The efficacy of relaxation training in treating anxiety.

Abstract

INTRODUCTION Research, clinical experience and general community agents are promoting the re-evaluation of old and naive forms of therapy as alternatives or adjuncts to pharmacological approaches in variety of suffering conditions (Krisanaprakornkit, Krisanaprakornkit, Piyavhatkul, & Laopaiboon, 2006). Relaxation training is probably the most used non-pharmacological, both stand-alone and psychotherapy-combined approach for the treatment of many medical and psychological diseases. Among the wide range of non-conventional and sometimes doubtful treatments, relaxation-based methods such as meditation, progressive muscular relaxation, applied relaxation, mindfulness and autogenic training have received the greatest scientific attention and validation. For example, mindfulness training in pain, hypertension, myocardial ischemia, inflammatory bowel disease, human immunodeficiency virus and substance abuse is presently under investigation in research supported by the National Institutes of Health (NTH) (Ludwig & Kabat-Zinn, 2008). Relaxation training is especially useful in treating stress and anxiety. Indeed, both the literature and dictionaries oppose relaxation to stress, anxiety or tension. Benson, one the most influential author in the field of relaxation, defined it as a state of decreased psycho-physiological arousal: calming state (Benson & Klipper, 1975). Anxiety is normal reaction to stress and represent common human emotion. But when anxiety becomes an excessive, irrational dread of everyday situations, it has became disabling disorder. According to Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV), anxiety disorders are classified into many types, including Panic Disorder, Specific Phobia, Social Phobia, Obsessive-Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), Acute Stress Disorder and Generalized Anxiety Disorders (APA, 2000). However, anxiety disorders constitute only the tail of the curve representing the general anxiety distress that affects the population (Manzoni, Pagnini, Castelnuovo, & Molinari, 2008). According to Zigmond and Snaith (Zigmond & Snaith, 1983), psychiatric disorder cannot be considered either present or absent since the degrees is continuously distributed in the population. In fact, complaints of anxiety are common among healthy individuals and have been associated with numerous negative health consequences (Balon, 2006; Muller, Koen, & Stein, 2005), absenteeism and decreased work productivity (Sanderson, Tilse, Nicholson, Oldenburg, & Graves, 2007). A broad understanding of the etiology of anxiety problems includes multiplicity of factors, such as biological, psychological and social determinants, which are moderated by range of risk and protective factors (Somers, Goldner, Waraich, & Hsu, 2006). The old debate over the primacy of these factors, overall biological or psychological, is gradually being replaced by pragmatic model considering all the relative contributions (Krisanaprakornkit, et al., 2006). In this paper we discuss the efficacy of relaxation training on anxiety both in clinical and community populations. RELAXATION TRAINING FOR ANXIETY Many studies have investigated the effects of relaxation training on anxiety in wide range of applications and research purposes. A recent meta-analysis on trials published within the last ten years (1997-2007) supports good efficacy of relaxation training in reducing anxiety (Manzoni, et al., 2008). State and trait anxiety (Spielberger, Gorsuch, & Lushene, 1970) are both influenced by training: each relaxation session may decrease state anxiety and the enduring practice of relaxation techniques may improve also trait anxiety in the middle-long term. There is no significant difference between the effects of group and individual training. The efficacy of the treatment increases with the duration of the protocol and with the request of home practice (Manzoni, et al. …