Applied Relaxation And
The Symptoms Of Stress

The negative effects of anxiety disorder can be reduced using applied relaxation (AR). AR is a clinically and therapeutically derived and tested method of treatment designed to help cope with various anxiety related symptoms. It has also been used to deal with phobias, panic attacks and disorders, insomnia and also apparently epilepsy. The specific method or technique of AR was first presented as a paper in 1976, and several studies since then have commented positively on its efficacy as a contributory element in the treatment of generalized anxiety disorder as well as more specific manifestations of anxiety. Applied relaxation is primarily used in a therapeutic setting, at least initially, but its emphasis on teaching the patient how to handle their anxiety on his or her own means that it can be self-applied once the patient has a full understanding of how it works.

The therapist first outlines to the patient the methodology of AR and explains how it can be used in relation to the patient's specific and individual anxiety problem(s). This also has the benefit of enabling the patient to ask questions on any aspect of the treatment on which they may be unclear, and also that the therapist can correct any misinterpretations or unrealistic expectations about AR that the patient may have.

Applied Relaxation

Anxiety often produces physical symptoms such as accelerated heartbeat, sweating etc and this is immediately followed by negative mental imagery related to the cause of the anxiety, which then in turn causes the physical symptoms to intensify which causes a further deepening and intensifying of the overall anxiety state.

Applied relaxation is used to focus primarily on the physical symptoms and to teach the patient how to react less strongly to them. AR therapy is designed to help the patient learn relaxation as a skill, similar to learning how to ride a bike or drive a car, with the aim being to eventually master the skill more or less automatically so that it can be practiced at any time and in virtually any situation, without being restricted to conventional relaxation settings such as lying on a bed or sitting in an armchair at home or in the therapist's room or office.

The ultimate aim is to teach the patient how to relax fairly quickly and to use this ability to deal with and overcome the physical symptoms of anxiety or phobia before they are compounded and intensified by the psychological or subjective symptoms which follow them.

The two main prongs of AR treatment are a) showing the patient how to recognize symptoms of oncoming anxiety and b) showing the patient how to deal with the anxiety rather than be overcome by it.

Firstly, patients are advised to watch out for, to become aware of the signals that indicate oncoming anxiety. This is done through self-observation at home and otherwise outwith the therapeutic setting.

They are given "worksheets" on which they record, over a period a couple of weeks, anxiety related symptoms. On the first week they are asked to record only the date, the specific situation and the level of the intensity of the anxiety. On the second week they are asked to describe in more depth how they actually felt and reacted to it. They are asked to record their anxiety levels on a scale of 0-100%, where 0 means total relaxation, 50% partial relaxation and 100% maximum anxiety.  

The first actual phase of applied relaxation involves the use of progressive muscle relaxation. This initially focuses on relaxing the face, neck, shoulders arms and hands, then, in a second session, relaxation of the back, chest, midriff, legs and feet.

You start by tensing each of the above listed muscle groups, i.e. first the face, neck, shoulders, arms and hands for five seconds each, then following that with 15 seconds of relaxation of each muscle group. This is then followed by the second session focusing on the other second muscle groups referred to and following that with the 15 seconds of relaxation. The aim is to relax the rest of the body overall while tensing the particular muscle group being focused on.  

At the conclusion of this the patient records their level of overall tension on the same scale alluded to previously, i.e. 0%, 50%, or 100%. This progressive muscle relaxation is practiced in an upright seated posture, not while lying down, because this helps to develop relaxation skills in situations when the patient is in more "natural" situations outwith the therapeutic setting. The patient is also asked to practice progressive muscle relaxation at home, usually twice daily, with each session lasting around 15-20 minutes and to record their experiences on their worksheet.

The second phase of applied relaxation involves what is known as release-only relaxation. This is aimed at reducing the time involved for the patient to become relaxed. This phase generally lasts for one or two weeks. With release-only relaxation the therapist removes the focus on tensing and relaxing different muscle groups, and instead encourages the patient to relax more directly by focusing on breathing and relaxing the muscles of the face and head progressively down through the body till finally reaching the toes. If however the patient experiences ongoing tension in a particular area, then tensing and relaxing is applied to that area. 

The next phase is called cue-controlled relaxation, in which the inhalation and exhalation of breath is focused on and which also uses a verbal cue to initiate relaxation more speedily. The verbal cue used is, appropriately enough, "relax". The patient first relaxes deeply by using the release-only method, indicating to the therapist when they have become deeply relaxed by raising a finger. The patient is then asked to focus on their breathing and the therapist then says the word "inhale" just prior to each inhalation, and "relax" just prior to each exhalation. This is done five times. The therapist then stops using the cue verbally and the patient starts to use their own prompt by thinking "inhale" and then "relax" with the exhalation. 

After a few minutes of this the therapist  verbally prompts again using the cues "inhale" and then with the exhalation "relax", again five times, and then the patient continues on his or her own again for another few minutes. The whole session is repeated again after a break of around 15 minutes. Following 1 or 2 weeks of practice with this the time it takes the patient to become relaxed is further reduced.

Then comes the "differential" phase of applied relaxation. This basically aims to teach the patient how to relax in normal or potentially stress inducing situations, i.e. when out and about in day to day life and outwith any conventional "relaxation" setting.

The patient is asked to use cue-controlled relaxation while seated upright or standing and to relax themselves while moving various parts of the body and ultimately while walking, the aim being to relax muscles that are not actually being used while other specific muscle groups are being used. This phase usually involves two sessions and also aims to further reduce the time it takes the patient to relax.

This is followed by the "rapid relaxation" phase of applied relaxation. This aims to further increase the patient's ability to relax in potentially stressful situations while also further reducing the time it would take the patient to become relaxed. This is done by asking the patient to self-induce relaxation between 15 to 20 times a day. Certain various cues are used to remind the patient to induce relaxation, such as whenever he or she looks at a watch or opens or closes a door for example. This form of rapid relaxation uses the cue controlled method and consists of taking three or four deep breaths and thinking "relax" with each exhalation.      

This is then followed by the application training phase which would start after the initial nine or ten sessions of introductory training and involves brief exposure to anxiety producing triggers. The patient is encouraged to learn how to use their experience with cue controlled relaxation just before exposure to the trigger and to continue using it during exposure to the trigger. The overall aim here is not to develop unrealistic expectations of eliminating anxiety altogether but rather to learn how to use cue controlled relaxation as a means of coping with it and reducing its negative effects. 

Finally, patients are advised to continue using applied relaxation overall, whether experiencing anxiety or not, so as to maintain their ability to quickly and effectively deal with it.

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