The Relaxation Response In Psychotherapy

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For many patients with psychological disturbances, who might be hesitant to enter therapy, relaxation-response training is a nonthreatening intervention that can be introduced prior to other more rigorous forms of therapy such as cognitive therapy or medication. Meditation and other modes of eliciting the relaxation response can be a means of preparing for standard psychotherapy by allowing the patient to observe thoughts and mental events.

In 1985, Kutz and colleagues were the first to systematically study the relationship between psychotherapy and meditation. They studied the change in psychological well-being and the impact on psychotherapy of a 10-week meditation program in 20 patients. The intervention consisted of weekly 2-hour group sessions and daily home practice. Patients showed significant decreases in psychological symptoms from pre- to posttreatment as measured by the Symptom Checklist 90 Revised (SCL-90R), a standard psychological inventory, and the POMS. Subjects experienced the largest decrease in depression and anxiety. These results suggested that meditation facilitated the goals of the psychotherapeutic process. It is worth considering why such meditation training may have been helpful.

Patients were instructed in mindfulness meditation and were taught how to become detached observers of their thoughts. This form of meditation helps patients increase their insight regarding how mental categories are developed. With the enhanced awareness patients can detach themselves from their habitual ways of thinking, and through therapy they can progress to greater cognitive flexibility and more adaptive self-im ages and lifestyle changes. Much of what occurs in psychotherapy is intended to bring about these changes. While meditation alone cannot obviate skilled therapy and is no substitute for a therapeutic alliance, it may be the case that the CNS changes that occur when meditation is used to elicit the relaxation response set the stage for more rapid and persistent psychotherapeutic change.

For many types of disorders such as anxiety and other stress-related disorders, elicitation of the relaxation response via meditation or other techniques can help reduce sympathetic nervous system activity, which can be a part of the treatment. Researchers have examined the effectiveness of meditation-based stress reduction program in a pilot study on patients with anxiety disorders.

Patients participated in an 8-week course in which they attended weekly 2-hour classes. In the sixth week they also attended an intensive 7.5-hour retreat. Patients showed significant reductions in anxiety, panic symptoms, and depression from pre- to posttreatment and results were maintained 3 years later. It has been suggested that, unlike those who participate in cognitive therapy, patients who practice mindfulness meditation are not asked to substitute one thought pattern for another. Instead, patients observe the "inaccuracy, limited nature, and intrinsic impermanence of thoughts in general and anxiety-related thoughts in particular."

While meditation and other techniques used to elicit the relaxation response can play an important role in the treatment of some psychological problems, such interventions might not be recommended for patients with certain personality disorders, dissociative disorders, or schizophrenia.

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