Integrating The Relaxation Response Into Health Care

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The relaxation response has been associated with improvements in many medical conditions including: hypertension, cardiac arrhythmias, chronic pain, insomnia, side effects of cancer therapy, side effects of AIDS therapy, infertility, and preparation for surgery and X-ray procedures. It is also important to indicate that more recently, the overall implications of integrating relaxation response in routine clinical treatments has been examined. Some relevant examples will be discussed.

The effect of a behavioral group intervention that included relaxation response training on chronic pain

Meditation and the Relaxation Response patients. One hundred and nine patients who were members of an HMO participated in the study. The average duration of pain among the patients was 6.5 years. The interventions consisted of 90-minute group sessions, which were held once a week. At the end of the 10-week intervention period, participants in the group showed decreases in negative psychological symptoms including anxiety, depression, and hostility. This study also showed that such an intervention could result in significant cost savings. Group participants showed a 36% decrease in clinic use during the first and second year following the intervention. This latter result is particularly pertinent. There is a growing interest in the use of nonpharmacologic interventions such as elicita-tion of the relaxation response to not only facilitate psychological and medical goals but to help reduce medical utilization and costs. The above study is simply an example of the way in which such interventions can have this positive economic effect while at the same time have beneficial clinical outcomes.

Relaxation-response training was shown to improve outcomes among a group of patients with peripheral vascular disease who underwent femoral an-giography. Forty-five patients participated in the study. Patients listened to either a relaxation tape that included instruction in progressive muscle relaxation and cognitive relaxation involving mental focusing or to a tape of recorded music. A third group of patients listened to a blank tape. Patients who listened to a relaxation-response tape experienced less anxiety and pain during the surgical procedure and requested significantly less medication that those patients who listened to the tape of recorded music or the blank tape. This study also showed that relaxation-response training can be administered very inexpensively and in ways that are practical for staff and patients.

Clearly, there is substantial research that shows that meditation and other relaxation-response techniques can be effective components in psychotherapy, behavior-change programs, and in medical treatment. Resistance to adjunctive use of such treatments, especially elicitation of the relaxation response, appears to be waning. A recent survey of medical schools found that approximately two-thirds now include discussions of relaxation techniques in their medical training. Knowledge of relaxation-response training can be helpful to physicians not only for the physiological benefits to patients but because many patients who present with medical problems really have a psychological disorder.

Such patients may feel uncomfortable about seeing a mental health professional or participating in psychotherapy. Relaxation techniques can be a means for the physician to start a dialogue about dealing with psychological disorders.

While the use of relaxation training is unquestioned in psychological treatment, there are still barriers to its use in medical settings. One barrier is a misunderstanding of the relaxation-response interventions and why they are used. Meditation and other introspective procedures bring about important central and peripheral physiological changes because they elicit the relaxation response. These central and peripheral changes are compatible with better mental and physical well-being. However, no single intervention can work for everyone. More research to define under what specific circumstances relaxation-response training would be most beneficial and cost effective for which patients still needs to be completed.

Many practitioners, insurers, and patients remain confused about the differences between the use of such services and psychotherapy. Relaxation training alone and when used with other types of behavioral therapies is more focused than traditional psychotherapy. It is often conducted in groups settings, and sessions are limited to 8 to 10 sessions. The important difference is that while the goal of psychotherapy is to change psychological symptoms, the goal of relaxation-response training with medical conditions is to change somatic manifestations. Relaxation training should be better understood, more routinely used, integrated, as well as paid for in medical settings. Such integration is imperative to the clients/patients and society.

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