Relaxation Therapy

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The overall goal of relaxation therapy is to elicit the body’s natural relaxation response, which includes slower breathing, lowered blood pressure, and an overall sense of calm and well-being.

Relaxation therapies help to minimize the effects of stress on one’s mind and body, thereby allowing an individual to cope with depression, anxiety, and the symptoms associated with chronic conditions such as Fibromyalgia. There is also an added benefit to relaxation therapies in that most are able to be self-taught and self-administered, usually requiring only brief instruction from a book or an experienced practitioner.

Relaxation techniques frequently utilize breathing and focused attention on images and thoughts that are pleasurable to the mind and the body. Common relaxation techniques that can be practiced by anyone at almost any time include deep breathing exercises and mindfulness meditation. Deep breathing exercises involve the conscious slowing of breathing and focus on taking regular, deep breaths. The inhalation rate is typically doubled as is the exhalation rate, effectively lengthening and deepening the breathing cycle. Mindfulness meditation allows the individual to focus on the images, sounds and smells around them through simple relaxation and enjoyment of one’s surroundings.

How Relaxation Therapies Work

The best way to understand how relaxation therapies work is to view them through the lens of stress. When the human body is under stress it releases certain hormones that trigger the heart rate and respiration rate to increase, as well as the blood vessels to constrict and reduce the blood flow. All of these events combine to allow energy to flow to parts of your body that need it most, such as the muscles or heart. Although stress is useful in short-term situations, some research suggests that when your body remains stressed for longer, more sustained periods of time, it can result in emotional and even physical damage, such as high blood pressure, chronic pain, depression and anxiety. Relaxation therapies work by reversing the body’s response to stress – slowing the heart rate, lowering blood pressure, and decreasing oxygen intake and the production of stress hormones.

Types of Relaxation Therapy

Autogenic training

Autogenic training places focus on the physical sensations of an individual’s breathing and heartbeat and prompts the individual to envision various body parts as warm, heavy, and/or relaxed. For example, an individual undergoing autogenic training might repeatedly say “My legs are warm and heavy” while visualizing that in fact his legs feel warm and heavy. Research has shown that this can actually produce warming in the extremities, which could potentially be of benefit to Fibromyalgia patients who are frequently intolerant to cool. However, there is limited scientific research regarding the use of autogenic training specifically to treat the pain associated with Fibromyalgia.

One case study from the Japanese literature reports that a 38 year old woman with Fibromyalgia responded to the use of autogenic training, along with the use of medical therapies (Goto et al., 2005). A small study compared the use of cognitive behavioral therapy (a type of psychological therapy that helps patients understand how their thoughts and feelings affect behavior) along with relaxation and physical exercise to autogenic training in 27 Fibromyalgia patients. This study found that the cognitive behavioral therapy, relaxation, and exercise regimen were more effective at treating Fibromyalgia symptoms than the autogenic training (Keel et al., 1998).

Biofeedback

Biofeedback utilizes various electronic devices to show individuals how their bodily functions such as blood pressure, heart and breathing rate, temperature, and degree of muscle tension, respond to stress and other stimuli. The idea behind biofeedback is that by being able to see how your body responds to various stimuli and stressors will enable you to better understand the feelings and reactions you have as a result.

Research related to biofeedback as a means to treat Fibromyalgia has shown encouraging results. One randomized controlled trial (the “gold standard” of research study designs) by Kayiran et al. investigated the use of biofeedback among 36 patients with Fibromyalgia. Eighteen patients received 20 sessions of biofeedback over a four week period, while the 18 control subjects received a medicinal therapy for eight weeks. Although both groups showed improvement in pain, fatigue, and depression at the end of the study, the biofeedback group showed the greatest improvement and the authors concluded that biofeedback may be a useful tool to treat pain, psychological symptoms, and decreased quality of life in Fibromyalgia patients. A 2007 study by Babu et al. also found that biofeedback helped to reduce pain in Fibromyalgia patients, as well as to improve the overall impact of Fibromyalgia on life quality and reduce the number of tender points.

Guided Imagery

Guided imagery uses focusing on pleasant images in an effort to replace negative and stressful feelings. This relaxation technique can be done alone or guided by a practitioner who uses a story or narrative to suggest mental images and visions. Guided imagery can be used to enhance muscle relaxation and provide a distraction from pain, which may be of benefit for Fibromyalgia sufferers.

A 2002 randomized controlled trial conducted by Fors et al. investigated the use of guided imagery as a means of treating pain in 55 female Fibromyalgia patients. The researchers found that those in the guided imagery group had significantly less pain when compared to the subjects in the control group. Another randomized controlled study showed that while guided imagery did not result in an improvement in pain for 48 Fibromyalgia patients, its use did correspond to improvements in improved ability to function and self-efficacy for managing pain (Menzies et al., 2006).

A recent comprehensive review of studies evaluating the efficacy of hypnosis and guided imagery in Fibromyalgia patients found that although some support exists for the use of guided imagery to reduce pain in Fibromyalgia, many studies are limited by poor design and methodologies. The authors call for additional studies to be conducted with improved designs and methods in order to determine the true effectiveness of guided imagery as a means to treat Fibromyalgia symptoms.

Progressive Muscle Relaxation

Progressive muscle relaxation involves systematic tightening and relaxing of different muscle groups throughout the body in an effort to decrease muscle tension and relieve anxiety. Individuals typically lie down or sit in a quiet area free from extraneous noises. Beginning with the face, muscles are tightened (by making a tight grimace or similar expression) for a count of five to 10 while the individual inhales. Once the count is reached, the individual exhales for an identical count of five to 10 and releases the tension from all the muscles in the face. The individuals would then repeat these steps with the neck and shoulders, back, arms, legs, feet and hands.

Limited scientific research has been conducted regarding progressive muscle relaxation and Fibromyalgia. A 2011 study by Arcos-Carmona et al. evaluated 56 Fibromyalgia patients and randomly assigned them to treatment with either aerobic exercise plus progressive relaxation techniques, or to a control sham treatment with a disconnected magnetic therapy device. The researchers measured anxiety, sleep quality, depression, and overall quality of life after the 10 week study. They found that those patients who received the aerobic exercise plus and relaxation techniques had significantly improved duration of sleep, anxiety, and quality of life.

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References

1.        Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily Fibromyalgia pain: a prospective, randomized, controlled trial. J Psychiatr Res. 2002;36(3):179-187.

2.        Menzies V, Taylor AG, Bourguignon C. Effects of guided imagery on outcomes of pain, functional status, and self-efficacy in persons diagnoses with Fibromyalgia. J Altern Complement Med. 2006;12(1):23-30.

3.        Goto F, Asama Y, Nakai K. A case of Fibromyalgia treated with medical and autogenic training. Nihon Jibiinkoko Gakkai Kaiho. 2005;108(12)1171-1174.

4.        Keel PJ, Bodoky C, Gerhard U, Muller W. Comparison of integrated group therapy and group relaxation training for Fibromyalgia. Clin J Pain. 1998;14(3):232-238.

5.        Kayiran S, Dursun E, Dursun N, Ermutlu N, Karamursel S. Neurofeedback intervention in Fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial. Appl Psychophysiol Biofeedback. 2010;35(4):293-302.

6.        Babu AS, Mathew E, Danda D, Prakash H. Management of patients with Fibromyalgia using biofeedback: a randomized control trial. Indian J Med Sci. 2007;61(8):455-461.

7.     Arcos-Carmona IM, Castro-Sanchez AM, Mataran-Penarrocha GA, Gueierrez-Rubio AB, Ramox-Gonzalez E, Moreno-Lorenzo C. Effects of aerobic exercise program and relaxation techniques on anxiety, quality of sleep, depression, and quality of life in patients with Fibromyalgia: a randomized controlled trial. Med Clin (Barc). 2011;137(9):398-401.

 

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