Behavioral Techniques II: Relaxation, etc. Flashcards
Relaxation Training
a. Teaching clients how to induce a state of deep muscle relaxation
i. Long standing hx in medicine & mental health
b. Relaxation is used as an anti-anxiety or anti-stress strategy
c. Based on the idea that deep muscle relaxation is incompatible w/anxiety
d. Muscle tension is part of the body’s natural response to anxiety-provoking thoughts & events
e. Deep muscle relaxation reduces physiologic tension & anxiety
Muscle Relaxation: Applications:
a. As a stand-alone technique: headache, chronic pain, insomnia, fatigue, high blood pressure, irritable bowel syndrome, neck/back/joint pain
b. As a component of tx: systemic desensitization, anxiety/stress management training (e.g., anxiety disorders, depression), anger management
Progressive Muscle Relaxation (PMR)
a. Involves teaching clients to systemically tense & then relax various muscle groups in sequence
PMR: Rationale
i. It’s easier to relax a muscle group from a state of tension than from a normal, resting state
ii. Process helps to increase client’s awareness of particular muscle groups & ability to identify tension & to distinguish between sensations of tension & deep relaxation & also where they carry their tension
iii. Contrast is very important to notice
PMR: Procedure
i. Therapist guides client through various muscle groups
1. Hands, forearms, biceps
2. Head, face, neck, & shoulders
3. Chest, stomach, & lower back
4. Thighs, buttock, calves, feet
ii. Alternate between tensing & relaxing
PMR: Goals
i. Detection of tension becomes a cue to relax the muscles
ii. Client has skill to deeply relax muscles on command
iii. Applied initially in session then practice at home via audiotape, CD, MP3
iv. Shorthand Procedure: tense & relax multiple muscles at once
PMR: Points Re: Clinical Use
i. Relaxation is an acquired skill
ii. Learning is gradual
iii. Practice is necessary
iv. Typical time to mastery is 2-4 weeks (w/daily practice)
v. Predict & normalize “unusual” sensations (e.g., tingling, warmth, jerking, surging)
vi. Tension phase: 5-7 sec; Relaxation phase: 20-30 sec
vii. Caution against excessive straining of muscles
viii. Inform clients that tensing & release should be quick, not gradual (alat once)
ix. Check for injuries/physical conditions that PMR could exacerbate (bypass certain muscle groups if necessary)
x. Model the procedure (to ensure correct form & to relieve inhibition)
xi. Tone of voice: low, soft, warm, slower than conversational speech
xii. Identify preferred PMR scripts
xiii. Explicitly draw attention to sensation of tension & contrasting sensation of relaxation
xiv. Intersperse phrases to deepen level of relaxation
xv. Use ratings as a shorthand method of communicating level of relaxation/tension
PMR: Homework
i. Practice 1-2x/day at home in a quiet, comfortable, private place
ii. Complete relaxation record for each practice session
iii. Caution against applying relaxation skills in day to day stressful situations until technique has been mastered
iv. Gradually wean client from PMR record
v. Progress from practicing long-form, to practicing short-form, to applying in-vivo
Applied Relaxation Training
a. Combines several relaxation techniques in sequence
b. Goals
i. Enable a person to induce relaxation in < 1 minute
ii. Empower person w/ rapid, reliable method of responding to anxiety/tension by inducing relaxation
c. Duration: 6-8weeks
d. Stages (each step builds on prior stage)
e. PMR
i. Release only relaxation
ii. Cue controlled relaxation
iii. Differential relaxation
iv. Rapid relaxation
v. Applied relaxation
Breathing Retaining aka “Controlled Breathing”
a. Like PMR, taught to clients as a self calming, stress reduction tool
b. Chest/thoracic breathing (poor breathing)
i. Shallow, irregular, & rapid &t ends to accompany anxiety, stress, tension, emotional distress
ii. Anxiety associated w/hyperventilation, constricted breathing, shortness of breath, fear of passing out
iii. Insufficient air reaches lungs→blood not properly oxygenated→heart rate & music tension increase→activates stress response
iv. Abdominal/diaphragmatic breathing
1. Healthy breathing =Deep, regular, even
2. Efficient in transporting oxygen & expelling waste (CO2)
3. Teach client to become aware of their breathing patterns
4. Encourage slow, deep, regular breathing as a way to induce calmness & relaxation
Breathing Retaining aka “Controlled Breathing”: Applications -
c. muscle tension/aches, GAD, panic dx, agoraphobia, depression, irritability/anger control, headaches, fatigue
d. Skills are typically learned quickly (though full benefits may not appear until after extensive practice)
e. Many techniques to increase awareness & teach abdominal breathing (Ex: imagery, counting, self-talk)
Breathing Retaining aka “Controlled Breathing”: STEPS-
i. Exhale first
ii. Inhale (& exhale) though nose
iii. Counting procedure (slow breathing, make exhalation longer than inhalation)
iv. Replace counting w/word cues
Systemic Desensitization
a. Combines exposure & relaxation methods
b. Applied to tx of a variety of anxiety dxs
c. A commonly used behavioral techniques in clinical practice (particularly in-vivo version vs. traditional imaginal version)
d. *In clinical practice exposure works better & faster w/out relaxation
Systemic Desensitization: Key Components
i. Relaxation Training
ii. Develop a Fear Hierarchy
1. A list of situations related to the feared stimulus that range from least to most anxiety provoking
2. Relaxation + Exposure to Hierarch Items = systemic desensitization
Systemic Desensitization: Mechanism of Action
i. Classical Conditioning
1. Counter-conditioning (reciprocal inhibition)
2. Pairing exposure to the stimulus w/response that is incompatible w/anxiety & fear (viz., relaxation)
