, ideally at 4 pm. Benefits include weight loss, and improved blood sugar, cholesterol, and insulin sensitivity (Vujović et al., 2022; Young et al, 2022).
O'Connor (2023) explained the scientific basis of meal timing:
Scientists have uncovered several mechanisms that explain why an early-eating schedule is better for your health. Our bodies are better able secrete insulin, a hormone that controls blood sugar levels, in the morning.
We also tend to be more insulin-sensitive early in the day, meaning our muscles are better able to absorb and utilize glucose from our bloodstreams. But as the day progresses, we become less and less insulin-sensitive. By nighttime, the beta cells in the pancreas that produce insulin become sluggish and less responsive to blood sugar elevations.
Hydration
Well-hydrated adults are more likely to experience healthy aging than those who do not consume sufficient fluids. Serum sodium levels rise when fluid intake falls. The National Institutes of Health evaluated three decades of health data from 11,255 adults. Adults with high-normal serum sodium were more likely to experience chronic health conditions, age more quickly, and die earlier than those with medium sodium levels (Dmitrieva et al., 2023).
In summary, our study shows that people whose fasting serum sodium exceeds 142 mmol/l have increased risk to be biologically older, develop chronic diseases, and die at a younger age. This threshold can be used in clinical practice to identify people at risk. Since decreased hydration is one of the main factors that elevates serum sodium, the results are consistent with hypothesis that decreased hydration may accelerate aging.
The authors cautioned that the data are observational, precluding cause-and-effect conclusions.
Physical exercise is crucial to psychophysiological health. While an hour
of exercise per day may be optimal, physicians often recommend at least
30 minutes of moderate-intensity activity (brisk walking) at least 5 days
per week or 20 minutes of high-intensity training (running) at least 3
days a week. The American College of Sports Medicine recommendations for four age groups are below (USDHHS, 2018). The table below was adapted from Brannon et al. (2022).
Exercise Health Benefits
Dozens of more recent studies have examined the relationship between physical activity and cardiovascular mortality. A systematic review of these studies shows that physical activity confers a 35% reduction in risk of death due to cardiovascular causes (Nocon et al., 2008). The same review concludes that physical activity confers a 33% reduction in risk of death due to all causes. Furthermore, both men and women benefit from physical activity, but risk reductions may be larger for women than for men (Nocon et al., 2008). More recent reviews confirm this link (Lavie et al. 2019; PAGAC, 2018). A dose–response relationship exists between levels of vigorous physical activity and reduced risk of all-cause mortality (Samitz et al., 2011), and a large reduction in risk appeared when comparing people who reported no activity to those who reported low levels of light-to-moderate physical activity (PAGAC, 2018; Woodcock et al., 2011). Thus, some activity is far better than none, but there are still benefits adding more activity to some activity (Brannon et al., 2022, p. 405.)
Physical exercise reduces mortality, increases life
expectancy by an average of 2 years, and is associated with a lower risk of
specific cancers (breast, colon, lung, prostate, and rectum), Type 2
diabetes, osteoporosis (decreased
bone density), hypertension, cardiovascular disease, and stroke. Moderate
physical activity can increase basal metabolism and help clients control
their weight, reduce low-density lipoproteins
(LDL), increase protective
high-density lipoproteins (HDL), and possibly lower
triglycerides. Watch the 10 Benefits Of Exercise On The Brain And Body video.
7,000 Steps
The 10,000-steps guideline originated in a Japanese pedometer marketing campaign. A prospective cohort study that followed 2100 adults on average for 10.8 years found that 7,000 steps were a mortality-risk dividing line. Participants who logged at least 7,000 steps experienced a 50-70% lower mortality risk than those who achieved less than 7,000 steps, regardless of step intensity (Paluch et al., 2021).
Exercise Effects on the Brain
Animal research has shown that exercise affects brain-derived neurotrophic factor, irisin, glial-derived neurotrophic factor, and microglia. Human studies have demonstrated positive effects on paralysis and dementia.
Studies with mice and rats have shown that exercise increases the expression of brain-derived neurotrophic factor (BNDF),
which increases the number of new neurons and neural connectivity, and aids learning to navigate the Morris water
maze (Gomez-Pinilla et al., 2001; Van Praag et al., 1999). Exercise also expresses the gene that codes for the hormone irisin, which may mediate some of the cognitive benefits of physical activity. Exercise increased spatial learning and memory in wild-type mice but not in irisin-deficient mice (Islam et al., 2021).
In mice predisposed to accumulate beta-amyloid plaques and develop Alzheimer's-like symptoms, mice with running
wheels (runners) performed better in the Morris water maze and showed half the beta-amyloid buildup of sedentary
mice (Adlard et al., 2005; Berchtold et al., 2005).
Rats who exercised daily on a treadmill for one week or were sedentary were subsequently injected with
6-hydroxy-dopamine, which selectively destroys dopaminergic (DA) neurons in the nigrostriatal pathway. Parkinson's
disease also involves the loss of DA neurons in this pathway. The rats that exercised lost fewer DA neurons than their
sedentary counterparts. Exercise may have increased the expression of another neurotrophic factor, glial cell-derived neurotrophic factor. This small protein promotes the survival of
dopaminergic and motoneurons (Zigmond & Cotman, 2005).
Microglia, the central nervous system's primary immune cells, centrally modulate neuroinflammation. Exercise may reprogram
microglia to increase their energy efficiency and resist neuroinflammation that can compromise cognitive functions like memory (Mee-Inta et al., 2019).
Exercise Effects on Paralysis and Dementia
MacDonald studied the effects of exercise on clients who had been paralyzed for an average of 5 years. Twenty-four
clients were assigned to exercise three times a week with bikes equipped with electrodes to stimulate pedaling, and
24 clients were assigned to stretching. At the end of 2 years, 40 percent of the exercisers and only 4 percent of
the stretchers increased motor function (McDonald et al., 2002).
A 6-year study of 1,740 participants over 65
associated moderate exercise with a reduced incidence of dementia (Brownlee, 2006).
Glossary
abbreviated relaxation exercises: procedures like Stroebel's Quieting Response
(QR) that produce low-to-moderate subjective and physiological change involve minimal sensory restriction, and
are practiced for very brief periods. They are designed to replace symptoms like anxiety with more
adaptive behaviors like cultivated low arousal or mindfulness.
active volition: a process where you direct yourself to act
like clenching a fist triggered by words like make or try.
analgesia: insensitivity to pain.
autogenic discharges: Luthe identified 53 categories of side effects like
tingling and muscle twitches in 100 novice clients.
autogenic meditation exercises: in autogenic training, these techniques teach visual imagery skills after mastering the six standard exercises.
autogenic modification procedures: in autogenic training, organ-specific formulae and intentional formulae are used when a client does not respond to the six standard exercises.
autogenic shift: in autogenic training, the transition to a passive,
pre-sleep, hypnagogic autogenic state.
autogenic training: a deep relaxation procedure developed by Schultz and Luthe
that involves six standard exercises, autogenic modification, and autogenic
meditation.
brain-derived neurotrophic factor (BDNF): a member of the neurotrophin family that increases the number of new neurons and neural connectivity, whose expression is increased by exercise.
clinically standardized meditation (CSM): a systematic secular meditative
procedure that incorporates components from meditative techniques like TM.
chrono-nutrition: the scientific study of the relationship between the timing of eating, circadian rhythms, and health.
deep relaxation procedures: procedures like Autogenic Training, meditation,
and Progressive Relaxation that may require 15 minutes to several hours, involve a break from routine activity,
and profoundly reduce physiological arousal and reset physiological activity to healthier values.
differential relaxation: in progressive relaxation, the inhibition of unneeded
muscle groups during routine activities.
empirical approach: data-guided strategy in which a therapist presents several
procedures to a client, determines which procedure they prefer, and monitors subjective cognitive and
physiological changes.
glial cell-derived neurotrophic factor: a small protein synthesized in response to exercise, that promotes dopaminergic and motoneuron survival.
habit: a behavior pattern often acquired through frequent repetition.
heaviness and warmth standard exercises: in autogenic training, exercises that
teach clients the first two relaxation themes, heaviness and warmth, are divided into seven parts.
heritability index: the percentage of variation due to genetic influences.
high-density lipoproteins (HDL): a protective lipoprotein
increased by exercise and moderate alcohol consumption.
hypnosis: a procedure that can aid therapy, for example, hypnotically-assisted
psychotherapy.
hypnotherapy: a controversialterm that
implies that hypnosis is a therapy like cognitive behavior therapy.
hypnotic induction: from Hilgard’s perspective, the promotion of an
altered state of consciousness termed a hypnotic state.
hypnotic suggestibility: responsiveness to suggestion, measured by
instruments like the Stanford Hypnotic Susceptibility Scale, appears to be distributed along a bell-shaped curve.
intentional formulae: in autogenic training, autogenic modification
procedures, which may be reinforcing or neutralizing, are used to increase or decrease behaviors.
irisin: a hormone expressed during exercise linked to learning and spatial memory in mice.
low-density lipoproteins (LDL): a potentially harmful form of lipoprotein,
especially when the particles are small, is decreased by exercise and moderate alcohol consumption.
microglia: primary central nervous system immune cells that modulate neuroinflammation.
negative hallucination: a hypnotic phenomenon where normal perception is
suppressed, for example, perceiving an audience as naked following a hypnotic suggestion.
organ-specific formulae: in autogenic training, autogenic modification
procedures that modify standard exercise themes. For example, “My back is warm” instead
of “My right arm is warm.”
osteoporosis: decreased bone density, is reduced by weight-bearing exercise
that remodels the skeleton's bones.
passive attitude: in autogenic training, allowing is
the most crucial element of the six standard exercises.
passive concentration: in autogenic training, the absence of effort and
goal direction.
passive volition: in autogenic training, visualizing the desired change and then
allowing the body to make the change at its own pace.
Quieting Response (QR): Stroebel's (1982) 6-second exercise instructs a
client to focus on a stress cue, smile inwardly, take an easy deep breath, and let the jaw, tongue, and shoulders
go limp as they exhale.
random-dot stereograms: hidden three-dimensional images created by repeating
patterns within one image that can be perceived by allowing your eyes to defocus until you see double.
Relaxation state (R-state): a positive psychological state experienced during
relaxation.
Relaxation-induced negative reactions (RINRs):
anxiety experienced during relaxation training.
response stereotypy: a person’s unique response pattern to stressors of
identical intensity.
self-efficacy: an individual’s expectancy that she can influence her
outcomes. This concept overlaps with locus of control, mastery, and perceived control.
self-hypnosis: self-suggestion.
six relaxation themes: in autogenic training, the themes include heaviness,
warmth, cardiac regulation, respiration, abdominal warmth, and forehead cooling.
six standard exercises: in autogenic training, exercises that focus on the
physiological changes of the six relaxation themes. While the heaviness and warmth exercises are divided into
seven parts, the remaining four exercises focus on only one body region (heart, lungs, abdomen, and forehead).
Stanford Hypnotic Susceptibility Scales: instruments that measure
hypnotizability.
systematic desensitization: Wolpe’s behavior therapy technique
incorporates an abbreviated version of progressive relaxation.
taking back procedures: in autogenic training, standard exercises end with
vigorous flexing of the arms, deep breathing, and opening the eyes, and the suggestion, "Arms firm, breathe
deeply, open eyes.”
Transcendental meditation (TM): mantric meditation developed by Maharishi
Mahesh Yogi, in which an individual repeats Sanskrit syllables that have been assigned by an instructor based on
age or personality.
transfer of training: generalization from clinic to a client's
environment.
triglycerides: a potentially harmful form of lipoprotein that is decreased by
exercise and increased by alcohol consumption.
visualization: the generation of mental imagery, which can be somatosensory and visual, is a common element in interventions ranging from autogenic training to behavior therapy.
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Assignment
Now that you have completed this unit, think about the reason you incorporate specific relaxation exercises in
your practice. What do you expect each to accomplish? Do they reliably achieve these goals? How do you encourage
client practice?
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