Relaxation Therapy, 3hr/$21

Course N21.  Test 6774.  Relaxation Therapy: Theory and Practice, 3 CE hours, $ 21


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Description: Helping patients learn relaxation techniques to aid stress reduction and management is based on the concept of the mind-body connection: Whatever relaxes the musculature produces mental relaxation and vice versa.

Objectives: At the end of this course, you will  1. Cite models of relaxation, 2. Describe relaxation exercises such as pacing,  releasing, and enjoying  and 3. Examine  relaxation effectiveness under various circumstances.

 Using the power of the mind and body to achieve a sense of relaxation through pacing, releasing, enjoying…


“Finish each day
and be done with it.
You have done what you can.
Some blunders and absurdities
no doubt crept in.
Forget them as soon as you can.
Tomorrow is a new day.
You shall begin it
well and serenely”. Ralph Waldo Emerson
Helping patients learn relaxation techniques to aid stress reduction and management is based on the concept of the mind-body connection: Whatever relaxes the musculature produces mental relaxation and vice versa. Since the relaxation response counteracts the stress response, it is impossible to be both relaxed and tense at the same time. Further, the relaxation response can reduce existing distress and eventually ameliorate its effect. Progressive muscle relaxation is a simple and effective way to help patients learn how to relax.Relaxation: A state of relative freedom from both anxiety and skeletal muscle tension.Source: University of Newcastle upon Tyne

1. Relaxation Effect Models

The Specific Effects Model 
The frequently observed desynchronies across behavioral, cognitive, and somatic measures of anxiety has led researchers (e.g., Davidson & Schwartz, 1976) to develop the specific-effects model. They suggest that relaxation oriented to one modality will benefit symptoms of that modality.  Based on this model, for example, Jacobson’s progressive relaxation, a somatic treatment, will help somatic symptoms such as tension headaches.

The Relaxation Response Model 
H. Benson (1975, 1983), based in his observation of the relaxation effects, argued that all the relaxation techniques produce a single “relaxation response,” characterized by diminished sympathetic arousal.

Integrative Model 
Schwartz, Davidson, and Goleman (1978), suggests that the majority of the relaxation procedures have highly specific effects, as well as more generally stress-reducing effects, therefore, the specific effects of various relaxation techniques may be superimposed upon a general relaxation effect.  For example, AT have specific effects on the autonomic functions included in the autogenic exercises, but it also produces a general decrease in physiological arousal.

A somatic-cognitive-behavioral distinction has been proposed by different researchers to help in the selection of appropriate relaxation techniques. Their rationale is that techniques directed to one of these modalities appear to have their greatest and most consistent effects on that particular modality.

Jacobson’s Method versus Modified Jacobsonian Procedures
The many differences between the Jacobson’s PMR technique and modified PMR methods warrant separate consideration.  Applied relaxation, Differential relaxation, and Rapid relaxation are included among the modified methods.

Source and Documentations:


2. Relaxation through Pacing

Pacing is about learning what your body can cope with without causing a relapse or a set back. Pacing is what many people with M.E. learn to do. Pacing is about learning what you really can do. Pacing is about not expecting or doing too much. Pacing is about staying positive about getting better and working sensibly towards that aim. Pacing is about not harming yourself by trying too hard.Some ideas on how to pace yourself1.Keep a simple diary of everything you do for at least two weeks. Write down how you felt at mid-day, at tea-time and at bed-time. You can get someone to help you do this if you find it hard to remember or if you feel too tired.

2. After two weeks, read over it to find out what things you did easily without getting tired. You may find you ought to start doing less!

3. Carry on keeping your diary.

4. When you read your diary you may spot that certain things you did made you very tired, like having to do a lot of talking. Could it be that phone calls are a real problem for you? Check.

5. Mental tasks, like talking and listening, can be very tiring. So, when thinking about things to do, it’s important to include thinking tasks, such as reading and writing, as well as those that are physical, such as brushing your teeth or getting dressed. Most of the things we do need to use both brain and muscle power.

6. Quite often the full effect of something you did won’t be felt for up to 3 days afterwards. A diary can be really helpful in spotting these sorts of patterns.

7.Don’t just do things the way you have always done them. For example, if you get up in the morning and eat your breakfast, maybe have a rest before you get dressed.

8. If you get tired in the middle of doing something – STOP! Go back to it later in the day or week.

9. As the days and weeks go by, try to build up slowly. Little by little you do more and more. You may have set-backs and off-days, but that is normal. Don’t push too hard.

10. Your muscles may ache at times. This is normal if you haven’t used those muscles for a while. But watch out! Really bad aches or pain mean you are pushing too hard. Don’t do it. Pace yourself! You have to become an expert at reading your body.

11.Do more of the sort of things you enjoy and are good at, so that you are less likely to get fed up or bored and give up.

12. It can really help to switch between brain activities, like reading and listening, and moving about, physical activities.

13. Make sure you make time to rest and relax. Resting means just that – doing nothing! Reading and watching TV may be relaxing, but your brain will still be active. Sit in a comfy chair or lie down. Why not listen to a tape or CD that is especially made to help people relax?

14.Don’t be tempted to compare what you can do now with what you used to do before you got ill. It will make you really fed up and gets you nowhere!

15. Many people find that they begin to feel better as soon as they stop fighting the illness. Do what you can. Build up gently. In the end the illness will have run its course and you will have helped yourself to get strong again.



3. Relaxation through Releasing

3.1 Quick Relaxation Techniques

Curling up with a good book, a two-mile jog, or a midday nap can produce relaxing effects, but it is not always possible to do these activities in the middle of a busy day. The following list of relaxation techniques can be interspersed throughout your daily activities. These `quick’ relaxations take only 10-15 seconds and can be practiced while your waiting at a stoplight, listening to lectures, talking on the telephone, walking to an appointment or any time. Some of the brief relaxations can also be extended for 15-20 minutes to achieve a deeper physically relaxed, mentally calm and centered feeling. Daily practicing and in-depth relaxation will also help the 15 second `quickies’ during the day to be more effective.Experiment with each of these `quick’ techniques until you find which ones work best for you. A reference source for the in-depth procedure is listed for each technique.

  1. Tense-Release. This simple technique helps relax muscle tension. Tense yourself all over a part at a time. Start with your face muscles and progess down to your feet. Hold yourself tense all over for 4 to 5 seconds . . . . then let go all at once. Focus on the feelings of relaxation when releasing the tension.Jacobson, Edmund. (1962). You Must Relax. New York: McGraw-Hill.
  2. Deep Breath. Deep breathe a minimum of twenty slow continuous breaths twice a day. As you breath in, say `I am’ and as you breath out say `relaxed.’ Any time you feel distressed, practice this deep breath and feel the tension leaving your body.Geba, B. (1973). Breath Away Your Tensions. New York: Random House/William Bookworks.
  3. Warm hands indicate relaxation. Cool hands indicate tension. Visualize your hands as warm. Imagine them in warm gloves, near a fire or in warm water. Say to yourself, `My hands are warm, relaxed and warm.’Rosa, K.R. (1976). You and AT. New York: Saturday Review Press/E.P. Datton.
  4. Instant vacation. Close your eyes, breathe deeply, relax every part of your body. Imagine yourself in a calm, nurturing environment. Recreate in your mind whatever gives you the greatest most relaxing pleasure — swinging in a hammock, sunbathing on the beach, strolling in the woods. Be there completely. Feel the sun on your face. Smell the scent of flowers or pine. Hear the rustling of leaves or water splashing. Experience all the pleasant sensations of this relaxing environment.Samuels, M. & N. (1975). Seeing with the Mind’s Eye. New York: Random House.
  5. Four S. First, smile slightly and tell your eyes to `sparkle’. Take a deep breath. As you exhale slowly let your jaw hang slack, shoulders sag, and forehead smooth out. Feel the tension pass all the way through your body until it seeps out through the soles of your feet. Remember the Four S’s = Smile, Slack, Sag, Smooth.Stroebel, C. Quieting Reflex Training, an audio tape series produced by BMA Audion Cassettes, 200 Park Avenue South, New York, NY 10003
  6. When you are first learning a relaxation technique, the use of audio cassette tapes can be very beneficial. Listed below are a few of the companies producing relaxation tapes.Bio Monitoring Applications, 2770 Madison Avenue, New York, NY 10016 Conscious Living Foundation, Box 513, Manhatten, KS 66502 New Harbinger Publications, 220 Adeline, #305, Oakland, CA 94607

3.2 Quick Relaxers

The East Lambs Primary Care Group have produced the following ‘mini-quick’ relaxers:

Tense yourself all over, one part at a time. Pull your toes up as if to touch your shins and hold it. Tense your thigh muscles…your buttocks…tense your fists and your arms, take a deep breath and hold it. Clench your jaws and close your eyelids tight. Hold yourself tense all over for four or five seconds then let go all at once. Don’t ease off, let go.  And feel the tension leave your body.

Cool air in, warm air out
With your eyes closed, shift your attention to the tip of your nose. As you breathe in, become aware of the air coming in your nostrils. As you breathe out, be aware of the sensations of the air passing back out.  Perhaps you notice that the air coming in tends to be cooler and the air you breathe out tends to be warmer. Just be aware of cool air in; warm air out.

Heavy feet
Just imagine that your feet and legs are getting heavier and heavier with each breath out. It’s almost as if you are wearing lead boots, my feet are heavy. Just imagine this for a few seconds. Or perhaps, some other part of your body works for you.

Hands warm
Visualise you hands as warm, relaxed and warm. You might imagine them in a bucket of warm water, near a fire or in warm, woolly gloves. Perhaps you can even begin to feel blood flowing down your arms into your hands.  Hands are warm…relaxed and warm.

Breathing tensions away
Gently focus your attention on your feet.  As you take in a slow, deep breath, imagine collecting all the tension in your feet and legs, breathing them into your lungs and expelling them as you exhale.  Then with a second deep breath, all the tensions in your trunk, hands and arms, expel that.  With a third one, collect and expel all those in your shoulders, neck and head.  With practice, some people are able to collect tension in the entire body in one deep inhalation.

Ideal relaxation
With your eyes closed, take a moment to create, in your mind’s eye, an ideal spot for relaxation.  You can make it any place, real or imagined.  Perhaps it is a favourite room, a beautiful meadow, an ocean beach, or a floating cloud. See yourself in comfortable clothes. Now, once you have created it, go back there for 15 seconds or go whenever you feel the need to relax.

There’s a reason for each of these parts.  As we get tense, our facial muscles tend to get tense and ‘hard-looking.’  Smiling breaks that up – it’s difficult to remain as stressed after smiling. A deep breath counteracts the tension-filled shallow breathing.  We tend to tense our jaws when stressed, so letting it hang slack lets go of some of that stress. The same with our shoulders – up and tense with stress, so letting them go and relaxing lets of the stress.  And, letting our forehead smooth out releases the tensions we tend to gather there when we frown or wrinkle our forehead.


The individual can also relax through massage. Deep, firm touch, moving from the head down the spine will help individuals with sleep difficulties. individuals who become overstimulated easily may benefit from massage throughout the day to help them calm down and relax.

3.3 Basic Releasing Techniques

IDEA Health & Fitness Source, April 2004 v22 i4 p80(1)

Relaxation 101. (handout)

Full Text: COPYRIGHT 2004 IDEA Health & Fitness

Ready to rip your hair out? So stressed you can’t sleep? Tired of tense muscles? It’s time to relax. Stress isn’t good for you. Mentally, stress causes anxiety, tension and hyper-alertness. Prolonged, unmanaged stress leads to irritability, loss of concentration and a weakened immune system. Learning how to relax can counteract these stress responses.

By releasing both physical and mental tension, relaxation restores your mind and body to a balanced state. Breathing exercises and progressive relaxation soothe the body. Guided imagery and visualization install peace of mind, especially when combined with physical relaxation. Striking a balance is the key.

To learn how to relax, try these techniques from Shirley Archer, JD, MA, a Pain Alto, California, wellness educator and fitness specialist who is the author of The Pilates Deck, The Strength & Toning Deck and Pilates Fusion: Wellbeing for Body, Mind and Spirit.

1. Conscious Breathing

Effective physical relaxation methods include simple breathing exercises, progressive relaxation and gentle, static stretching. If you don’t have much time, simply take a few moments to focus on your breathing. Mentally “observe” your inhalation and exhalation, without making any effort to control the breath. Pay attention to how the breath moves the body. Notice subtleties, such as whether the chest or belly rises with inhalation, and how the body responds to exhalation. This singular focus brings you into the present moment and into the immediate experience of your body. It often results in slower, deeper diaphragmatic breaths that further relax the body.

2. Progressive Relaxation

After you are comfortable with conscious breathing, try progressive relaxation. It consists of sequentially tensing and relaxing individual muscles. This method helps you develop body awareness and educates you on how to release tension. When you do progressive relaxation, start from the top of the body and progress to the bottom, or vice versa. Proceeding sequentially gives you an easy-to-follow sense of order.

3. Visualization

Mental techniques can also be helpful. Visualization uses images that appeal to the senses–sight, sound, smell, touch and taste–to create mental and physical responses. Visualization involves mentally rehearsing a perfect performance or specific goal and includes all aspects of the experience, triggering sense and memory. Athletes use visualization to enhance sports performance. The technique is effective because images are almost as real to the mind as actual experience. Regularly using visualization can create confidence, direct positive behavioral change, strengthen motivation and engender feelings of control.

You may experience anxiety when trying a new relaxation technique. Know, too, that some methods can periodically bring strong emotions to the surface. You may cry or feel sad. Don’t worry. This type of release is normal and can represent an important “letting go.” If you have an extremely strong emotional reaction, you may want to consult with a counselor or other health care provider.


Guided imagery is a mental relaxation technique. In contrast to visualization, guided imagery is not used to rehearse any specific behavior. Rather, it is used to create a mind-body relaxation experience. Guided imagery incorporates all the senses and focuses attention inward. In this technique you listen to someone (live or on audiotape or CD) who helps guide you into imagining a comfortable place or private sanctuary. This exercise helps if you have difficulty bringing up specific images to lead you into a comfortable and relaxed experience.

To find tapes or CDs on guided imagery and meditation (or on breathing, progressive relaxation and visualization), search an online bookseller, such as, or visit a local bookshop or music store. When doing guided imagery at home, set up a soothing setting. Dim the lights, and close the door to eliminate extraneous noise. Since body temperature usually falls when people relax, have a blanket or sweater nearby. If you enjoy fragrance, scent the air with aromatic burners or soothing essential oils like lavender to create a special feeling of relaxation.

3.4 Relaxation Exercises

Relaxation exercises are effective techniques for reducing stress. These exercises help you to feel less tense and more relaxed. The result is a greater sense of physical and emotional well-being. A brief relaxation activity requires 60 to 90 seconds, so it can be done easily and quickly on the job, in the car, or in a few minutes of free time at home.

Step 1. Assume a passive and comfortable position. Although sitting may be most conducive to relaxation, you can do these exercises while standing, riding in a car, lying down, or as you prepare for an anticipated stressful event.
Step 2. Practice one or more of the following activities several times each day. This will help keep you calm, and will reduce tension when it occurs.
  • Deep breathing: Exhale slowly, and tell all your muscles to relax. Say as you exhale, “I feel tension and energy flowing out of my body”. Repeat the above exercise five or six times and you’ll become more relaxed.
  • Whole body tension: Tense every muscle in your body, stay with that tension, and hold it as long as you can without feeling any pain. Slowly release the tension and very gradually feel it leave your body. Repeat three times. Notice how your feelings change.
  • Shoulder shrugs and head rolls: Try to raise your shoulders up to your ears. Hold for the count of four, then drop your shoulders back to normal position. Rotate your head and neck. Vary this by rotating your shoulders up and down, and head and neck around–first one way, then the other, then both at the same time.
  • Imagine air as a cloud: Open your imagination and focus on your breathing. As your breathing becomes calm and regular, imagine that the air comes to you as a cloud–it fills you and goes out. Notice that your breathing becomes regular as you relax.

Some relaxation exercises work better for some people than others. Practice whatever exercises seem to fit you best.

(These exercises were adapted from Stress and How to Live With It. Cheryl Tevis, Ed Meredith Corp. 1982.)


Take 5 minutes a day to practice a relaxation technique such as: breathing techniques, music therapy, massage therapy, taking a bath, and reading a book. And, never underestimate the relaxation power of a long stroll, walk or run!

Treatment for arthritis includes relaxation therapy, or learning ways to release muscle tension by yourself, such as progressive relaxation where you tighten muscle groups one by one, relaxing tension throughout your body.

3.5 More Relaxation Exercises

Before trying the full exercise below, first practice steps 1 through 5, so you can get used to deep breathing and muscle relaxation.

Exercise 1

  1. Find a quiet place where you can rest undisturbed for 20 minutes. Let others know you need this time for yourself.
  2. Make sure the setting is relaxing. For example, dim the lights if you like, and find a comfortable chair or couch.
  3. Get into a comfortable position where you can relax your muscles. Close your eyes and clear your mind of distractions.
  4. Breathe deeply, at a slow and relaxing pace. People usually breathe shallowly, high in their chests. Concentrate on breathing deeply and slowly, raising your belly, rather than just your chest, with each breath.
  5. Next, go through each of your major muscle groups, tensing (squeezing) them for 10 seconds and then relaxing. If tensing any particular muscle group is painful, skip the tensing step and concentrate just on relaxing. Focus completely on releasing all the tension from your muscles and notice the differences you feel when they are relaxed. Focus on the pleasant feeling of relaxation. In turn, tense, hold, and relax your:
    • Right and left arms. Make a fist and bring it up to your shoulder, tightening your arm.
    • Lips, eyes, and forehead. Scowl, raise your eyebrows, pucker your lips, and then grin.
    • Jaws and neck. Clench your teeth and relax, then tilt your chin down toward your chest.
    • Shoulders. Shrug your shoulders upward toward your ears.
    • Chest. Push out your chest.
    • Stomach. Suck in your stomach.
    • Lower back. Stretch your lower back so that it forms a gentle arch, with your stomach pushed outward. Make sure to do this gently, as these muscles are often tight.
    • Buttocks. Squeeze buttocks together.
    • Thighs. Press thighs together.
    • Calves. Point your toes up, toward your knees.
    • Feet. Point your toes down, like a ballet dancer’s.

    You may find that your mind wanders. When you notice yourself thinking of something else, gently direct your attention back to your deepening relaxation. Be sure to maintain your deep breathing.

  6. Review these parts of your body again, and release any tension that remains. Be sure to maintain your deep breathing.
  7. Now that you are relaxed, imagine a calming scene. Choose a spot that is particularly pleasant to you. It may be a favorite comfortable room, a sandy beach, a chair in front of a fireplace, or any other relaxing place. Concentrate on the details:
    • What can you see around you?
    • What do you smell?
    • What are the sounds that you hear? For example, if you are on the beach, how does the sand feel on your feet, how do the waves sound, and how does the air smell?
    • Can you taste anything?

    Continue to breathe deeply, as you imagine yourself relaxing in your safe, comfortable place.

  8. Some people find it helpful at this point to focus on thoughts that enhance their relaxation. For example: “My arms and legs are very comfortable. I can just sink into this chair and focus only on the relaxation.”
  9. Spend a few more minutes enjoying the feeling of comfort and relaxation.
  10. When you are ready, start gently moving your hands and feet and bringing yourself back to reality. Open your eyes, and spend a few minutes becoming more alert. Notice how you feel now that you have completed the relaxation exercise, and try to carry these feelings with you into the rest of your day.

Exercise 2

  1. Sit comfortably. Loosen any tight clothes. Close your eyes. Clear your mind and relax your muscles using steps 4 and 5 above.
  2. Focus your mind on your right arm. Repeat to yourself, “My right arm feels heavy and warm.” Stick with it until your arm does feel heavy and warm.
  3. Repeat with the rest of your muscles until you are fully relaxed.

These exercises don’t work right away for everyone. It can take some time to feel these exercises are working, so practicing may help. If any of these steps makes you feel uncomfortable, feel free to leave it out. Ask your doctor or nurse about other ways to relax if these exercises don’t work for you.



4. Relaxation through Enjoyment

4.1  Enjoying Life

Consider some of these activities that will help you enjoy life, reduce stress and relax:

  • Reading a good book
  • Visiting with friends
  • Walking in the woods
  • Taking a relaxing bath or shower
  • Perusing a hobby
  • Seeking spiritual peace
  • Watching a funny video
  • Laughing with family members
  • Healthy food and good digestion
  • Giving things away.


4.2  Manage Your Psychological Well-being

One way to manage your psychological and physical well-being is to have people you can turn to for emotional support. This support might come from family, church members, friends, or others who have experienced the kind of stress you are experiencing. Emotional support involves give-and-take. You must be willing to support other people in addition to receiving support from them.Diet also appears to influence a person’s ability to cope with stress. Elevated blood cholesterol levels combined with hypertension or high blood pressure increase your chances of stroke and heart attack. Be moderate in your consumption of coffee, tea, soft drinks, and drugs containing caffeine. Caffeine stimulates the sympathetic nervous system and may promote even more nervousness and tension. Although alcohol and drugs are common ways of dealing with stress, they can be addictive and tend to deal only with the symptoms of the problems. They mask the cause of stress without eliminating it. Eat an adequate and nutritious breakfast each day. Most authorities suggest you consume at least one-fourth of your daily calories and nutrients at breakfast. Hunger can leave you less able to cope with stress. All in all, it just makes good sense to eat moderately and regularly, especially when you’re under stress.A basic exercise program also is likely to improve your ability to manage stress. Stretching and flexing the muscles of the neck, arms, shoulders, back, thighs, and midsection reduce the chance that these muscles will tighten up and produce common indicators of stress-headache, neckache, and backache. A more advanced exercise program that is likely to help manage stress involves cardiovascular fitness. Over a period of time, cardiovascular exercise will benefit the heart, lungs, and arteries and result in biochemical changes that elevate your mood and encourage a healthy self-concept. You can do more work or do your regular work with less fatigue. Although many people may be “on the go” during the day, their activity is most often sporadic and does not necessarily improve the strength and endurance of the cardiovascular system.The best cardiovascular fitness program involves daily aerobic or rhythmic, repetitive exercise three times a week. Aerobic exercise moves oxygen through the body. The activities most commonly used for cardiovascular conditioning are running, brisk walking, cycling, swimming, rowing, aerobic dancing, and cross-country skiing. These activities are noncompetitive and less psychologically stressful than other sports such as golf or tennis.If you’re older than 35, have a thorough medical checkup before beginning such a program. In addition to support groups, diet, and exercise, managing stress also means balancing your personal, social, and work-related activities.

  • Develop a variety of interests, activities, and relationships.
  • Balance work with recreation.
  • Don’t keep anxiety and anger bottled up (talk about problems to someone who cares).
  • Set reasonable personal expectations and goals.
  • Learn to accept what cannot be changed.
  • Learn to say no to requests you cannot reasonably handle.
  • Give in once in a while, even if you think you are right.

Monitor Your Present Level of StressRecognizing early warning signals of stress-related problems is the second step in reducing damage caused by stress. Not all symptoms of excessive stress can be observed easily.

Early Warning Signs:

  • Exaggerated, out-of-proportion anxiety;
  • Excessive moodiness;
  • Withdrawal from responsibility;
  • Constant insomnia;
  • Poor emotional control;
  • Severe feelings of helplessness and dependency;
  • Marked change in appetite or sex drive;
  • Chronic fatigue; and
  • Susceptibility to illness.

Other indicators of stress are such comments as:

  • “I can’t keep my mind on my work;”
  • “I feel all tied up in knots;”
  • “I can’t relax;” and
  • “I feel miserable and I don’t know why.”

Or have you noticed:

  • A door slammed a little too hard;
  • An overpowering sense of fatigue;
  • Lots of faultfinding and bickering; and
  • A constant state of turmoil.

All of these signs indicate stress has reached a serious level.In addition to recognizing symptoms of stress, you need to be prepared for potentially stressful events. For instance, certain times of the year may be par-ticularly stressful for some people because of work or other pressures. Or you may be anticipating, or undergoing, major changes such as moving, retire-ment, pregnancy, or a new job, which could be very stressful. If you are undergoing many changes, look for ways of coping with stress and avoid, if possible, taking on anything new at this time.

A helpful way of monitoring your stress level is to keep a Daily Stress Log like the following sample. Record how often, causes of, and reactions to stress-ful events, people, places, and situations. As you take steps to manage stress, the Daily Stress Log provides a before and after check on your progress. A Daily Stress Log worksheet is provided at the end of this lesson to help you monitor your own levels of stress.

Maneuver to Avoid Extremely Stressful SituationsYou can handle stress through two maneuvers- arrange stress and change your reaction to stress-ful events.

Arrange Stress

This suggestion is always questioned. How can anyone arrange stressful situations? Most of the time you cannot, because many stressful events occur unexpectedly. However, there are many situations that you know are stressful. You can plan around these and lessen the effects of stress. For many people, stress results when they feel overwhelmed by many things that need to be done at the same time. If you plan in advance how to handle potential problems, you can often prevent them from getting out of hand. And, often you can postpone some situations so that two very stressful events don’t happen at the same time.

Change Your ReactionsSince everyone lives in a stressful environment at some time, here are a few rules for handling stress.

  • Have a positive attitude-If you can convince yourself that the source of stress is necessary, you will have fewer after-effects.
  • Accept and discuss-Accept that your lifestyle produces stress and that you can control the unwanted side effects. Look for trouble spots and do what you can to try to change them. Discuss situations that you and your family find particularly distressing. Work together to reduce the causes of stress.
  • Clarify responsibility-Much stress in a family can be reduced by clarifying family members’ roles and responsibilities. Make sure everyone understands clearly what is expected of him or her. Set clear priorities for yourself and your family. Communicate positively and discuss issues openly.
  • Improve your time management-Time, man-aged well, can help reduce stress resulting from too much to do in too little time. Set up realistic time limits for yourself and others.
  • Learn to relax-Often, in the midst of stressful situations, it might be difficult to relax. Yet just a few minutes of sitting in a comfortable chair listening to soothing music, taking a warm bath, doing deep muscle relaxation (alternately tense and relax muscles of your body), or meditating will help you relax and reduce stress. At times you need to loaf a little. True, too much inactivity often breeds boredom and may increase stress, but everyone needs some “do nothing” time. Daydreaming and reflecting may allow time for creative solutions to problems.



Now Enjoy these Actual Bumper Stickers

“Out of my mind. Back in five minutes.”
“Laugh alone and the world thinks you’re an idiot.”
“Sometimes I wake up grumpy; other times I let him sleep”
“It’s as BAD as you think, and they ARE out to get you.”
“I took an IQ test and the results were negative.”
“Warning: Dates in calendar are closer than they appear.”
“Give me ambiguity or give me something else.”
“He who laughs last, thinks slowest”
“Always remember you’re unique, just like everyone else.”
“Consciousness: that annoying time between naps.”
“Be nice to your kids. They’ll choose your nursing home.”
“3 kinds of people: those who can count & those who can’t.”
“Ever stop to think, and forget to start again?”

5. More Relaxation Strategies

Review these links and become acquainted with all techniques.


6. Relaxation Effectiveness Studies

Relaxation techniques are highly efficient and produce long-term benefits in the treatment of clinical anxiety (Borkovec & Sides, 1979; Bernstein & Borkovec, 1973; Clum, Clum, & Surls, 1993; Rasid, & Parish, 1998).Panic Disorder 
Several studies report the elimination of panic attacks via cognitive or breathing techniques in at least 80-90% of their clients (Barlow, 1988; Beck, 1988; Clark, 1986; Clark, Salkovskis, & Chalkley, 1985).  A recent study investigated the efficacy of applied relaxation and cognitive behavior therapy for treating panic disorder. Thirty-eight outpatients with no or mild avoidance were assessed. Both treatments yielded significant improvements that were maintained or furthered at follow-up.  Sixty-five percent of those who received AR were panic-free after treatment, and 82% were panic-free at follow-up, and 74% of those who received CBT were panic-free after treatment, and 82% were panic-free after follow-up. These treatments made lasting changes in generalized anxiety and depression, which has shown that AR and CBT are effective treatments for panic disorder without avoidance (Oest & Westling, 1995). Generalized Anxiety Symptoms 
Different multi-component (cognitive, relaxation, and exposure techniques) treatments for the treatment of generalized anxiety have shown significant improvements of anxiety (Borkovec & Costello, 1993). Deffenbacher and Suinn (1987) recommend teaching relaxation as a self-control procedure as part of these treatments. Expressive Relaxation Training has proven to be quite effective in the treatment of anxiety. This method was used to treat male and female psychiatric outpatients with general anxiety disorders. Ratings of anxiety, depression, avoidance behavior, social impairment disability, and quality of interpersonal relationships were markedly improved at ERT termination (Andreoli, Casolari, & Rigatelli, 1995).Test Anxiety 
Relaxation seems to be effective in the treatment of test anxiety and significantly better than no-treatment controls.  However, cognitive methods seem to be more effective than relaxation (Lehrer & Woolfolk, 1993). Social Phobia 
Relaxation appears to be effective in the treatment of social phobias.  Treatment comparisons showed that either exposure, relaxation, or CT are effective in the treatment of social phobias (Heimberg, 1989).

Anger, Hostility and Aggressive Behavior

Relaxation techniques, such as PMR, meditation, and AT seem to be equally effective as CT in reducing symptoms of hostility (Deffenbacher, McNamara, Stark, & Sabadell, 1990).  However, the combination of CT and relaxation therapies are particularly effective in treating excessive anger in children and adults (Kendall & Braswell, 1986; Meichenbaum & Novaco, 1985; Novaco, 1975). A combination of cognitive-relaxation compared with relaxation coping skills was measured to show which proved more useful in treating general anger. It was shown that some measures slightly favored the cognitive-relaxation method. The two methods also showed reductions in clinically meaningful general anger and maintenance of anger and anxiety after a one year follow-up period at a somewhat equivalent rate (Deffenbacher & Stark, 1992).


Relaxation techniques are useful in treating adults (Primavera & Kaiser, 1992) and children’s (Mehta, 1992; Sartory, Mueller, Metsch, & Pothmann, 1998) headaches.  Relaxation or biofeedback training helps between 40% and 80% of tension headache sufferers (Blanchard, Ahles, & Shaw, 1979).  Greater improvements are reported at follow-up than immediately after treatment.  Autonomically focused techniques (e.g., TBFK, AT) are used for migraine headaches (Lisspers & Ost, 1990).  Somatic techniques (e.g., PMR) are used for  the treatment of migraine headache (Blanchard, Appelbaum, Radnitz, Morrill, Kirsch, Hillhouse, Evans, Guarnieri, Attanasio, Andrasik, Jaccard, & Dentineer, 1990).  CT appears to be a particularly potent method for treating tension headaches (Murphy, Lehrer, & Jurish, 1990).  A combination of CT and relaxation therapy has been shown to be more effective than relaxation alone (Tobin, Holroyd, Baker, Reynolds, & Holm, 1988).  No systematic differences have been found between CT and relaxation for migraine headache (Sorbi, Tellegen, & du Long, 1989).  Use of PMR and restricted environmental stimulation therapy showed a significant decrease in headache reports (Wallbaum, Rzewnicki, Steele, & Suedfeld, 1991). The active treatment group improved significantly more than the control group, as well as showed continuing improvement during follow-up periods, while the control group had deteriorated by 34% since the end of the treatment.

PMR is an effective treatment for idiopathic insomnia (objective insomnia, Borkovec, 1979).  Knapp, Downs, and Alperson (1976) suggests that the majority of the relaxation training significantly reduces the latency to sleep onset and the number of awakenings.  There is some evidence that PMR also improves pseudoinsomnia (self-reported insomnia) (Greeff & Conradie, 1998).  Because cognitive rather than physiological arousal is critical to the cause and/or maintenance of insomnia, several researchers recommend a combination of CT and PMR methods (Lacks, 1987). A recent study has also found that self-administered treatment of progressive relaxation training is highly effective in treating insomnia. After a one year follow-up period, patients had learned to relax to an average of 83%, and also learned to achieve a state of calmness which improved their overall sleeping patterns by 86%. (Gustafson, 1992).

Substance Abuse
Between 10-40% of alcoholics suffer panic-related anxiety disorder, and 10-20% of anxiety disorder clients abuse alcohol or other drugs (Cox, Norton, Swinson, & Endler, 1990).  Relaxation and self-management techniques significantly reduce anxiety and tension in alcoholics (Parker & Gilbert, 1978; Parker, Gilbert, & Thoreson, 1978). Relaxation seems to be highly recommended for anxious alcoholics (Kushner, Sher, & Beitman, 1990) who drink to avoid experiencing stress or in response to stress.  Relaxation training effects could substitute for alcohol effects.

Recent studies have found that the use of relaxation imagery in smoking cessation programs to be effective. The study targeted smokers aged 18-60, and showed quit rates to be 69%, and abstinence rates of 55%. These findings suggest that relaxation imagery can be a useful tool to deter smoking (Wynd, 1992).

Relaxation Therapies with Children
Children are as good or better able than adults to learn relaxation techniques (Zaichkowsky & Zaichkowsky, 1984; Hiebert, Kirby, & Jaknovorian, 1989).  Most of the studies show that relaxation can be beneficial in treating anxiety-related academic difficulties and pain (Heitkemper, Layne, Sullivan, & David, 1993).  Relaxation therapy can also be a positive addition to improving psychosomatic disorders (Richter, 1984), and hyperactive children’s impulsivity, disruptive behavior, academic performance, and self-concept (Omizo & Williams, 1982).

Hypertension and Heart Disease

Relaxation training is more effective in controlling mild essential hypertension than no-treatment, delayed-treatment, and control procedures (Agras, Southam, & Taylor, 1983).  This training alone, however, is not as effective as antihypertensive medications in reducing blood pressure (Jacob, Shapiro, Reeves, Johnson, McDonald, & Coburn,1986).  Some studies of relaxation therapy for hypertension have reported highly significant effects for relaxation therapies (Jacob, Chesney, Williams, Ding, & Shapiro, 1991).  In 1988, the joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure recommended that relaxation be used for treatment of mild hypertension, and as an adjunct to medication for treatment of more severe hypertension.  There is evidence that stress management techniques can decrease the doses of anti-hypertensive medications needed (Glasgow, Engel, & D’Lugoff, 1989).  Where blood pressure is significantly elevated, however, it should not be considered safe to maintain hypertensive patients on relaxation treatment alone.  Relaxation-based interventions also have a prophylactic effect against heart disease (Dath, Mishra, Kumaraiah, & Yavagal, 1997, Patel, Marmot, & Terry, 1981; van-Dixhoorn, 1998).  A combination of thermal biofeedback and PMR training administered to those suffering from essential hypertension has produced satisfactory results. A significant decline in systolic and diastolic blood pressure was observed in the treatment group, as opposed to an increase in both for the control group. (Hahn, Ro, Song, & Kim, 1993).

Relaxation techniques have been used to treat those suffering from fibromyalgia.  Studies have compared the effectiveness of  relaxation, exercise, and a combination of the two. It was found that all three treatment groups produced improvements in self-efficacy for physical function, which was best maintained by the combination group after a two year follow-up period (Buckelew, Conway, Parker, et al., 1998).

Menopausal Symptoms 
Applied Relaxation was tested on individuals who suffered from postmenopausal hot flushes. The number of flushes was measured from one month before to six months after treatment was applied, and was found to reduce the frequency by an average of 73%  (Wijma, Melin, Nedstrand, & Hammar, 1997).

Irritable Bowel Syndrome

Studies combining relaxation and CT have shown positive results in the treatment of irritable bowel syndrome (Neff & Blanchard, 1987; Blanchard & Schwarz, 1988). Progressive Muscle Relaxation administered to those suffering from Irritable Bowel Syndrome has been shown to significantly alleviate symptoms associated with the condition (Blanchard, Greene, Scharff, & Schwarz-McNorris, 1993). Fifty percent of the group was clinically improved by the end of the treatment, and results also indicate that relaxation training alone can be a useful treatment for Irritable Bowel Syndrome.

Relaxation treatments have been shown to produce significant improvement in asthma (Vazquez & Buceta, 1993),  Facial muscle EMG BFK appears to successful in decreasing parasympathetically mediated bronchoconstriction.  (Kotses, Harver, Segreto, Glans, Creer, & Young, 1991).  After reviewing the emotional precipitants of asthma, Kotses (1998) recommends the use of procedures that promote relaxation and reduce stress.

A recent study tested the hypotheses that persons with diabetes mellitus treated with twelve sessions of biofeedback-assisted relaxation would decrease blood glucose compared with untreated controls. Treatment consisted of EMH biofeedback, thermal biofeedback, relaxation therapy, and diabetes education. The results confirmed the stated hypotheses, as well as an earlier study, which concludes that biofeedback-assisted relaxation can be an adjunct to conventional therapy for insulin-dependent diabetes. (McGrady, Graham, & Bailey, 1996).

Relaxation techniques have been used to treat side effects of cancer therapy.  Relaxation training has been successful in decreasing the duration and severity of post treatment nausea (Morrow, 1986); and secondary insomnia (Cannici, Malcolm, & Peek, 1983). Recent studies have also shown relaxation to be effective in increasing immune effects during chemotherapy treatment for ovarian cancer . It is suggested that relaxation can positively affect immune parameters in cancer patients. (Lekander, Fuerst, Rostein, Hursti, & Fredrickson, 1997). Relaxation combined with imagery and cognitive-behavioral training have been used to reduce pain during cancer treatment with substantiated success. (Syrjala, Donaldson, Davis, & Kippes, 1995).


PMR, EMG BFK, TBFK, cognitive restructuring, time scheduling, and non-directive therapy has been shown to be effective in the treatment of dysmenorrhea (Balick, Elfrier, May, & Moore, 1982; Sigmon & Nelson, 1988).

Progressive muscle relaxation has shown to be quite effective in treating symptoms associated with HIV. Conditions such as anxiety, mood, self-esteem, and t-cell count were measured after a stress management program consisting of 20 bi-weekly sessions of progressive muscle relaxation was implemented. Analysis showed significant improvements on all measures, and suggests that using stress management to reduce arousal of the nervous system would be an appropriate component of treatment for HIV infection (Taylor 1995). Studies have also compared the effectiveness of guided imagery and PMR on HIV symptoms. Results have shown that imagery reduced depression and fatigue, while PMR increased CD4+T lymphocyte count and also reduced depression (Eller 1995).


Progressive relaxation has been shown to be highly effective in the reduction of seizures (Whitman, Dell, Legion, & Eibhllyn, 1990). Frequency of seizures was monitored over an eight-week interval, and three subsequent follow-up periods after the therapy was implemented. During the third eight week follow-up interval, seizures were shown  to reduce by over fifty  percent.

Alzheimer’s Disease 
Studies focusing on PMR for 34 patients with Alzheimer’s have successfully shown significant decreases in behavioral disturbances, as well as improved performances  on measures of memory and verbal fluency, from baseline to two month follow-up testing (Suhr, Anderson, & Tranel, 1999).

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