“It takes all kinds to make a world”; so runs the old saying and – certainly, in my dealings over the years with both patients and members of healthcare staff – it has, if nothing else, proved to be almost entirely consonant with actual experience. For whilst it would be accurate to assert that many patients of my acquaintance have shown little if any interest in historical sources of relaxation training and their applied potential for coping with serious physical illness, such interest has indeed surfaced from time to time, sometimes decidedly so. Moreover, since – as you will appreciate – I have no way of knowing into which of these categories you might naturally fall, I have decided to include the briefest of historical notes on the subject matter here. Should, on the other hand, this fail to ‘connect’ with you, i.e. as being quite your own particular ‘scene’ so to speak, I would simply suggest that you quietly ‘give it a miss’ and proceed to the posting to follow.
In an earlier item of correspondence, you may recall my mentioning the name of Edmund Jacobson, who I suppose, could rightly he described as the “father” of modern progressive relaxation (PR) training and therapy. Jacobson’s particular thesis was that anxiety and relaxation are mutually exclusive states. This quite simply means that anxiety cannot be present where the muscles of the body are truly relaxed. Jacobson’s method derives from a very simple comparison of tension with relaxation and as far back as the 1930s, he was proposing and beginning to develop a physiological, i.e. tense-release response of particular muscle groups, as a method of combating tension and anxiety overall. Since people often have little awareness of the sensation of relaxation, each individual is first invited to tense a set of muscles as hard as he/she is able. This deliberately introduces the sensation of real tension (but now under conscious control). Thereafter, the person relaxes those same muscles and thus begins to learn, i.e. as an internal sensation, the difference between tension and relaxation. Given the necessary practice, the individual comes to discriminate more and more finely between the different degrees of sensation, i.e. tension-relaxation that may be experienced. (Hopefully it is becoming increasingly apparent that both Autogenic Training (AT) and Progressive Relaxation (PR) are selective, in that only those individuals who are willing to persevere with their training methods will enjoy their benefits).
Jacobson clearly believed that via the deployment of a systematized approach, an individual could almost completely eliminate muscular tension and in so doing, induce deep physical and mental relaxation. This, he went on to claim, was achieved by systematically tensing and relaxing specific muscle groups He began with the extremities such as toes and feet, fingers and hands etc., working inward and upward toward the trunk and head. Jacobson applied this method throughout much of the course of his experimental activities, reporting the results of his work in the years to follow in a series of published papers.
He continued ceaselessly to develop and refine this method and strategy and in 1962 reported on the culmination of his life’s work. This now entailed a basic model for progressive relaxation. It involved 15 muscle groups of the body overall, each requiring to be trained in from one to nine, hour-long daily sessions, before progressing to the next muscle group etc. (In all honesty I have always thought that in those very early days, Jacobson must have identified and have been working with a patient-population, almost entirely unknown to me: i.e. one with plenty of time on their hands and possessing oodles of ability to concentrate for hours on end).
Clearly, a similar thought did not escape the notice of the next major contributor to relaxation training, namely one Joseph Wolpe. Wolpe’s principal contribution however, was to use the relaxation and control response as a “counter-condition· to tension and fear, (always provided that the former, i.e. relaxation, was greater in strength and intensity than the latter, i.e. tension and fear). Wolpe’s early work was with animals, in fact cats, in which he first induced a fear response, thereafter training the same cats to learn and assimilate another, stronger but different and wholly incompatible to fear response, i.e. relaxation. Finally, he invoked this relaxation response, whilst gradually presenting the fear response over a number of carefully graded stages, ranging from mild to severe.
Wolpe further found and reported that relaxation (as the physiological converse to tension) was an ideal response for this kind of counter-conditioning programme. Thereafter, he increasingly applied what he had learned from his work with cats, to humans. Using the Jacobson progressive relaxation model as his starting point, Wolpe modified it in two important ways. Firstly, the prohibitive amount of time required for Jacobson relaxation training was markedly reduced; in fact to six 20 minute supervised sessions, with two daily 15 minutes home sessions in between. Second, he placed the treatment emphasis firmly on the circumstances surrounding the identified cause of anxiety, as well as its actual cause.
By way of example, let us say that a subject was known to have developed a fear of flying on-board an aircraft. Wolpe’s approach would first require that a set of graded associated fears from least to greatest, be identified and listed. Least of all of these might be, “thinking about the day of the flight”; next might come, “actually preparing for the journey to the airport”. Anxious feelings would thereafter be likely to further increase and intensify as the subject was “nearing the airport perimeter”. “Walking into the airport building on route to reception” would most likely be next to impart a further twist to the fear spiral as, beyond that would be “checking in” and “transference to the departure lounge”. Finally, the actual stimulus, i.e. that containing the fullest measure of fear and anxiety (and to which all of those referred to previously can be perceived to be remorselessly building up) would receive its most powerful boost as “the aircraft was boarded and roared into life for take-off along the runway”. Thus, by negating each fearful and carefully graded supporting stimulus in turn (hopefully to the point of elimination) the most fearful (actual) stimulus of “flying” might at least be reduced to manageable proportions. Wolpe named this the process of “systematic desensitization”, i.e. desensitizing the subject to his overall fear, by means of a graded, gradual and systematic approach. He also used the term “reciprocal inhibition”, to describe it, since each painstakingly graded fear response is being “matched” and “reciprocated against” and therefore inhibited (or diminished) by increasingly more powerful and intense relaxation responses.
Since the days of Wolpe’s modification and further development of Jacobson’s work, several attempts have been made to take things even further. This entailed work on the precise specification of optimal training conditions, including identification and deployment of times of maximum alertness. Readings were taken of basic physiological responses, e.g. heart rate, blood pressure, electro-dermal activity (or skin conductance) etc. Psychological parameters·, e.g. fear, anxiety state, were also recorded. Work was focused upon a need to identify those problems associated with the longer term, i.e. attitudinal and behavioural resistance, which are most suited to treatment with relaxation training. “What”, you might well be asking, “are the underlying reasons for any such documented experimental work?” The answer is that this, above all, represents the tried and tested method of describing and disseminating one’s findings to and among one’s peers. It exposes and subjects it to the comment and criticism of colleagues working in similar fields of interest and activity: and it is the surest pathway to further and continuing refinement via controlled research. Only in such universally accepted ways can any real confidence in the efficacy of methods/techniques employed be justified.
A further reason is to generate and extend the flow of other and new ideas in the interests of time and necessary adaptation to particular needs. Examples of the above might be cited as work, which has increased and enhanced our knowledge of i. physiological and reported subjective effects of progressive relaxation training, ii. reported specific effects of progressive relaxation training on the effects of anxiety-provoking imagery and circumstances·· and iii. differences in effect and on endurance between ‘live’ and taped progressive relaxation training.
In reality, this blog affords little more than a comment on the need for and value of properly and adequately designed research methods. What it perhaps most clearly demonstrates is the truth of the old saying, “nothing is original”. Nevertheless, the continual updating and refinement of old ideas, leading to the postulation of fresh hypotheses for testing, has always been and will doubtless continue to be the way of scientific research and thus a “high road” to genuine progress. Hopefully it will also have reinforced an important truth evident both in what has been written here, as well as in daily personal experience. It is that relaxation does not exist or function in a vacuum. Indeed, an apparent tendency among some to refer to it as though it does (and thus to dismiss or be entirely unmindful of the need to prepare the ‘stage and scene’ on which it is required to ‘play out’ its role in our search for an enhanced quality of life) is just one major contributory factor to any failure to live up to reported expectations. In my next blog, we shall begin to identify and – hopefully – effectively deal with these and other evasions and omissions. (C) SB.
To train a subject/patient to induce the counter response, e.g. relaxation and a feeling of overall control, to an initial response of tension and fear.
A measurable or quantifiable dimension/characteristic/trait.
Examples of this might entail bringing patients through noxious and unpleasant treatment schedules, entailing the use of machinery; e.g. “linear accelerators” and noxious, i.e. toxic drug regimens.