Vol. 25 • Issue 4 • Page 26
The relaxation response is the opposite of the fight-or-flight response; eliciting this response decreases blood pressure, slows heart and breathing rates, and relaxes muscles.
While all people can benefit from learning how to relax and skillfully manage stress, persons with disabilities have an even greater need for this skill. People with chronic conditions are often negotiating states of chronic stress and hyper-arousal to pain as well as daily mobility challenges.
For those with disabilities and chronic conditions, mind-body techniques that elicit the relaxation response can alleviate some of the secondary stress of recovery, support functionality and, most importantly, teach patients how to achieve wellness on a practical, tangible, applicable level in daily life.
Stress and Wellness
At the Benson-Henry Mind-Body Medicine Institute (BHI) at Massachusetts General Hospital in Boston, Dr. Herbert Benson has pioneered an empirically validated stress-management methodology to elicit the relaxation response. His research, which spans over 30 years, explores how stress may exacerbate or contribute to illness. The institute's mind-body medicine approach is a scientifically validated set of clinical practices that have a foundation in the biopsychosocial model and the relaxation response.
Stress is a reaction that requires behavioral changes. BHI teaches patients active, rather than reactive, stress management. Patients learn to tap their innate ability for relaxation to ward off the harmful manifestations of stress.
Benson views holistic medical practice as a "three legged stool." The first leg is pharmaceuticals; the second leg is surgery and/or procedures; and the third leg is self-care, which includes the daily use of strategies such as the relaxation response, guided imagery, positive self-affirmations, etc. For conditions where stress can be a contributing factor, such as hypertension, heart disease, chronic pain, insomnia, infertility and menopause, a holistic mind-body treatment plan can include relaxation-response training, coping-skills training and exercise.
"The research demonstrates that these interventions do not mutate our genetics, but we can alter or change our genetic expression," Benson states. In lay terms, we will always be prone to stress, but we can impact how it affects us. Benson notes that all people can discover these capacities within themselves.
In addition to the empirically documented clinical benefits, Benson notes that what patients take away from a mind-body approach is a new determination "to have a greater role in becoming and staying healthy."
Mind-body research does not claim to lead to regenerative capacities in neurological or paralytic conditions; rather, the relaxation response can be helpful in treating the secondary pain or stress triggered by such medical conditions. As Benson notes, "The relaxation response guides patients to take advantage of innate capacities to calm the mind and body."
Application with Chronic Disability
Mind-body modalities provide two main benefits. First, they help patients develop awareness of the mind-body pathway, or an understanding of how one's own mind and body interact with and impact one another. The second benefit is that they teach patients specific techniques for self-care and/or relaxation.
Before implementing mind-body approaches with rehabilitation patients, it can be helpful to start with a few exploratory assessment questions. For example, ask patients or caregivers to keep a stress log for a week between sessions to gain a real-life account of the stress demands on them. This is often a new concept for patients, and they may have a hard time identifying their sources of stress or stress patterns.
The following questions can be a starting point:
• How does the patient relax? How does he or she manage stress? (emotional)
• What are his or her stress thresholds for the body and mind? (interactions)
• What are his or her functionality thresholds-under what circumstances? (physiological)
• How does the patient talk to himself/herself? (cognitive) Pay attention to thought processes.
Next, each disability/condition presents its own challenges to achieving a relaxed state, due to the type of limitation-mobility, cognitive, neurological or functional-with which the patient struggles. A wide range of techniques or modes of relaxation can promote wellness, such as hypnosis, biofeedback, guided imagery, meditation, mindfulness, tai chi, diaphragmatic breathing and progressive muscle relaxation (see "Stress Management," April 28, 2008). It is critical to explore the widest range of options available to patients in order to accommodate the particular disability. Also explore a range of sensory modes (kinesthetic, visual, auditory and so on) to find strategies that do not add stress and allow the patient to implement them with ease.
The BHI clinical model includes two steps for eliciting the relaxation response. Step 1 involves engaging any modality (an image, word, phrase or sound) and using repetition of that cue to decrease stress arousal. Step 2 involves instructing patients to acknowledge thoughts when they intrude and then passively return to the repetition.
This technique "breaks the train of everyday thought and quiets the brain," Benson explains. "[Functional MRI] studies have demonstrated less static in the brain. Patients in turn can benefit, with practice, from the gains of building up their resiliency."
Increased resiliency opens up many possibilities, allowing patients to feel able to live their lives more actively and less trapped by their symptoms.
Even patients with cognitive deficits can still benefit from the techniques. Benson provides an example: "I worked with a young woman, a caregiver to her grandfather who is afflicted with severe Alzheimer's disease. He was from the Roman Catholic faith and repeated the prayers daily. What seemed preservative and annoying to others actually brought him solace, and the repetition generated the relaxation response for him."
Health Care Costs and Self-care
With health care costs continuing to rise, chronically disabled people often do not receive the ongoing intermittent treatment they may require. This is where integration of mind-body approaches can fill an often-neglected pocket of health care: teaching lasting self-care techniques.
"Patients can implement these interventions daily, and they are free and cost effective," Benson points out. "We nowhave the scientific data [to support] relaxation modes that have been used conventionally for centuries. What you are changing is your genetic expressions-these techniques and approaches have been practiced for a millennium. Think of your great grandmother who started her day with a prayer-all we've done is put modern scientific results to it."
Benson also notes that in current times there is an unfortunate cultural shift from rituals of rest, self-care and restoration. "What is [disheartening] is that as our world gets more stressful and complex, we have given up the behaviors that are most essential for coping."
Integrating mind-body strategies in rehabilitation treatment is a two-part process. It involves not only guiding patients but also enlisting practitioners and caregivers to gain first-hand experience with these strategies in order to improve the quality of care they provide and individualize the approach for each patient.
Implementing the relaxation response "crosses all disciplines and can be added to the daily routines of both practitioners and patients," Benson says. Caregivers will benefit from learning the relaxation response as well.
"When people who care for others are calmer, they can feel under more control during stressful days," Benson adds. Learning how to relax and being a calming presence is an interpersonal process.
Current research at BHI is looking at innovative domains such as "remembered wellness." Benson notes, "We are looking at new genomic data aiming to understand the power of belief and expectancy along the resiliency continuum."
There is much to explore in the world of mind-body interventions, and teaching patients how to relax should be a standard intervention in any course of rehabilitation treatment.
Dr. Reji Mathew is a psychotherapist/clinical instructor at the New York University. Her clinical expertise is in integrative psychotherapy, particularly cognitive behavioral skills training. Reach her via email at firstname.lastname@example.org.
• The Benson-Henry Institute for Mind Body Medicine www.mbmi.org
• Visit the BHI store at www.mbmi.org/shop/default.asp for relaxation CDs, videos, DVDs and books, including The Relaxation Response by Herbert Benson, MD.