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Complementary & Alternative Medicine
Index Of Alternative Therapies And Modalities
When deciding to begin a complementary therapy or to see a complementary practitioner, first speak with your primary health care provider.
Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.
Numerous relaxation techniques and behavioral therapeutic approaches exist, with a range of philosophies and styles of practice. Most techniques involve repetition (of a specific word, sound, prayer, phrase, body sensation or muscular activity) and encourage a passive attitude toward intruding thoughts.
Methods may be deep or brief:
- Deep relaxation methods include autogenic training, meditation and progressive muscle relaxation.
- Brief relaxation methods include self-controlled relaxation, paced respiration and deep breathing.
Other related techniques include guided imagery, passive muscle relaxation and refocusing. Applied relaxation often involves imagining situations to cause muscular and mental relaxation. Progressive muscle relaxation aims to teach people what it feels like to relax by comparing relaxation with muscle tension.
Relaxation techniques are taught by many types of health care professionals, including complementary practitioners, medical doctors, psychotherapists, hypnotherapists, nurses or sports therapists. There is no formal credentialing for relaxation therapy. Books, audiotapes or videotapes are sometimes used as teaching tools.
During stressful situations, the sympathetic nervous system increases activity, leading to the "fight-or-flight" response. Heart rate, blood pressure, breathing rate, blood supply to the muscles and dilation of the pupils often increase. It has been suggested that chronic stress may lead to negative effects on health such as high blood pressure, high cholesterol levels, upset stomach or gastrointestinal distress, and weakening of the immune system.
Harvard professor and cardiologist Herbert Benson, M.D., coined the term the "Relaxation Response" in the early 1970s to describe a state of the body that is the opposite of the stress response. The Relaxation Response is proposed to have the opposite effects of the stress response, including reduced sympathetic nervous system tone, increased parasympathetic activity, decreased metabolism, decreased blood pressure, decreased oxygen consumption and decreased heart rate. It is theorized that relaxation may counteract some of the negative long-term effects of chronic stress. Proposed relaxation techniques include massage, deep meditation, mind/body interaction, music- or sound-induced relaxation, mental imagery, biofeedback, desensitization, cognitive restructuring and adaptive self-statements. Rhythmic, deep, visualized or diaphragmatic breathing may be used.
One type of relaxation called Jacobson muscle relaxation, or progressive relaxation, involves flexing specific muscles, holding the tension and then relaxing. The technique involves progressing through muscle groups one at a time, beginning with the feet, up to the head, spending about one minute on each area. Progressive relaxation may be practiced while lying down or sitting. This technique has been proposed for psychosomatic disorders (those originating in the mind), pain relief and anxiety. The Laura Mitchell approach involves reciprocal relaxation, moving a part of the body in a direction opposite of an area of tension and then letting it go.
Scientists have studied relaxation therapy for the following health problems:
Anxiety and stress
Numerous studies in humans suggest that relaxation therapy (for example, using audio tapes or group therapy) may moderately reduce anxiety, phobias such as agoraphobia (fear of crowds), dental fear, panic disorder and anxiety resulting from severe illnesses or before medical procedures. However, most research is not high quality, and it is not clear which specific relaxation approaches are most effective. Better evidence is needed before a strong recommendation can be made.
Early studies in humans report that relaxation may temporarily reduce symptoms of depression. Well-designed research is needed to confirm these results.
Several studies suggest that relaxation therapy may help people with insomnia fall asleep and stay asleep longer. Cognitive (mind) forms of relaxation such as meditation may be more effective than somatic (body) forms such as progressive muscle relaxation. Most studies are not well designed or reported. Better research is necessary before a firm conclusion can be drawn.
Most studies of relaxation for pain are poor quality and report conflicting results. Multiple types and causes of pain have been studied. Better research is necessary before a clear conclusion can be drawn.
High blood pressure
Relaxation techniques have been associated with reduced pulse rate, systolic blood pressure, diastolic blood pressure, lower perception of stress and enhanced perception of health. Further research is needed to confirm these results.
There is early evidence that progressive muscle relaxation may improve physical and emotional symptoms associated with premenstrual syndrome. Better-quality research is necessary before a recommendation can be made.
There is promising early evidence from trials in humans supporting the use of relaxation therapy to temporarily reduce menopausal symptoms. Better-quality research is necessary before a firm conclusion can be drawn.
Preliminary evidence suggests that relaxation therapy may help reduce the severity of headaches in children and migraine symptoms in adults. Positive changes in self-perceived pain frequency, pain intensity and duration, quality of life, health status, pain related disability and depression have been reported. Additional research is necessary before a firm conclusion can be drawn.
Chemotherapy-induced nausea and vomiting
Early trials in humans report that relaxation therapy may be helpful in reducing nausea related to cancer chemotherapy. Better-quality research is necessary before a firm conclusion can be drawn.
Limited early research reports that muscle relaxation may improve function and quality of life in people with rheumatoid arthritis. More studies are needed to reach a firm conclusion.
Early research reports that relaxation with imagery may reduce relapse rates in people who successfully completed stop-smoking programs. Further research is needed before a recommendation can be made.
In a randomized clinical trial, mime therapy including automassage, relaxation execises, inhibition of synkinesis, coordination exercises and emotional expression exercises was shown to be a good treatment choice for patients with sequelae of facial paralysis.
Relaxation has been reported to reduce fibromyalgia pain in one randomized controlled study. However, results from other studies are conflicting, and therefore further research is needed before a clear recommendation can be made.
In a randomized study of patients with osteoarthritis pain, Jacobson relaxation was reported to lower the level of subjective pain over time. The study concluded that relaxation may be effective in reducing the amount of analgesic medication taken by participants. Further well-designed research is needed to confirm these results.
Results of randomized controlled studies of relaxation techniques for obsessive-compulsive disorder show conflicting results. Further research is needed before conclusions can be drawn.
Preliminary studies of relaxation techniques in individuals with asthma report a significant decrease in asthma symptoms, anxiety and depression, along with improvements in quality of life and measures of lung function. Further large trials in humans are needed to confirm these results.
Studies assessing relaxation to improve psychological well-being and "calm" in multiple types of patients have reported positive results, although the results of most trials have not been statistically significant. Although this research is suggestive, additional work is merited before a firm conclusion can be drawn.
Irritable bowel disease
Early research in humans suggests that relaxation may aid in the prevention and relief of irritable bowel disease symptoms. Large, well-designed trials are needed to confirm these results.
Mental health and quality-of-life improvements have been seen in preliminary studies of HIV/AIDS patients. These findings suggest the need for further, well-controlled research.
Tinnitus (ringing in the ears)
Relaxation therapy has been associated with benefits in preliminary studies of tinnitus patients. Further research is needed to confirm these results.
Preliminary research in patients with Huntington's disease has evaluated the effects of either multisensory stimulation or relaxation activities (control) for four weeks, with unclear results. Further research is necessary before a conclusion can be drawn.
Preliminary research in patients with angina reports that relaxation may reduce anxiety, depression, frequency of angina episodes, medication need and physical limitations. Large well-designed studies are needed to confirm these results.
Myocardial infarction (heart attack)
Initial research in which patients were given an advice and relaxation audiotape within 24 hours of hospital admission for a heart attack found a reduction in the number of misconceptions about heart disease, but no benefits on measured health-related outcomes.
Post-traumatic stress disorder
Relaxation has been studied for post-traumatic stress disorder with no benefit seen in these patients.
A small study showed that biofeedback-assisted relaxation benefits patients with neurocardiogenic syncope. Further study is necessary to confirm these results.
Early studies suggested that progressive muscle relaxation training may benefit patients with heart failure when used as an adjunct to standard care.
Relaxation therapy has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using relaxation therapy for any use.
Adjustment disorder (a behavioral problem)
Arrhythmia (abnormal heart rhythm)
Chronic fatigue syndrome
Chronic obstructive pulmonary disease
Coronary artery disease
Hemiplegia (paralysis of one side of the body)
Immune system stimulation
| Improved sleep quality|
Increased breast milk
Irritable bowel syndrome
Ischemic heart disease
Low back pain
Neurogenic cognitive disorders
Night eating syndrome
Pelvic floor spasms
Peptic ulcer disease
Promotion of long-term health
Quality of life
Repetitive strain injuries
Tension headache (in adults)
Most forms of relaxation therapy are considered safe in healthy adults, and severe adverse effects have not been reported. It has been theorized that relaxation therapy may increase anxiety in some individuals or that it may cause autogenic discharges (sudden, unexpected emotional experiences characterized by pain, heart palpitations, muscle twitching, crying spells or increased blood pressure). People with psychiatric disorders such as schizophrenia or psychosis should avoid relaxation therapy unless recommended by a qualified health care provider. Relaxation techniques that involve inward focusing may intensify a depressed mood, although this has not been clearly shown in scientific studies.
Jacobson relaxation techniques (flexing specific muscles, holding the tension, then relaxing the muscles) and similar approaches should be used cautiously by people with heart disease, high blood pressure or musculoskeletal injuries.
Relaxation therapy is not recommended as the sole treatment for potentially severe medical conditions. It should not delay diagnosis by a qualified health care provider and treatment with more proven techniques.
Relaxation therapy has been suggested for many conditions. Early scientific evidence suggests that relaxation may play a role in treating anxiety, although better studies are needed that identify which approaches are most effective. Research also reports possible effectiveness for anxiety, depression, pain, insomnia, premenstrual syndrome and headache, although this evidence is early and better studies are needed to form clear conclusions. Relaxation is generally believed to be safe when practiced appropriately, but it should not be used as the sole treatment for severe illnesses.
The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Relaxation Therapy
Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created.
Some of the more recent studies are listed below:
- Andrasik F, Grazzi L, Usai S, et al. Pharmacological treatment compared to behavioural treatment for juvenile tension-type headache: results at two-year follow-up. Neurol Sci 2007;May, 28(Suppl 2):S235-S238.
- Arntz A. Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. Behav Res Ther 2003;Jun, 41(6):633-646.
- Astin JA. Mind-body therapies for the management of pain. Clin J Pain 2004;20(1):27-32.
- Berger AM, VonEssen S, Kuhn BR, et al. Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: results of a feasibility intervention study. Oncol Nurs Forum 2003;May-Jun, 30(3):513-522.
- Biggs QM, Kelly KS, Toney JD. The effects of deep diaphragmatic breathing and focused attention on dental anxiety in a private practice setting. J Dent Hyg 2003;Spring, 77(2):105-113.
- Borkovec TD, Newman MG, Pincus AL, Lytle R. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. J Consult Clin Psychol 2002;Apr, 70(2):288-298.
- Boyce PM, Talley NJ, Balaam B. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol 2003;98(10):2209-2218.
- Bugbee ME, Wellisch DK, Arnott IM, et al. Breast core-needle biopsy: clinical trial of relaxation technique versus medication versus no intervention for anxiety reduction. Radiology 2005;234(1):73-78.
- Cheung YL, Molassiotis A, Chang AM. The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psychooncology 2003;Apr-May, 12(3):254-266.
- Cimprich B, Ronis DL. An environmental intervention to restore attention in women with newly diagnosed breast cancer. Cancer Nurs 2003;Aug, 26(4):284-292. Quiz, 293-294.
- Deckro GR, Ballinger KM, Hoyt M, et al. The evaluation of a mind/body intervention to reduce psychological distress and perceived stress in college students. J Am Coll Health 2002;May, 50(6):281-287.
- Delaney JP, Leong KS, Watkins A, Brodie D. The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. J Adv Nurs 2002;Feb, 37(4):364-371.
- Diette GB, Lechtzin N, Haponik E, et al. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia. Chest 2003;Mar, 123(3):941-948.
- Edelen C, Perlow M. A comparison of the effectiveness of an opioid analgesic and a nonpharmacologic intervention to improve incentive spirometry volumes. Pain Manag Nurs 2002;Mar, 3(1):36-42.
- Egner T, Strawson E, Gruzelier JH. EEG signature and phenomenology of alpha/theta neurofeedback training versus mock feedback. Appl Psychophysiol Biofeedback 2002;Dec, 27(4):261-270.
- Fichtel A, Larsson B. Relaxation treatment administered by school nurses to adolescents with recurrent headaches. Headache 2004;Jun, 44(6):545-554.
- Larsson B, Carlsson J, Fichtel A, Melin L. Relaxation treatment of adolescent headache sufferers: results from a school-based replication series. Headache 2005;Jun, 45(6):692-704.
- Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial. J Psychiatr Res 2002;May-Jun, 36(3):179-187.
- Foster RL, Yucha CB, Zuk J, Vojir CP. Physiologic correlates of comfort in healthy children. Pain Manag Nurs 2003;Mar, 4(1):23-30.
- Gay MC, Philippot P, Luminet O. Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson [correction of Erickson] hypnosis and Jacobson relaxation. Eur J Pain 2002;6(1):1-16.
- Ginsburg GS, Drake KL. School-based treatment for anxious african-american adolescents: a controlled pilot study. J Am Acad Child Adolesc Psychiatry 2002;Jul, 41(7):768-775.
- Good M, Anderson GC, Stanton-Hicks M, et al. Relaxation and music reduce pain after gynecologic surgery. Pain Manag Nurs 2002;Jun, 3(2):61-70.
- Goodale IL, Domar AD, Benson H. Alleviation of premenstrual syndrome symptoms with the relaxation response. Obstet Gynecol 1990;75(4):649-655.
- Grazzi L, Andrasik F, Usai S, et al. Pharmcological behavioural treatment for children and adolescents with tension-type headache: preliminary data. Neurol Sci 2004;25(Suppl 3):270-271.
- Hanley J, Stirling P, Brown C. Randomised controlled trial of therapeutic massage in the management of stress. Br J Gen Pract 2003;Jan, 53(486):20-25.
- Hoebeke P, Van Laecke E, Renson C, et al. Pelvic floor spasms in children: an unknown condition responding well to pelvic floor therapy. Eur Urol 2004;46(5):651-654; discussion, 654.
- Kober A, Scheck T, Schubert B, et al. Auricular acupressure as a treatment for anxiety in prehospital transport settings. Anesthesiology 2003;Jun, 98(6):1328-1332.
- Kroner-Herwig B, Frenzel A, Fritsche G, et al. The management of chronic tinnitus: comparison of an outpatient cognitive-behavioral group training to minimal-contact interventions. J Psychosom Res 2003;Apr, 54(4):381-389.
- Lechner SC, Antoni MH, Lydston D, et al. Cognitive-behavioral interventions improve quality of life in women with AIDS. J Psychosom Res 2003;Mar, 54(3):253-261.
- Leng TR, Woodward MJ, Stokes MJ, et al. Effects of multisensory stimulation in people with Huntington's disease: a randomized controlled pilot study. Clin Rehabil 2003;Feb, 17(1):30-41.
- Machiko T, Katsutaro N, Chika O. A study of psychoneuroendocrinological effects of music therapy [Article in Japanese]. Seishin Shinkeigaku Zasshi 2003;105(4):468-472.
- McCain NL, Munjas BA, Munro CL, et al. Effects of stress management on PNI-based outcomes in persons with HIV disease. Res Nurs Health 2003;Apr, 26(2):102-117.
- McGrady AV, Kern-Buell C, Bush E, et al. Biofeedback-assisted relaxation therapy in neurocardiogenic syncope: a pilot study. Appl Psychophysio Biofeedback 2003;28(3):183-192.
- Murray LL, Kim HY. A review of select alternative treatment approaches for acquired neurogenic disorders: relaxation therapy and acupuncture. Semin Speech Lang 2004;25(2):133-149.
- Ostelo RW, van Tulder MW, Vlaeyen JW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev 2005;Jan 25(1):CD002014.
- Pallesen S, Nordhus IH, Kvale G, et al. Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions. Behav Res Ther 2003;Jan, 41(1):31-48.
- Pawlow LA, O'Neil PM, Malcolm RJ. Night eating syndrome: effects of brief relaxation training on stress, mood, hunger, and eating patterns. Int J Obes Relat Metab Disord 2003;Aug, 27(8):970-978.
- Piazza-Waggoner CA, Cohen LL, Kohli K, Taylor BK. Stress management for dental students performing their first pediatric restorative procedure. J Dent Educ 2003;May, 67(5):542-548.
- Schofield P, Payne S. A pilot study into the use of a multisensory environment (Snoezelen) within a palliative day-care setting. Int J Palliat Nurs 2003;Mar, 9(3):124-130. Erratum in: Int J Palliat Nurs 2003;Apr, 9(4):178.
- Shapiro SL, Bootzin RR, Figueredo AJ, et al. The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study. J Psychosom Res 2003;Jan, 54(1):85-91.
- Sheu S, Irvin BL, Lin HS, Mar CL. Effects of progressive muscle relaxation on blood pressure and psychosocial status for clients with essential hypertension in Taiwan. Holist Nurs Pract 2003;Jan-Feb, 17(1):41-47.
- Siev J, Chambless DL. Specificity of treatment effects: cognitive therapy and relaxation for generalized anxiety and panic disorders. J Consult Clin Psychol 2007;Aug, 75(4):513-522.
- Soo S, Moayyedi P, Deeks J, et al Psychological interventions for non-ulcer dyspepsia. Cochrane Database Syst Rev 2004;(3):CD002301.
- Turner-Stokes L, Erkeller-Yuksel F, Miles A, et al. Outpatient cognitive behavioral pain management programs: a randomized comparison of a group-based multidisciplinary versus an individual therapy model. Arch Phys Med Rehabil 2003;Jun, 84(6):781-788.
- Viens M, De Koninck J, Mercier P, et al. Trait anxiety and sleep-onset insomnia: evaluation of treatment using anxiety management training. J Psychosom Res 2003;Jan, 54(1):31-37.
- Viljanen M, Malmivaara A, Uitti J, et al. Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial. BMJ 2003;Aug 30, 327(7413):475.
- Wang SM, Caldwell-Andrews AA, Kain ZN. The use of complementary and alternative medicines by surgical patients: a follow-up survey study. Anesth Analg 2003;Oct, 97(4):1010-1015.
- Wilhelm S, Deckersbach T, Coffey BJ, et al. Habit reversal versus supportive psychotherapy for Tourette's disorder: a randomized controlled trial. Am J Psychiatry 2003;Jun, 160(6):1175-1177.
- Willumsen T, Vassend O. Effects of cognitive therapy, applied relaxation and nitrous oxide sedation: a five-year follow-up study of patients treated for dental fear. Acta Odontol Scand 2003;Apr, 61(2):93-99.
- Yu DS, Lee DT, Woo J, Hui E. Non-pharmacological interventions in older people with heart failure: effects of exercise training and relaxation therapy. Gerontology 2007;53(2):74-81.
- Yu DS, Lee DT, Woo J. Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure. J Psychosom Res 2007;Apr, 62(4):427-437.
Last updated May 07, 2008
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