Effectiveness of relaxation training in reducing adverse reactions to cancer chemotherapy

Cancer patients who had developed negative conditioned responses to their chemotherapy either did (relaxation training) or did not (no relaxation training) receive progressive muscle relaxation training and guided relaxation imagery instructions immediately before and during their chemotherapy treatments. Physiological (blood pressure and pulse rate) measures of arousal, frequency of vomiting, and patient-reported and nurse-reported indices of negative affect and nausea were collected during pretraining, training, and posttraining chemotherapy sessions. Results indicated that during both the training and the posttraining sessions, patients in the relaxation training condition reported feeling less emotionally distressed and nauseated, and showed less physiological arousal following the chemotherapy infusion, than patients in the no relaxation training condition. The attending nurses' observations confirmed the patients' self-reports. No differences were found in frequency of vomiting between conditions. These data clearly suggest that the use of relaxation procedures may be an effective means of reducing several of the adverse side effects of cancer chemotherapy.     

Long‐term efficacy of cognitive training for age‐associated memory impairment: A six‐month follow‐up study

The purpose of this investigation was to assess the impact of pretraining on the long‐term effect of an imagery‐based mnemonic in persons with age‐associated memory impairment (AAMI). Eighty‐two participants were randomly assigned to one of six groups: (1) verbal judgment pretraining plus mnemonic training, (2) visual imagery elaboration pretraining plus mnemonic training, (3) relaxation pretraining plus mnemonic training, (4) nonspecific pretraining plus mnemonic training, (5) nonspecific training, and (6) wait list. Participants receiving the three specific pretraining techniques along with mnemonic training (Groups I to 3) recalled more than those receiving nonspecific pretraining with mnemonic training (Group 4) or nonspecific pretraining without mnemonics (Group 5). Participants receiving mnemonic training (Groups 1 to 4) did not differ from nonmnemonic controls (Group 5) at 6 months. The results suggest that specific pretraining strategies can help maintain beneficial effects of imagery‐based mnemonics over time.     

Stress management skill for nursing students

Assessed the effectiveness of a 10-session, 5-week, group-administered stress management program for nursing students. The stress management group included sessions on progressive relaxation, deep muscle relaxation, autogenic training, visual imagery and modified systematic desensitization. Ten female nursing students participated in the stress management group. A second group of nursing students (7 female and 1 male) served as a control group. State and trait anxiety measures were taken before the group began and immediately prior to both mid-term and final examinations. The stress management group effectively reduced trait anxiety (p less than .05), while the control group's trait anxiety levels remained relatively unchanged. The experimental group showed a reduction in state (test-taking) anxiety from mid-semester to final examinations, while the control groups showed a slight increase from mid semester to final examination.     

Preparing patients for cancer chemotherapy: effect of coping preparation and relaxation interventions

Sixty cancer chemotherapy patients were randomly assigned to one of four treatments: (a) relaxation training with guided relaxation imagery (RT), (b) general coping preparation package (PREP), (c) both RT and PREP, or (d) routine clinic treatment only. All patients were assessed on self-report, nurse observation, family observation, and physiological measures and were followed for five sequential chemotherapy treatments. Results indicate that the PREP intervention increased patients' knowledge of the disease and its treatment, reduced anticipatory side effects, reduced negative affect, and improved general coping. RT patients showed some decrease in negative affect and vomiting, but not as great as in past studies. The data suggest that a relatively simple, one-session coping preparation intervention can reduce many different types of distress associated with cancer chemotherapy and may be more effective than often-used behavioral relaxation procedures.     

Single- and successive-site EMG training in responding to anticipated pain

In a comparison among relaxation procedures, 32 college students were assigned to four groups of equal size. Electromyographic response training was given with biofeedback (EMG training) on the forehead (frontal area) alone, on the frontal area, neck (sternomastoid), and forearm areas in succession, or on these three sites in conjunction with recorded relaxation instructions used at home. Relative to a control group, which received no training, the three biofeedback-trained groups maintained lower EMG levels on the frontal and sternomastoid sites, and the group provided with the relaxation instructions plus EMG training showed lower skin conductance levels. These patterns were generally maintained during the presentation of a stimulus (stressor) that ostensibly signaled an impending electric shock. Other measures, including peripheral temperatures and self-reported anxiety, also showed effects consistent with the stressor presentations but did not differentiate the groups. The results are discussed in terms of common clinical relaxation procedures, an alternative procedure for training several sites simultaneously, and implications for models of EMG training and arousal.This paper summarizes a portion of the data originally presented in a masters thesis by the first author (Diaz, 1982).     

Imaginal response events in systematic desensitization: a pilot study.

The primary focus of systematic desensitization (SD) is physiological responsivity in the presence of a conditioned aversive stimulus. However, SD also effects changes in motorapproach behavior and self-report. This study explores the possibility that SD directly affects the motor response system by way of conditioning covert approach responses in the presence of the imaginal aversive stimulus. Two independent variables were investigated: the content of instructions and actual covert motor responses during SD. Twenty-four subjects were classified as high- or low-responders on the basis of electromyographic responsiveness to instructions to imagine movement. Half the high- and half the low-responders were given a series of instructions to imagine-motor-approach behavior toward snakes. The remaining subjects received instructions to imagine only the snakes themselves with no reference to motor response. Imaginal scenes of 30-sec duration were alternated with relaxation periods of the same length. A significant difference was found between the posttreatment scores of high- and low-responders on performance measures, the high-responders performing better. The difference between the two instruction groups was not statistically significant. Self-report data suggested some subjects given instructions to imagine only snakes actually imagined themselves approaching snakes. Therefore, data were re-analyzed after instruction groups were reconstructed accordingly. A statistically significant difference was found on both factors. Continued investigation may further support imagery as covert behavior, open to empirical study.     

Stretch-based relaxation training

This paper is a review of progressive relaxation training based on muscle stretching exercises. Stretch-based relaxation training is an alternative to traditional tense-release methods for teaching self-regulation of muscle activity. The rationale and basic procedures for stretch-based relaxation are presented, along with a review of research studies exploring the clinical efficacy of the techniques. Experimental evidence has demonstrated decreases in subjective measures of muscle tension and activation, as well as decreases in EMG activity at selected target muscle sites when stretch-based relaxation procedures are employed. The clinical application of stretch-based relaxation is presented and illustrated with a case study describing the use of these procedures to assist in the treatment of neck tension/pain and anxiety. Discussion centers on the potential role of stretch-based relaxation in the management of anxiety and musculoskeletal disorders.     

Comparison of Frontal EMG Biofeedback and Several Types of Relaxation Instructions in Reducing Multiple Indices of Arousal

During the training phase, 96 subjects were given one of four types of relaxation instructions (single instructions, repeated instructions, relaxation training, no instructions) and in addition either did or did not receive frontal EMG biofeedback training. Results indicated that each of the instructions and biofeedback procedures were equally effective in reducing frontal EMG, but that none of these procedures had any effect on subjective anxiety or autonomic indices of arousal (pulse rate, skin temperature, and finger pulse volume). During the generalization/stress phase, subjects were threatened with electric shock and were told to apply the relaxation techniques they learned during the training phase even though no additional instructions and/ or biofeedback training would be provided. To assess the effectiveness of the shock manipulation, a no-threat control group was included. Results indicated that: a) the shock manipulation was effective in increasing arousal, b) previous instructions and/or biofeedback were equally effective in reducing frontal EMG levels, but that c) only relaxation training was consistently effective in reducing subjective and autonomic indices of arousal. These findings: a) suggest that in stressful situations, relaxation training may be more effective than either EMG biofeedback or simple relaxation instructions in producing a general relaxation effect as opposed to a specific EMG effect; and b) indicate the importance of assessing the effectiveness of relaxation procedures during stressful situations during which subjects’ levels of arousal are elevated above resting baseline levels.     

Predicting treatment outcome to progressive relaxation training in essential hypertensive patients

Nineteen borderline essential hypertensive patients participated in (a) a pretreatment assessment of sympathetic nervous system activity (SNS), (b) a progressive muscle relaxation training program, and (c) a posttreatment assessment of SNS functioning. During both pre- and posttreatment assessments, each subject participated in a laboratory session during which cardiovascular responses to two behavioral challenges were measured, a 24-hr urine collection for catecholamine analysis and the completion of relevant self-report questionnaires. Results revealed that subjects who improved the most with relaxation training (showed the greatest reduction in blood pressure) were individuals who, at pretreatment, (a) were less reactive to laboratory challenges, (b) possessed lower levels of resting epinephrine, and (c) scored lower on measures of trait anger and higher on assertiveness. Posttreatment assessment results showed that relaxation training did not affect cardiovascular reactivity to laboratory tasks or self-report of anger and assertion.Funding for this study was made available through a West Virginia University Senate Research Grant (87-824).     

Daily coping practice predicts treatment effects in children with sickle cell disease

OBJECTIVE: To examine the 1-month effects of a pain coping skills intervention in children with sickle cell disease (SCD). METHODS: Forty-six African American children (8-17 years old) were randomly assigned to either a coping skills condition or a standard care control condition. Children were asked to practice daily with audiotaped instructions of skills (e.g., relaxation, imagery). RESULTS: Multivariate analyses of summary measures indicated that children in the coping intervention (versus control group) reported a significantly more active approach to managing pain. Multilevel random effects models applied to daily diary data indicated that on pain days when children practiced their strategies, they had fewer health care contacts, fewer school absences, and less interference with household activities than on days when they did not practice. CONCLUSIONS: Brief training in coping skills followed by minimal therapist contact may lead to a range of benefits when children practice with their skills on a consistent basis.     

Stress management training and relaxation imagery in the treatment of essential hypertension

The present study compared the effectiveness of three procedures in the treatment of 34 individuals with essential hypertension: (1) stress management training plus relaxation imagery, which consisted of an adaptation of existing stress management techniques in conjunction with extensive relaxation training using relaxation imagery; (2) relaxation imagery alone; and (3) weekly blood pressure checks. The relaxation imagery technique involved visualization of a relaxing image along with concentration on suggestions of relaxation, heaviness, and warmth. Treatment was individualized and lasted 8 weeks. Results indicated stress management plus relaxation imagery and relaxation imagery alone were significantly more effective than blood pressure checks in reducing systolic and diastolic blood pressures during treatment and in maintaining diastolic blood pressure reductions during follow-up. However, no significant differences were found between the two treatment procedures. Clinical implications of these findings are discussed.     

The effects of aerobic exercise on cardiovascular, facial EMG, and self-report responses to emotional imagery.

This study examined the effects of exercise on subsequent psychophysiological and self-report responses to emotional imagery, using excitation-transfer theory as a guiding conceptual model. Twenty-four female undergraduates engaged in aerobic exercise (stationary cycling) for 15 minutes, and an equal number of subjects rested quietly for the same time period. All subjects then engaged in anger and sadness imagery trials. Cardiovascular, facial electromyographic, and self-report responses to the imagery were assessed. The results indicated that the subjects in the exercise group showed less peripheral vasoconstriction in response to the imagery than did the quiet rest subjects. Subjects in both groups displayed greater electromyographic activity in the depressor and zygomatic muscle regions during anger than sadness imagery, and subjects in the exercise group tended to show greater corrugator tension during sadness than during anger imagery. Few differences between the groups were found on self-report measures. These findings are discussed with reference to previous research, theoretical implications, and future directions.     

The effects of nonconcurrent and concurrent relaxation training on cardiovascular reactivity to a psychological stressor

Eight patients in a cardiac rehabilitation program, after exposure to two psychological stressors approximately equivalent with respect to cardiovascular reactivity, were given nonconcurrent progressive muscle relaxation training and retested for reactivity. They were then provided with relaxation training concurrently with one of the stressors and exposed again to the two stressors. No significant effects for nonconcurrent progressive muscle relaxation training were detected. Concurrent training, in contrast, produced reductions in both systolic and diastolic blood pressure. Reductions resulting from training on the target stressor showed little tendency to generalize to the nontarget stressor; the discrimination was particularly well defined for systolic blood pressure. We conclude that muscle relaxation techniques are maximally effective in reducing reactivity to psychological stressors when relaxation training is provided concurrently with the stressor. Our findings further suggest that to inculcate the relaxation response reliably across different situations, specific training to enhance generalization may be needed.     

The role of regular home practice in the relaxation treatment of tension headache

This study evaluated the contribution of regular home practice in the treatment of tension headache (HA) with progressive muscle relaxation (PMR) by giving 14 tension HA sufferers 10 sessions (over 8 weeks) of standard PMR with home practice and application instructions while 13 additional patients received the same PMR training (except for the omission of cue-controlled relaxation) with no home practice or application instruction. A third group of 6 patients merely monitored HA activity. Both treated groups showed significant reduction in HA activity, whereas the symptom monitoring group did not change. The 2 treated groups did not differ. On a measure of clinically significant reduction in HA activity (at least 50% reduction in HA activity), however, the group receiving home practice instruction (50%) showed a trend (p = .056) to improve more than did those receiving PMR without home practice (15%).     

Behavioral Preparation of Patients for Gastrointestinal Endoscopy: Information,Relaxation, and Coping Style

Abstract

The effectiveness of two techniques for preparing patients to undergo a stressful medical examination was assessed using observer self-report, and physiological measures of distress during gastrointestinal endoscopy. Patients were either informed about expected sensations, trained in systematic muscle relaxation, or received normal hospital procedures. The influence of coping styles on the effectiveness of information and relaxation techniques was examined for measures of fear, avoidance, emotional control, arousability, and independence.

Information and relaxation interventions reduced heart rate increases and observer ratings of distress during tube insertion. Relaxation training also increased positive mood change following the procedure. Interactions between coping styles and recovery measures suggested patients benefited most from preparation that matched their preferred coping style, but were not harmed by preparation that did not match their preferred style. Discussion focuses on how coping styles may interact with preparation procedures and suggests that the use of coping styles as criteria for excluding patients from certain preparation techniques is inappropriate.     

Training and Transfer of Training Effects in EMG Biofeedback Assisted Muscular Relaxation

Twenty-two normal adults participated in an electromyographic (EMG) biofeedback experiment designed to test if the feedback stimulus is necessary in obtaining EMG reductions during typical laboratory procedures, and if prior training on one muscle facilitates the training of a second muscle. One group of subjects received forearm feedback training followed by frontalis training. A second group received training in the reverse order. Two control groups relaxed first on their own followed by either forearm or frontalis training. Attention was directed toward motivating control subjects to perform maximally during relaxation without feedback. Heart and respiration rates and skin conductance and temperature were also recorded. Both trained and untrained subjects produced significant EMG reductions but did not differ from each other; nor did a transfer of training effect emerge. No differences resulted between feedback and non-feedback conditions for the other physiological measures or for changes in state anxiety. These data compromise somewhat the previous demonstrations of EMG biofeedback “learning,” and are unsupportive of EMG biofeedback as a general relaxation training technique.     

Cognitive imagery and physiological feedback relaxation protocols applied to clinically tense young adults: a comparison of state, trait, and physiological effects

Examined changes in targeted and general tension behaviors as well as reductions in physiological tension associated with cognitive imagery and electromyographic biofeedback relaxation procedures. Three groups of 15 female college students participated. During three weekly sessions each person received either guided cognitive imagery relaxation, frontalis muscle feedback relaxation, or a self-rest control procedure. The Anxiety Differential was administered before and after each session, while frontalis EMG, heart rate, and skin temperature were monitored continuously. A second Temperament Analysis was administered after the final session. The imagery procedure was associated with moderate reductions in physiological tension and significant reductions in state anxiety and three tension-related personality dimensions. Self-rest persons displayed lesser reductions in general tension with little physiological change. While biofeedback persons showed the largest reductions in physiological tension, they displayed only small and variable changes in state anxiety and personality dimensions. The data raise continued questions about the application of physiologically based operant relaxation procedures and support the use of cognitively mediated protocols for the treatment of specific or general anxiety behaviors.     

A Comparison of Auditory and Visual Feedback in Biofeedback Assisted Muscular Relaxation Training

This study compared the efficacy of auditory and visual feedback in electromyographic (EMG) biofeedback assisted relaxation training of the frontalis muscle.Twenty-eight subjects, divided into 4 groups matched on baseline frontalis EMG levels and trait anxiety, received 7 training sessions each under one of the following conditions: (1) auditory feedback-eyes closed; (2) auditory feedback-eyes open; (3) visual feedback; or (4) no feedback-eyes closed. The group who received auditory feedback with the eyes closed manifested significant lowering of EMG over session compared to no significant reduction in EMG for the other three groups. EMG changes failed to correlate significantly with changes in self reports of subjective relaxation derived from pre-to-post session state anxiety test data. The possibility that the ineffectiveness of visual feedback in this study may be specific to the frontalis muscle was discussed and the need for further research in several areas was stressed.     

The uses of hypnotherapy with learning disabled children

Explored the impact of group hypnotic and self-hypnotic training on the academic performance and self-esteem of learning disabled (LD) children. Three hypnotic training sessions and instructions for 6 weeks of daily self hypnotic practice that contained suggestions for imagery related to improvement in these areas were given to 15 children (12 males and 3 females, ages from 7 to 13), their reading teacher, and both their parents, and their responses were compared to a similar but untreated control group of 18. No overall differences were observed between groups. A multiple regression analysis revealed important predictors of self-esteem improvement for the experimental group. The child's hypnotic susceptibility score and self-hypnotic practice by children and parents were the most relevant. These LD children were at least as hypnotically susceptible as a normative sample. Hypnotherapy is seen as feasible in group administration by persons only moderately trained in hypnosis and of potential benefit to self-esteem improvement in LD children, depending on individual difference factors.