Behavioral Relaxation Training Research Articles

Brief relaxation training effects on long-term endocrine therapy adherence among women with breast cancer.

12061 Background: Despite life-saving potential, many women struggle to adhere to adjuvant endocrine therapy (AET) for their early-stage, hormone receptor-positive breast cancer. Prior research has demonstrated that emotional distress is a barrier to AET adherence. The current study aimed to test the long-term effects of two 5-week post-surgical group-based stress management interventions, cognitive behavioral therapy (CBT) and relaxation training (RT), versus an attention-matched health education (HE) control on AET adherence at long-term follow-up. Methods: We conducted long-term follow-up (median = 8 years, range = 7-11 years) of a cohort of women who enrolled in a randomized controlled trial of CBT vs. RT vs. HE shortly after surgery for stage 0-3 breast cancer.We measuredadherence with the Endocrine Therapy Medication Usage Questionnaire (ETMUQ) given at long-term follow-up. First, we established adherence factors on the ETMUQ via confirmatory factor analysis. We then used structural equation modeling to regress these factors on study arm, controlling for patient age, stage of disease, and treatments received (chemotherapy/radiation). Results: The sample was predominately middle-aged ( M= 54.81, SD= 10.19), White (41.5%) and Hispanic (42.2%), partnered (62.2%) with stage 1 (57.0%) or stage 2 (25.9%) disease. Of the women who completed long-term follow-up (N = 59, 44.7% of original sample); more than half (n = 30; 50.8%) reported having at least some problems with adherence. There was an effect of intervention group on adherence, such that women receiving RT (n = 15) had significantly better adherence than those receiving CBT (n = 20) on the factor measuring Forgetfulness/Inconsistency ( B(SE) =.57 (.34), p=.001), and marginally better adherence than those receiving CBT on the factor measuring Intentional Nonadherence ( B(SE) =.60 (.33), p =.062). There was no such effect when comparing RT or CBT to HE (n = 24). Conclusions: Women receiving RT were less likely to forget to take their AET and marginally less likely to intentionally miss doses of AET in the long-term compared to women receiving CBT. Future research could investigate the mechanism by which RT may improve adherence. For example, RT may reduce somatic symptoms related to AET or improve a patients’ self-efficacy to cope with these symptoms thereby reducing intentional non-adherence. In addition, RT may improve patients’ attention and awareness leading to less forgetfulness. Clinical trial information: NCT02103387.

The Effect of Behavioral Relaxation Training on Distress and Cancer Screening Intention of Patients with Upper Gastrointestinal Endoscopy

Purpose: This study evaluates the effect of behavioral relaxation training on distress and cancer screening intention of patients with upper gastrointestinal endoscopy. Methods: The research was conducted in a non-equivalent control group posttest design. Data were collected from endoscopy subjects in B city from October to November of 2018. Fifteen minutes of behavioral relaxation training were provided to the experimental group (n=40) and traditional relaxation therapy methods were provided to the control group (n=40). Outcome measures were distress and cancer screening intention of patients with upper gastrointestinal endoscopy. Data were analyzed with a ${chi}^2$-test, independent t-test, Fisher's exact test with SPSS/PC version 23.0. Results: The objective discomfort (t=8.81, p<.001) of the experimental group was lower than that of the control group; there were no significant differences in the subjective discomfort (t=1.73, p=.088). The cancer screening intention (t=-5.85, p<.001) of the experimental group was significantly higher than that of the control group. Conclusion: Behavioral relaxation training was effective in heightening cancer screening intention. Therefore it can be usefully applied to increase cancer screening intention.

Mechanisms of behavior modification in clinical behavioral medicine in China.

Behavior modification, as the core of clinical behavioral medicine, is often used in clinical settings. We seek to summarize behavior modification techniques that are commonly used in clinical practice of behavioral medicine in China and discuss possible biobehavioral mechanisms. We reviewed common behavior modification techniques in clinical settings in China, and we reviewed studies that explored possible biobehavioral mechanisms. Commonly used clinical approaches of behavior modification in China include behavior therapy, cognitive therapy, cognitive-behavioral therapy, health education, behavior management, behavioral relaxation training, stress management intervention, desensitization therapy, biofeedback therapy, and music therapy. These techniques have been applied in the clinical treatment of a variety of diseases, such as chronic diseases, psychosomatic diseases, and psychological disorders. The biobehavioral mechanisms of these techniques involve the autonomic nervous system, neuroendocrine system, neurobiochemistry, and neuroplasticity. Behavior modification techniques are commonly used in the treatment of a variety of somatic and psychological disorders in China. Multiple biobehavioral mechanisms are involved in successful behavior modification.

Comparison of younger and older adults’ acceptability of treatment for generalized anxiety disorder co-occurring with Parkinson’s disease.

Acceptability ratings of medication or Behavioral Relaxation Training (BRT), for general anxiety disorder (GAD) co-occurring with Parkinson’s Disease (PD) were obtained from younger (n = 79) and older (n = 54) adults. Participants read a case description of an older adult with PD and comorbid GAD followed by a description of BRT or medication presented in counterbalanced fashion and then provided acceptability ratings. A two (younger, older adult) x two (medication, BRT) mixed factorial ANOVA was performed with AARP scores as the dependent variable. Results replicate and extend earlier research indicating that behavioral and cognitive behavioral treatments for older adults are more acceptable than medication. Moreover, the effect of age cohort, demographic characteristics and psychological comorbidity did not affect acceptability ratings.

Behavioral relaxation training for Parkinson’s disease related dyskinesia and comorbid social anxiety.

Parkinson's disease (PD) is a progressive, neurodegenerative neurological disorder of unknown etiology. Loss of dopaminergic cells in the substantia nigra of the brain is responsible for motor, affective and cognitive changes observed. No cure is available. Common motor symptoms are tremor, rigidity, and bradykinesia, as well as postural instability in later stages of the disease (Weiner, Shulman, & Lang, 2001). As the disease progresses medication induced motor symptoms, such as dyskinesia--involuntary gross motor wiggling or dance-like movement affecting upper and lower extremities--may emerge (Weiner et al, 2001). Awareness of the importance and impact of nonmotor symptoms has grown with clinical and research experience indicating cognitive and behavioral components substantially contributing to impaired quality of life and increased severity of motor symptoms. Yet, anxiety remains unrecognized and under treated among PD patients. (O'Sullivan, Williams, & Gallagher, 2008; Schulman, Taback, Rabinstein & Weiner, 2002). Anxiety disorders are the most common psychological disorder in the general population (Thyer et al., 1985), while anxiety disorders among older adults often co-occur with medical and neurological disorders (Raj et al., 1993). PD and comorbid anxiety have been documented repeatedly with estimates of 40-75% (Schiffer, et al., 1988; Shulman et al., 2002; Stein, Heuser, Juncos, Uhde, 1990). Clinical treatment, when provided, is primarily pharmacological with anxiolytics, benzodiazepines or antidepressants used. Pathological neurodegenerative changes in noradrenergic mechanisms may be responsible for anxiety experienced by patients with PD (Marsh, 2000). No experimental studies have examined the efficacy of medication in this population. The effects of anxiety on functioning of PD are formidable and further diminish quality of life (Marinus, Leentjens, Visser, Striggelbout & Van Hilten, 2002). Comorbid anxiety results in increased motor dysfunction including more severe tremor, freezing (sudden inability to move), dyskinesia and situational anxiety. Indeed, anxiety may produce excess disability than that observed solely due to PD. Treatment of motor and non motor symptoms of PD focuses on maintaining and improving quality of life. Addressing comorbid anxiety is an important target in this process and relaxation training has been suggested (Marsh, 2000). Despite the wide spread occurrence of comorbid anxiety and PD, few reports of relaxation training with PD patients are available. Schumaker (1980) examined the effect of frontal electromyographic (EMG) biofeedback and progressive muscle relaxation training on manual motor performance of PD patients. No effect of intervention on motor performance was observed. Behavioral Relaxation Training (BRT) has been used to successfully manage tremor of two older adults; one with essential tremor (ET) and another with ET and PD (Chung et al., 1995). Chung et al reported decreased tremor severity and improved performance in activities of daily. Improved psychological adjustment was anecdotally reported. Lundervold (1997) reported that BRT and coping self-instructions were effective with an ET patient in reducing tremor severity related to negative arousal (anger in specific social situations). Decreased emotional distress and EMG activity among four muscle groups was observed. More recently, Lundervold, Pahwa and Lyons (2009) reported using behavioral intervention that included BRT for management of PD and comorbid general anxiety. Two contemporary behavioral accounts describe anxiety and distress among movement disorder patients (Lundervold & Poppen, 2004; Macht & Ellgring, 1998). These reports describe a three component behavioral model. From a behavioral perspective, identification of current maintaining contextual variables, (i.e., setting events, antecedents and consequences) is critical in selection appropriate interventions (Speigler & Guevremont, 2003). …

Effect of Behavioral Intervention on Comorbid General Anxiety Disorder and Parkinson's Disease

A multiple-baseline, across-behaviors experimental design was used to evaluate the effects of a multicomponent behavioral intervention for anxiety secondary to Parkinson's disease (PD). A 67-year-old man with an 18-year history of PD, a 13-year history of anxiety, and meeting DSM-IV-TR criteria for general anxiety disorder (GAD) took part in the study. Dependent variables were the Clinical Anxiety Scale (CAS), Subjective Unit of Discomfort (SUD) ratings, and the Behavioral Relaxation Scale, a direct observation measure of relaxed behavior. Systematic increases in relaxed behavior with corresponding reductions in SUD ratings and CAS scores were obtained following Behavioral Relaxation Training (BRT). Further decreases in SUD ratings occurred following BRT + Imagery and BRT + Coping. Generalization assessment of relaxed behavior in the home environment indicated 78% relaxed. Social validity ratings, obtained by a “blinded” rater during neuropsychological assessment, indicated the patient was as “calm as other individuals.” Behavioral intervention was rated as highly acceptable. Behavioral intervention was beneficial in reducing anxiety beyond that obtained by medication alone. Further research replicating these findings is needed.

Efficacy of Behavioral Relaxation Training for Individuals with Traumatic Brain Injury

Efficacy of Behavioral Relaxation Training for Individuals with Traumatic Brain Injury

Effect of behavioral activation treatment on chronic fibromyalgia pain: Replication and extension.

A multiple-baseline-across two behavior sets and positions (reclined, upright) was used to experimentally examine the effect of Behavioral Activation Treatment for Pain (BAT-P) on pain-related behavior of a 44-year-old woman with a 22-year history of fibromyalgia (FM). BAT-P, based on the matching law, is comprised of Behavioral Relaxation Training (BRT), scheduled relaxation-activity cycles, daily relaxation practice, shaping performance of valued activities, visual feedback of performance and descriptive praise. Visual feedback was provided for pain interference rating, performance of relaxation skills, and self-rated depression. A behavioral contract was implemented to increase maintenance of intervention effects. Percent-relaxed behavior was functionally related to BRT with limited generalization from reclined to upright positions or across behavior sets. BAT-P resulted in clinically significant decreases in self-reported pain interference, pain anxiety, and depression and medication usage. Pain anxiety cognition declined without direct cognitive restructuring. Results were maintained at three- and sixmonth follow up. Findings replicate results of BAT-P for FM pain interference and pain anxiety cognition. Use of systematic maintenance procedures extends past research on BAT-P. Results provide further support for the utility of “pure” behavior analytic interventions for FM and the benefit of such procedures for pain anxiety cognition.

Abbreviated upright Behavioral Relaxation Training for test anxiety among college students: Initial results.

Effect of abbreviated upright Behavioral Relaxation Training (BRT) on two self-report measures of test anxiety was examined using a quasi-experimental pre-post between groups (N = 20) research design with selfreferred college students. At time 1 (T1) assessment, all participants completed the Abbreviated Test Anxiety Scale (ATAS) and were trained in the use of the Subjective Unit of Discomfort (SUD) rating scale. Participants recorded SUD ratings in vivo over a one-week period. Experimental group participants received two group sessions of upright BRT with instructions to practice BRT in vivo. Control group participants simply recorded SUD ratings during the intervention period. At time 2 (T2) assessment, all participants provided SUD rating data and completed the ATAS. Correlated t-tests indicated statistically significant differences in ATAS and SUD ratings in favor of abbreviated BRT. Robust effect, despite small sample size, provides further evidence for the effectiveness of BRT as an easy to learn, rapid relaxation training procedure for anxiety disorders. Application of abbreviated BRT in a group setting is a significant advance. Replication using a larger sample size with measurement of relaxed behavior and effect on academic performance is needed.

Effect of Behavioral Activation Treatment on fibromyalgia-related pain anxiety cognition.

Effects of Behavioral Activation Treatment (BAT) on pain anxiety, depression, and pain interference on a 43-year-old female with an 11-year history of chronic fibromyalgia pain are described. Analgesic, anxyiolytic, and antidepressant medications were stabilized prior to participation. Dependent measures were the Behavioral Relaxation Scale, a direct observation measure of relaxed behavior, and self-report measures of depression, pain anxiety and pain interference. A within session pre-post training assessment, embedded in a multiple-baselineacross-relaxed-positions single-subject experimental design, was used. BAT, based on the matching law, was comprised of behavioral relaxation training (BRT), activity-relaxation cycles, engaging in valued activities, and visual feedback of functioning. BRT resulted in an immediate increase in reclined relaxed behaviors with generalization to the upright relaxed position. A 100% improvement from baseline pain interference ratings was obtained following BAT. All four dimensions of pain anxiety declined to normative levels following BAT. Pain anxiety cognition declined without direct intervention. Depression declined to normative levels. Medication usage decreased from beginning to end-of-intervention but rose at follow up. Results were maintained at three-month follow up. Pain anxiety cognition was conceptualized verbal behavior that functioned as an establishing operation (EO) affecting consequences of overt and visceral (emotional) pain behavior. Altering contingencies related to overt healthy behavior delimits the effectiveness of the EO. Further research on BAT and pain anxiety cognition EOs is

Alternate forms reliability of the Behavioral Relaxation Scale: Preliminary results.

Alternate forms reliability of the Behavioral Relaxation Scale (BRS; Poppen,1998), a direct observation measure of relaxed behavior, was examined. A single BRS score, based on long duration observation (5-minute), has been found to be a valid measure of relaxation and is correlated with selfreport and some physiological measures. Recently, alternate forms of BRS observation have appeared in the literature; however, it is unknown if alternate forms are reliable relative to the long form observation method. BRS data from 10 adults, taking part in research on Behavioral Relaxation Training (BRT), were examined. Correlation analyses of long form BRS scores, interval-by-interval BRS (very short form: one 60-second; short form: two 60-second; medium form: three 60-second intervals) and composite BRS scores obtained from a single 120- or 180-second observation were conducted. All alternate forms BRS observation methods were robustly associated with long form BRS scores (r = > .80, p = .005). Alternate forms BRS observation methods provide more flexibility in applied situations without loss of reliability when measuring overt relaxed behavior. Further research needs to examine reliability of alternate forms BRS observation methods using physiological measures and direct observation measures as criterion

Increasing functional communication through relaxation training and neuromuscular feedback

The following research examined the effects of behavioural relaxation training and biofeedback on ataxic tremor of an adult with acquired brain injury. The paticipant was taught relaxation techniques before biofeedback was introduced. Once he was proficient in relaxation, these skills were then used as a foundation for biofeedback training. Specific skills, facilitating the use of a letter board, were taught when the participant was able to relax the appropriate musculature to criterion. The results demonstrated that the participant learned how to significantly decrease the severity of tremor. As a result, he became more proficient at communicating via his letter board. Collateral effects were increased attempts at communication and fewer episodes of anger.

Reduction of tremor severity and disability following behavioral relaxation training

The effects of behavioral relaxation training (BRT) for the treatment of moderate to severe essential tremor (ET) was evaluated with two older adults, ages 73 and 83, using a single-case design and statistical analysis. Measures included within-session clinician and self-rated tremor severity and disability in activities of daily living (ADL), EMG activity, and daily self-ratings of tremor severity and ADL disabilities. Following a brief 2–4 week baseline period BRT was conducted. Clinically significant reductions of 47–66% in within session clinical and self-rated tremor severity and daily self-ratings were obtained. Statistically significant changes in self- and clinician ratings occurred following BRT. In some cases, EMG activity also declined following intervention. Results at a seven week follow up were mixed and related to continued use of relaxation skills. While the cost ratio (medication: BRT) indicates that relaxation training is more expensive relative to standard medical intervention, cost–benefit to patients off sets the financial difference. Relaxation training may be an efficacious first step in a biobehavioral stepped care treatment model.

Behavioral assessment of relaxation: The validity of a Behavioral Rating Scale

Poppen ( Behavior Relaxation Training and Assessment 1988) has developed an observational method of assessing the degree to which individuals show a relaxation response. Although promising, this method, the Behavioral Rating Scale (BRS), has yet to be thoroughly investigated. Subjects in this study were randomly assigned to a progressive relaxation training group or an attention-control group. Following a training period, subjects participated in a laboratory session in which self-report measures of relaxation were obtained, physiological measures were monitored, and behavioral observations were made using the BRS. Results supported the use of the BRS as a valid, observable measure of an individual's relaxation response. Discriminant validity was demonstrated by between-group differences on the BRS and contruct validity was shown by significant correlations between changes on the BRS and changes on self-report and physiological measures. It is argued that, though alternative explanations are feasible, this study's results support the use of the BRS as an effective assessment tool when measuring an individual's response to progressive muscle relaxation.

The Effects of Behaviour Relaxation Training on Adults with Profound Multiple Disabilities: A Preliminary Study on Treatment Effectiveness

This paper investigates the use of behavioural relaxation with subjects who have profound learning disability and concomitant handicaps. Behavioural relaxation training is a simple psychological procedure where subjects are encouraged to adopt a relaxed posture. Ratings of relaxation were taken after each session and subjects were also assessed for the amount of time they spent on task in an occupational activity. Five people participated in the study. Two showed consistent improvements with the procedures, one showed improvement on rated relaxation but no improvement in engaging in the task, and two people showed no response to the treatment. One of the participants who was resistant to relaxation treatment responded readily to a reinforcement procedure and increased his time on task following the introduction of the reinforcement.

The effects of behavioural relaxation on cognitive performance in adults with severe intellectual disabilities

Behavioural relaxation training has been found to be effective in the treatment of generalized anxiety in people with intellectual disability. The present study is designed to assess whether or not these techniques can help individuals in more generalized aspects of their life. Two groups of 10 adults with a severe intellectual disability formed a relaxation group and a control group. The relaxation group were given a course in behavioural relaxation training and the control group were given a quiet reading period for the same amount of time. Each subject was given a digit span test, a test of long-term memory and an incidental learning test after each session. Results suggest behavioural relaxation training has a beneficial effect on performance on tests of short-term memory and incidental learning, but no effect upon long-term memory.

The effects of cue control relaxation on adults with severe mental retardation

This study was designed to assess two aspects of behavioural relaxation training with subjects who have severe mental retardation. The first was whether or not cue words could be linked effectively to training so that they would eventually produce a relaxation effect in the absence of a full relaxation procedure. The second was to determine the effects of relaxation training and subsequent cue control on concentration and attention to an occupational task. Five subjects participated, and individual case designs were used. Cue Control, behavioural relaxation training (BRT), and new therapists were introduced at different times for each subject to ascertain the effects of each variable. Subjects were assessed at baseline and following each training session on a behavioural relaxation scale to judge the direct effects of relaxation training and on the amount of time spent concentrating on an occupational task. BRT produced reductions in rated anxiety and improvements in concentration for all subjects. The cue control words were effective only after they had been linked to BRT. In most cases, the introduction of a new therapist had no appreciable effect on anxiety or concentration. There was some suggestion that in the final cue only phases concentration was better and more consistent than during the BRT phases of the study.

Helping people to relax in over‐stimulating environments

Behavioural relaxation training can be used in a variety of settings. This article describes its usefulness with five highly anxious individuals who attend an adult training centre in Scarborough.

Behavioral Relaxation Training and AssessmentRoger Poppen New York: Pergamon, 1988, 136 pp., hardcover $22.50, soft cover $12.95

Behavioral Relaxation Training and AssessmentRoger Poppen New York: Pergamon, 1988, 136 pp., hardcover $22.50, soft cover $12.95

Book Reviews

Book reviewed in this article: Understanding Mental Retardation. By E. Zigler and R. Hodapp. Peer Relationships in Child Development. Edited by Thomas J. Berndt and Gary W. Ladd. Behavioral Relaxation Training and Assessment. By Roger Poppen. Autism: Nature, Diagnosis and Treatment. Edited by Geraldine Dawson. Homes for Mentally Handicapped People. By N. Raynes, R. Sumpton and M. Flynn. New Parents for Older Children. By Alan Rushton, Judy Treseder and David Quinton. Prader‐Willi Syndrome: Selected Research and Management Issues. Edited by M. L. Caldwell and R. L. Taylor. Preventing Substance Abuse Among Children and Adolescents. By Jean E. Rhodes and Leonard A. Jason. The Psychobiology of Down's Syndrome. Edited by Lynn Nadel. Neuropsychological Assessment in Clinical Child Psychology. By George W. Hynd. Recent Developments in Adolescent Psychiatry. Edited by L. K. G. Hsu and M. Hersen.