The Relaxation Response And Behavior Change

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Relaxation-response training can be used to facilitate behavior modification goals. Most patients who begin a diet or a smoking cessation program are able to stay with the program for short periods of time. When stresses arise, however, it generally becomes more difficult to maintain the new routine. Coping with stress and anxiety has a "psychic cost" that takes the form of a diminished capacity for self-regulation. Presum

Meditation and the Relaxation Response ably, the cause of this "stress disinhibition effect'' is a depletion in the cognitive and emotional resources required to maintain self-regulation. Increased stress and anxiety lead to immediately gratifying, but ultimately damaging behaviors, such as dietary indiscretions, alcohol or drug abuse, and an increase in smoking. Relaxation training has proved to be effective as an acute coping strategy to reduce anxiety. [See Coping with Stress.]

The extent to which stress-related relapses are prevented is directly related to the degree to which relaxation-response training alleviates stress and anxiety. For example, smoking-cessation programs are unsuccessful in about 60 to 80% of cases and stress has been identified as a major contributor to this high rate of failures. In a recent study, smokers who had completed a smoking-cessation program were assigned to either a relaxation training or a control group each of which met for 3 months. The relaxation-based intervention included audiotapes for home training in guided imagery techniques. The relaxation group was asked to practice 20 minutes a day at least four times a week. Relaxation-trained subjects reduced stress, enhanced imagery effectiveness, and, perhaps most importantly, were more successful in abstaining from smoking compared with control subjects who were not exposed to the training. During a 3-month follow-up only 28% of the relaxation-trained subjects relapsed whereas 49% of the control subjects resumed smoking.

Since relaxation training is often taught as a part of behavior-change programs with multiple components it is difficult to measure to what degree the beneficial effects are attributable to relaxation training alone. The effect of relaxation training was evaluated in one of the most successful behavior-change programs, the Lifestyle Heart program, developed by Ornish. In this program relaxation training is combined with diet and exercise regimens as well as group support to reduce symptoms in patients with coronary heart disease. In a controlled trial patients attended a week-long retreat followed by two 4-hour sessions each week thereafter. They performed 1 hour of aerobic exercise and participated in 1-hour sessions of stress management techniques which consisted of relaxation, yoga, stretching, breathing techniques, meditation, and guided imagery.

Among the participants the mean degree of coronary artery stenosis regressed from 61.1 to 55.8%. These results were compared with those in a group of nonparticipating patients in whom the mean degree of stenosis actually progressed from 61.7 to 64.4%. Analysis also showed that diet alone could not account for the beneficial effects. While almost all the patients maintained a healthier diet, those who practiced stress management more often showed greater stenotic regression.

In another study involving 156 patients who had had a myocardial infarction, relaxation response training augmented the effects of concurrent therapeutic strategies. Patients were randomized into two groups: one was given physical exercise training alone and the other was given both physical exercise and relaxation training. Several questionnaires were administered: the State-Trait Anxiety Inventory (a 40-item standardized anxiety inventory); a sleeping habits questionnaire (a 10-item questionnaire concerning hours of sleep, sleep quality, etc.); a functional complaints questionnaire (a 25-item inventory concerning complaints frequently expressed by cardiac patients); and the Heart Patients Psychological Questionnaire (HPPQ) (including scales on well-being, subjective invalidity, displeasure, social inhibition). Patients in the exercise-only group reported no change in psychological measures, whereas the group who received relaxation training reported less anxiety and subjective invalidity. The two groups also differed on physical outcomes as measured by exercise testing. Improvement was defined as the absence of signs of cardiac dysfunction that required treatment and was greater in the relaxation-training-and-exer-cise group compared with the exercise-only group.

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