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First edition 1995
Second edition 2000
Third edition 2005
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vii
Foreword
Relaxation is a word that is commonly used across layout of the content is such that specific tech-
many different cultures to describe a range of niques can be readily accessed as stand-alone chap-
feelings, emotions and behaviour. It is associated ters; however, for health care students and health
with feelings of pleasure, control and self-assurance; professionals to benefit fully from the knowledge
emotions of laughter, calmness and tranquillity; carefully and systematically brought together by
activities such as resting, exercise, massage, the author, the text should be read in full.
bathing, listening to music, eating, drinking alco- The book is presented in a logical sequence start-
hol and relaxation training. Health professionals ing with a review of stress as a concept that can be
and lay people alike are regularly informed by explained by various physiological, endocrinologi-
articles in the popular press, texts and scientific cal and psychological theories. The rationale for the
journals of the benefits of relaxation for health; techniques presented in subsequent chapters high-
however, there is often uncertainty about what is lights the theoretical links where these are explicit
meant by relaxation, which technique to choose and identifies where techniques are based on prin-
and how to go about it. ciples that may not fit or may overlap with more
The need for relaxation as a therapeutic interven- than one of these existing theoretical positions. As
tion is evidenced through the links between stress well as the underpinning rationale, a summary of
and illness; when undertaken as part of our every- the research evidence to support each technique is
day activities, relaxation can provide a mechanism discussed. The importance of reviewing the evi-
for lowering stress and thus offer some protection dence to inform decisions in practice is reiterated
against stress-related problems. Health care profes- in Chapter 27, which includes a useful discussion
sionals such as psychologists, nurses, physiother- on issues around current research, on strengths to
apists, occupational therapists, speech and language date and on future directions. This chapter also
therapists, social workers, GPs and professionals contains an interesting discussion around selection
such as coaches and sport and exercise scientists of techniques. Chapter 23, highlighting ‘on-the-
working in the health and leisure industries may all spot’ techniques, is crucial for putting into practice
be involved in teaching relaxation techniques. a shortened version of what has previously been
The third edition of this popular textbook retains learned.
its eclectic and practical approach, presenting a Relaxation Techniqueswill continue to provide a
number of additional relaxation techniques along useful guide for health professionals, students and
with those previously included, all of which can be lay people who wish to increase their understand-
successfully self-taught or taught by health care ing of stress, its causes and its impact on health. It
personnel. The text is well illustrated and this is also provides a concise and detailed summary of
helpful for gaining an understanding of the various measurement strategies that can be used to evalu-
techniques and putting them into practice. The ate the outcome of interventions designed to
viii FOREWORD
reduce or alleviate the effects of stress. The book is selected for the right situation. For lay people, this
eclectic, with no one method being presented more book raises awareness of relaxation as a strategy to
favourably than another, the author acknowledg- improve physical and psychological health; and
ing that in practice, physical and cognitive methods for readers wishing to teach themselves a method
are often presented together. For students, this sin- of relaxation, there is plenty of choice.
gle volume provides theoretical underpinning, This book provides essential information that
evidence from current research and practical appli- will be useful to those involved in training others
cation of many different techniques of relaxation. in relaxation techniques and to individuals who
In this regard it is a unique and useful text. For wish to teach themselves skills of relaxation, irre-
clinicians, this is a useful bench text with opportu- spective of the level of prior knowledge of the
nity to extend existing practice through the intro- topic or practical experience. This third edition is
duction and application of additional approaches an exciting addition to the current literature, bring-
which are informed by both current research and ing further techniques and greater indepth discus-
current practice. Techniques are presented with an sion and critique to the topic. Read on; you will
explanation of why they are useful, how to use find the direction given by the author to be prac-
them, where they have been evaluated, where they tical, meaningful and stimulating, with new points
can be used interchangeably, and what needs to be of debate emerging.
done to ensure that the best techniques can be Marie Donaghy
ix
Preface to the third edition
Since the preface to the first edition of Relaxation Particular thanks are offered to Marie Donaghy
Techniqueswas written, developments in the health who has been through the whole manuscript
care scene have created a new emphasis on evi- making useful suggestions and contributing many
dence of effectiveness. This has led to the need for of the ideas which appear in this edition. Her advice
an additional chapter on the results of research. has been invaluable and I am again greatly
New evidence has also been incorporated into the indebted to her. The people who so kindly helped
individual chapters and may be found in their with the first and second editions are also remem-
sections on evaluation. bered for their valued assistance, with a special
The chapter on exercise (Ch. 14) has been appreciation in respect of Margaret Polden and
rewritten to take account of developments in that June Tiley, who have sadly since died. I would
field; it also contains an expanded section on the also like to acknowledge the guidance I have
psychological effects of physical activity. received from the publishers, Elsevier, and to
Chapter 26 now carries a passage relating to thank them for the way they have presented the
audit, in acknowledgement of the importance of work.
this topic, although the contribution made here is This edition focuses on the same techniques
no more than an introduction to what has become as the first one, i.e. techniques which are easily
a major subject. learned and which can be readily applied in the
This third edition contains two new chapters, stressful situation, wherever it arises. It is hoped
one on cognitive behavioural approaches, reflect- that the work in its present form will provide
ing their increasingly dominant position (Ch. 22); the reader with useful additions. In essence, it
the other on techniques which did not appear in remains the same book in an expanded and
earlier editions (Ch. 24). There is also a glossary updated form.
and a table (Appendix 3) suggesting certain tech- Rosemary Payne
niques for specific conditions. Cardiff 2004
xi
Preface to the first edition
Afew years ago, when giving a talk on relaxation The book begins with a review of some of the
techniques, I was asked by a social worker if the theory surrounding stress and relaxation. This is
techniques I was describing could all be found in followed by a chapter on general procedure which
one publication. I said I knew of no book which is applicable to all methods. Chapter 3 discusses
contained them all. Since then, other health care stress, beginning with a further passage of theory
professionals have, on different occasions, put sim- and moving on to consider a variety of practical
ilar questions to me. Is there a book which focuses coping skills. The following 19 chapters deal with
on the practical side of relaxation training? Can the specific techniques: 12 chapters are, broadly speak-
detail of the methods be found under one cover? ing, concerned with physical or muscular tech-
Many books mention relaxation techniques but niques and seven deal with mental or psychological
tend not to present them in any depth, unless the methods. There follows a chapter concerning
entire work is devoted to a single method. It seemed ‘on-the-spot’ techniques for dealing with stressful
that there was a gap which needed to be filled. situations, using skills drawn from earlier lessons.
It is estimated that 80% of modern diseases have Relaxation in the antenatal context is the subject of
their beginnings in stress (Powell & Enright 1990) Chapter 25*, and is included because of the promi-
and that stress-related illness accounts for at least nent role that relaxation plays in the field of obstet-
75% of GPconsultations (Looker & Gregson 1989). rics. Assessment is addressed in Chapter 26, and
As concern about the safety, efficacy and cost of the final chapter takes a look at a few topics not so
psychotropic drugs grows (Sibbald et al 1993), far discussed: the relation between the approaches
there is increasing interest in non-drug treatments, themselves, some ways in which they can be com-
of which relaxation training is an example. bined, and a brief reference to approaches which
The book is addressed to health care profession- are not included. Physical and psychiatric dis-
als such as nurses, occupational therapists, physio- orders are not within the scope of this work.
therapists, speech and language therapists and Techniques whose main purpose is to promote
social workers; GPs and psychologists also may relaxation are termed primary. The ‘muscular’
find it useful. It can equally be used by lay people methods belong in this category, as does autogenic
since it is written in a jargon-free style. training. Where relaxation is not the main purpose,
Factors of practicality have governed the selec- the technique can be seen as secondary: visualiza-
tion of methods. Thus, techniques which require tion, meditation and the Alexander technique fall
expensive equipment or specialized expertise are
not included, while the methods chosen are those
*To avoid confusion, the chapter numbers have been changed
which lend themselves to presentation in small
to match the chapter numbers in the third edition rather than
group settings. the first.
xii PREFACE TO THE FIRST EDITION
into this category. Other approaches which enhance to the trainer as female. The trainee is referred to as
relaxation may be still further removed. These male in Chapters 2–15 and as female in Chapters
include cognitive techniques such as uncovering 16–28.
irrational assumptions and modifying automatic The words ‘trainer’ and ‘instructor’ are both
thoughts. Here, relaxation can be seen as a side- used, the choice being largely determined by the
effect rather than a goal (Fanning 1988). nature of the method: for example, in autogenics,
It is not intended that health care professionals progressive relaxation and behavioural relaxation
should, on the strength of reading this book, con- training the word ‘trainer’ is often used, while in
sider themselves teachers of autogenics and the imagery, meditation, Alexander technique and
Alexander technique. These two methods are Mitchell’s approach, the word ‘instructor’ seems
included to indicate their contribution to the field; more appropriate. The word ‘therapist’ is also
they are described for interest and for the applic- used where it seems fitting.
ability of their central ideas. For example, images Anumber of people have helped in the making
of warmth and heaviness (autogenics) are relaxing of this book. One important contributor is Keith
in any context, as also is postural advice (Alexander Bellamy, whose photographs have done so much to
technique). Such concepts have universal value. make the book what it is, not forgetting Sarah
Indications of the effectiveness of the techniques McDermott, who acted as the model. With regard
are included but the book does not set out to review to the text, Ian Hughes has given invaluable help in
the evidence from the scientific literature. Other his careful reading and refining of the chapter on
works do that, for example Lichstein (1988). Pitfalls measurement. I would also like to mention those
associated with some methods are listed at the end who have read other chapters and to whom I am
of the relevant chapters. indebted for their helpful suggestions. Alexandra
The word ‘relaxation’ is used in two ways here Hough, Wendy Mair, Margaret Polden and Jim
as it is in other works: first, in a general sense where Robinson have all been kind enough to do this,
it signifies a global state of rest; and second, as a and Christopher Rowland Payne undertook to
technique such as progressive relaxation. It is diffi- read the whole manuscript. Thanks also go to
cult to avoid both meanings in a book of this sort; Michael Adams, Joyce Gibbs, Olga Gregson,
however, efforts are made throughout the work to Andrzej Kokoszka, Brenda MacLachland, Pat
distinguish the meanings wherever ambiguity Miller, Alison Ough, Stuart Skyte, Dinah Thom,
arises. June Tiley and Elizabeth Valentine. Finally, a word
The author is aware of the implications of of appreciation for the members of all the groups
gender-weighted language. She is also aware of the with whom I have worked. Without them, this
cumbersome phrasing that can result from a deter- book would never have been written.
mination to avoid sexist forms of speech. In an
attempt to avoid both traps and for the sake of clar- Rosemary Payne
ity, it has been decided to refer throughout the book Cardiff 1994
3
1
Chapter
Theoretical background
It could be said that relaxation is doing nothing
CHAPTER CONTENTS (Beck 1984). In spite of this, many people say they
find it difficult to relax. Doing nothing, it seems, is
Physiological theories 4
not as easy as it sounds, and the existence of a
Psychological theories 8 wealth of relaxation techniques appears to endorse
this view.
The ‘specific effects’ hypothesis and unitary
‘Relaxation’ is often used with reference to
theories 10
muscles, where it signifies release of tension and
Case scenarios 11 the lengthening of muscle fibres, as opposed to the
shortening which accompanies muscular tension,
Stress management 12
or contraction. Such a definition could be applied
Types of relaxation technique 12 to the methods described in the earlier chapters of
‘Deep’ and ‘brief’ relaxation 13 this book. However, since relaxation has a mental,
Somatic and cognitive techniques 13 as well as a physical dimension, this definition is
too restricted for our purposes.
Skill acquisition and motor learning
Amore comprehensive view comes from Ryman
theory 13
(1995), who defines relaxation as ‘a state of con-
sciousness characterized by feelings of peace, and
release from tension, anxiety and fear’. This
emphasizes psychological aspects of the relaxation
experience, such as the pleasant sensation and
absence of stressful or uncomfortable thoughts.
Thus, the word ‘relaxed’ is used to refer either to
lax muscles or to peaceful thoughts. It is assumed
that a link exists between them since an apparently
general state of relaxation can be induced by using
either physical or psychological methods.
Relaxation can be said to have three aims
(Titlebaum 1988):
1. As a preventive measure, to protect body
organs from unnecessary wear, and in particular,
the organs involved in stress-related disease
(Selye 1956, 1974).
4 INTRODUCTION
2. As a treatment, to help relieve stress in con- AUTONOMIC NERVOUS SYSTEM
ditions such as essential hypertension (Patel & controls physiological arousal
Marmot 1988), tension headache (Spinhoven et al
1992), insomnia (Lichstein 1983), asthma (Henry
et al 1993), immune deficiency (Antoni et al 1991),
SYMPATHETIC NERVOUS PARASYMPATHETIC NERVOUS
panic (Öst 1988) and many others. Relaxation SYSTEM SYSTEM
strategies may help to make the body’s innate enables the body to cope with restores a state of calm to the body
threat and challenge
healing mechanisms more available.
3. As a coping skill, to calm the mind and allow Figure 1.1 The autonomic nervous system.
thinking to become clearer and more effective.
Stress can impair people mentally; relaxation can individual to make a physical response. The
help to restore clarity of thought. It has been found changes are collectively known as the ‘fight–flight
that positive information in memory becomes more response’ which is characterized by an increase in:
accessible when a person is relaxed (Peveler &
● heart rate
Johnston 1986).
● blood pressure
Mechanisms thought to be responsible for bringing ● blood coagulation rate
about the state of relaxation have been explored, ● blood flow to voluntary muscles
giving rise to a number of theories. Some of these ● glucose content of the blood
emphasize physiological aspects, such as auto- ● respiratory rate
nomic activity and muscle tension, while others ● acuity of the senses
focus on psychological elements such as attitudes ● sweat gland activity
towards the self. The major theories are briefly
and a decrease of:
described below.
● activity in the digestive tract.
PHYSIOLOGICAL THEORIES In the absence of challenge or excitement, these
actions are reversed: the sympathetic nervous sys-
tem loses its dominance and the parasympathetic
Body systems associated with the states of stress
assumes control. The actions of these systems are
and relaxation include:
shown in greater detail in Figures 1.2 and 1.3.
● the autonomic nervous system
Some of the changes which occur as a result of
● the endocrine system and
sympathetic stimulation produce noticeable symp-
● the skeletal musculature.
toms, such as an increased respiratory rate, stom-
achcramps and cold sweat. States such as fear and
The autonomic nervous system
anger illustrate this and underline the association
Physiological arousal is governed by the autonomic between the emotions and the internal organs.
nervous system. This has two branches: the sym- When the changes are pronounced and occur fre-
pathetic, which increases arousal when the organ- quently, the organs concerned can become fatigued
ism is under threat, and the parasympathetic, and this has given rise to the concept of psycho-
which restores the body to a resting state. Their somatic illness (p. 27). The relaxation response
actions are involuntary and designed to enable the method of Benson aims to counteract the effects of
organism to survive (Fig. 1.1). sympathetic activity by promoting the action of the
In a situation of challenge, excitement or danger parasympathetic nervous system (Ch. 21), thereby
the sympathetic nervous system increases the exploiting the reciprocal nature of the two parts of
activity of the heart and redistributes blood from the autonomic nervous system.
the viscera to the voluntary muscles. Blood pres- However, activity of the parasympathetic sys-
sure and respiratory rate are increased; sensory tem is not always benign (Poppen 1988). Asthma is
awareness is heightened, and there is a mechanism exacerbated by bronchial constriction and gastric
for losing excess heat. These factors enable the ulcers by acid secretion. Both bronchial constriction
Theoretical background 5
Spinal Lateral chain
Structures Effects of stimulation
cord of ganglia
Pupil dilated
Iris muscle
Slightly relaxed
Superior Blood vessels in head Vasoconstriction
cervical
ganglion Salivary glands Secretion inhibited
Oral and nasal mucosa Mucus secretion inhibited
Skeletal blood vessels Vasodilatation
Heart Rate and force of contraction increased
T1 11
22
33 Coronary arteries Vasodilatation
44 Coeliac Trachea and bronchi Bronchodilation
55 ganglion
66
77 Stomach Peristalsis reduced
88 Sphincters closed
99 Intestines Peristalsis and tone decreased
1100 Vasoconstriction
1111 Liver Glycogen glucose conversion increased
1122
L1 11 Superior Spleen Contracted
L2 22 mesenteric Adrenaline and noradrenaline
L3 33 ganglion Adrenal medulla secreted into blood
Large and small intestine Peristalsis reduced
Sphincters closed
Kidney Urine secretion decreased
Inferior
mesenteric Bladder Smooth muscle wall relaxed
ganglion Sphincter closed
Sex organs and genitalia Generally vasoconstriction
Figure 1.2 The sympathetic outflow, the main structures supplied and the effects of stimulation. Solid lines ———,
preganglionic fibres; broken lines ---, postganglionic fibres. (From Waugh & Grant 2001.)
and acid secretion are associated with parasympa- the action of the internal organs in response to
thetic dominance, yet the conditions of asthma environmental stimuli.
and gastric ulcer are often relieved by relaxation When a situation is perceived to be stressful the
and aggravated by stress. The theory is not consist- brain immediately responds by stimulating the
ent regarding these conditions (Ch. 27, p. 232). adrenal medulla to release the catecholamines
adrenaline and noradrenaline. The function of these
neurotransmitters is to prepare the organs for action
The endocrine system
by, for example, increasing alertness and redistrib-
Closely associated with the autonomic nervous sys- uting the blood. Acting in the longer term, the
tem are the endocrine system and the adrenal glands. pituitary gland releases the adrenocorticotrophic
These are situated above the kidneys (Fig. 1.4) and hormone (ACTH). This stimulates the adrenal cor-
consist of medulla and cortex (Fig. 1.5). Their tex to produce mineralocorticoids and glucocorti-
function is to produce hormones which modify coids, the most important of which is cortisol, which
6 INTRODUCTION
Spinal Cranial nerve
Ganglia Structures Effects of stimulation
cord numbers
Pupil constricted
Iris muscle Contracted
III Ciliary
Lacrimal gland Tear secretion increased
VII Salivary glands: Saliva secretion increased
Pterygopalatine
submandibular
IX
sublingual
X Submandibular
parotid gland Saliva secretion increased
Heart Rate and force of contraction decreased
Otic
Coronary arteries Vasoconstriction
Trachea and bronchi Bronchoconstriction
Secretion of gastric juice and
Stomach
peristalsis increased
Small intestine Digestion and absorption increased
Blood vessels dilated
Liver and gall bladder
Secretion of bile increased
Pancreas Secretion of pancreatic juice increased
Kidney Urine secretion increased
Secretion of intestinal juice and
Small intestine
peristalsis increased
Secretions and peristalsis increased
Large intestine
Sphincter relaxed
Muscle of wall contracted
Bladder
Sphincters relaxed
Male: erection
Sex organs
Female: variable; depending
and genitalia
on stage in cycle
Figure 1.3 The parasympathetic outflow, the main structures supplied and the effects of stimulation. Solid lines ———,
preganglionic fibres; broken lines ---, postganglionic fibres. (From Waugh & Grant 2001.)
helps to maintain the fuel supply to the muscles. and the stress response is no longer needed, the
In this way it supports the action of the cate- neurotransmitter acetylcholine is released to restore
cholamines (Waugh & Grant 2001) (Fig. 1.6). There a state of balance in the autonomic nervous system.
is also evidence suggesting that the stimulation of The organs which were previously stimulated
normal levels of cortisol enhances the immune sys- now weaken their hold and their actions subside.
tem (Looker & Gregson 1989, Jefferies 1991). High
levels of cortisol, such as those created by prolonged
The skeletal musculature
stress or by pharmacological doses are, however,
associated with a suppressed immune system. Jacobson (1938) proposed that the release of tension
Under challenge, all the above hormones are in the skeletal musculature had the effect of calm-
released. When the situation of challenge passes, ing the mind. The neuromuscular system is thus
