Relaxation Therapies Overview

Constant stress is one of the defining features of modern life, and the source of many common health problems. Stress plays an obvious role in nervousness, anxiety, and insomnia, but it is also thought to contribute to a vast number of other illnesses.

In the past, most people engaged in many hours of physical exercise daily, an activity that reduces the effects of psychological stress. Life was also slower then and more in harmony with the natural cycles of day and season. Today, however, our bodies are relatively sedentary, while our minds are forced to respond to the rapid pace of a society that never stops. The result is high levels of stress and reduced ability to cope with it.

There are several ways to mitigate the damage caused by stress. Increased physical exercise can help, as can simple, common sense steps like taking relaxation breaks and vacations. If these approaches don’t have adequate results, there are more formal methods that may be helpful.

This article discusses a group of stress-reduction techniques often called relaxation therapies. In addition to these methods, yoga , Tai Chi , hypnosis , massage , and biofeedback can also help induce a relaxed state.

There are many types of relaxation therapies, and they use a variety of techniques. However, most of them share certain related features.

In a great many relaxation techniques, one begins by either lying down or assuming a relaxed, seated posture in a quiet place and closing the eyes. The next step differs depending on the method. In autogenic training, relaxation response, and certain forms of meditation, one focuses one’s mind on internal sensations, such as the breath. Guided-imagery techniques employ deliberate visualization of scenes or actions, such as walking on a quiet beach. Progressive relaxation techniques involve gradual relaxation of the muscles. Finally, some schools of meditation incorporate the repetition of a phrase or sound silently or aloud.

All of these techniques are best learned with the aid of a trained practitioner. The usual format is a group class supplemented by regular home practice. If you are diligent enough, experience suggests that you can develop the ability to call on a relaxed state at will, even in the middle of a very stressful situation.

Although many studies have been performed on relaxation therapies, most of them suffer from inadequate design. To be fair, there are considerable difficulties in the path of any researcher who wishes to scientifically assess the effectiveness of a relaxation therapy such as hypnosis. There are several factors involved, but the most important is fairly fundamental: it isn’t easy to design a proper double-blind, placebo-controlled study of relaxation therapy. Researchers studying the herb St. John’s wort, for example, can use placebo pills that are indistinguishable from the real thing. However, it’s difficult to design a form of placebo relaxation therapy that can’t be detected as such by both practitioners and patients.

One very clever method used by some researchers involves the use of intentionally neutral visualizations. Instead of imagining lying in bed and sleeping peacefully, patients in the placebo group might be told to visualize something like a green box. The problem here is that researchers teaching the visualization method to participants may inadvertently convey a sense of disbelief in the placebo treatment. This can be solved by using relatively untrained people who are themselves deceived by experimenters to teach the method, but the practical obstacles are significant.

For this reason, many studies of relaxation therapy have made major compromises to the double-blind, placebo-controlled model. Some randomly assigned participants to receive either relaxation therapy or no treatment. In the best of these studies, results were rated by examiners who didn’t know which participants were in which group (in other words, “blinded observers”). However, it isn’t clear whether benefits reported in such studies are due to the relaxation therapy or less specific factors, such as mere attention.

Other studies have compared relaxation therapies to different techniques, such as hypnosis or cognitive psychotherapy. However, the same difficulties arise when trying to study these latter therapies, and the results of a study that compares an unproven treatment to one that is also imperfectly documented are not very meaningful

Even less meaningful studies of relaxation therapies simply involved giving people the therapy and monitoring them to see whether they improved. For at least a dozen reasons, such open-label trials prove nothing at all, and we do not report them here. (The reasons are discussed in the article Why Does This Database Rely on Double-blind Studies? )

Given these caveats, the following is a summary of what science knows about the medical benefits of relaxation therapy.

The Possible Benefits of Relaxation Therapy

Insomnia

Numerous controlled studies have evaluated relaxation therapies for the treatment of insomnia . ¹ These studies are difficult to summarize because many involved therapy combined with other methods such as biofeedback, sleep restriction, and paradoxical intent (trying notto sleep). The type of relaxation therapy used in the majority of these trials was progressive muscle relaxation (PMR). Many of these trials used the clever form of placebo treatment described above; others simply compared relaxation therapy to no treatment.

Overall, the evidence indicates that relaxation therapies may be somewhat helpful for insomnia, although not dramatically so. For example, in a controlled study of 70 people with insomnia, participants using progressive relaxation showed no meaningful improvement in the time to fall asleep or the duration of sleep, but they reported feeling more rested in the morning. ² In another study, 20 minutes of relaxation practice was required to increase sleeping time by 30 minutes. ³

Asthma

A review article published in 2002 found 15 published controlled trials that evaluated relaxation therapies for the treatment of asthma . ⁴ Most of the studies were rated as very poor or poor quality. Overall the results failed to demonstrate improvement, although a muscular relaxation technique called Jacobsen’s relaxation did show a hint of benefit.

Anxiety

There is a fair amount of evidence in support of relaxation therapies as means to treat the symptoms of anxiety , at least in the short-term. ⁵ In a 2008 review of 27 studies, researchers concluded that relaxation therapies (including Jacobson's progressive relaxation, autogenic training, applied relaxation, and meditation) were effective against anxiety. ⁶ However, these favorable findings should be tempered by the fact that not all of the studies were randomized, controlled trials.

Hypertension

It seems intuitive that relaxation should lower blood pressure. Indeed, many studies have evaluated the benefits of relaxation therapies for hypertension and related cardiovascular risks. ⁷ The results, however, have been mixed at best. In a review of 25 studies of various relaxation therapies for high blood pressure (totaling 1,198 participants), researchers found that those studies employing a control group had no significant effect on lowering blood pressure compared to sham (placebo) therapies. ⁸ On the other hand, a separate review of nine randomized trials concluded that the regular use of transcendental meditation may significantly reduce both systolic and diastolic blood pressure compared to a control. ⁹ Similarly, an analysis of 17 randomized controlled trials of various relaxation therapies, found that only transcendental meditation resulted in significant reductions in blood pressure; biofeedback, progressive muscle relaxation, and stress management training produced no such benefit. ¹⁰ In addition, a trial of 86 patients with hypertension suggested that daily, music-guided slow breathing reduced systolic blood pressure measured over a 24-hour period. ¹¹

Other Conditions

Other conditions that have at least minimal supporting evidence for response to relaxation therapies include the following:

• Angina ¹²
• Back pain ¹³
• Bulimia nervosa ¹⁴
• Cancer treatment support , ^{15 16 17 18 19 20} including cancer pain ²¹
• Chronic pain in general ^{22 23 24 25}
• Congestive heart failure ²⁶
• Depression ²⁷
• Fibromyalgia ²⁸
• Interstitial cystitis ²⁹
• Irritable bowel syndrome ³⁰
• Menopause ³¹
• Obsessive-compulsive disorder (OCD) ³²
• Osteoarthritis ³³
• Premenstrual syndrome (PMS) ³⁴
• Pregnancy support (reducing perceived stress) ³⁵
• Psoriasis ³⁶
• Rheumatoid arthritis ³⁷
• Stress in general ^{38 39}
• Stroke rehabilitation ⁴⁰
• Surgery support (primarily reducing pain and stress before or after surgery) ⁴¹
• Tension headaches ⁴²
• Ulcerative colitis ⁴³

In many cases the results are marginal at best, and contradictory outcomes between trials are common.

One study suggests that the use of visualizations prior to surgery cannot only reduce the need for pain medications, it can also help prevent hematomas (collections of blood under the skin). ⁴⁴ However, more study would be needed to verify this somewhat difficult-to-believe result. A more easily accepted study found that either relaxation therapy or aerobic exercise can improve symptoms of fatigue after cancer surgery, and that each approach is about as effective as the other. ⁴⁵ Another study found that cancer patients exposed to empathetic care along with self-hypnotic relaxation experienced significantly less pain and anxiety during an uncomfortable, invasive procedure than similar patients receiving only empathetic or usual care. These interesting results suggest that pain under these circumstances is more effectively relieved when the patient relies on his or her own self-coping abilities rather than someone else’s kindness. ⁴⁶ Researchers in Taiwain have also studied the role of relaxing music in reducing cancer pain. One hundred and twenty-six hospitalized patients were randomly selected to listen to music for 30 minutes and take pain medication or just take the medication. Patients were given the choice of folk songs, Buddhist hymns (Taiwanese music), plus harp, or piano (American). The group who listened to music experienced significantly more pain relief coompared to the group that did not. ⁴⁷ Numerous studies have also investigated the benefits of relaxation therapies on patients with HIV . A careful review of 35 randomized trials found that relaxation therapies may be generally helpful at improving the quality of life of HIV-positive patients and in reducing their anxiety , depression , stress , and fatigue . ⁴⁸ These interventions, though, had no significant effect on the growth of the virus, nor did they influence immunologic or hormonal activity. Subsequently, however, a small study involving 48 HIV patients found that mindfulness meditation—a popular method for inducing the relaxation response—slowed the loss of the specific immune cells destroyed by the virus, though more research needs to be done to confirm this result. ⁴⁹ Some studies have evaluated highly specific guided visualizations, rather than general relaxation. For example, it has been suggested that a systematic program of imagining microscopic soldiers shooting down one’s cancer cells can improve the chances of surviving cancer . Unfortunately, despite much enthusiasm shown by some patients and practitioners, there is still no meaningful evidence to support this appealing idea at present. ⁵⁰ Nonetheless, there is some evidence from a set of small trials that specific immune-oriented visualizations can provide enhanced protection against herpes flare-ups and winter colds . ⁵¹ Contrary to common claims, published evidence does notdemonstrate that transcendental meditation (TM) improves mental functioning. ⁵² There is a bit of evidence, however, that TM might be helpful for improving exercise capacity and general quality of life in people with congestive heart failure . ⁵³ A careful review of 20 trials found psychological interventions such as cognitive behavioral therapy, biofeedback, relaxation and coping were associated with reduced chronic headache or migraine pain in 589 children as compared to sham (placebo), standard therapies, waiting list control or other active treatments. ⁵⁴

There is no widely accepted license for practicing relaxation therapy. However, it is often practiced by therapists and psychologists.

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