The Relaxation Response

When humans face a threat, our bodies respond through the fight or flight response. The body gets ready for action – literally, either ready to fight or ready to run to safety – by bringing extra blood flow to the muscles, raising heart rate and blood pressure, and increasing muscle tension for speed and strength. Like the body’s response to pain, the fight or flight response was intended for rare moments of extreme need to help you survive danger. The body was not meant to be this way all of the time. Most importantly, while these changes are helpful for our survival from a life or death threat, they have consequences to our physical and emotional well-being if they persist for a long period of time. This includes making our pain, fatigue, and stress worse.

One of the most effective tools for managing pain, fatigue, and other symptoms is to learn how to stop or calm the fight or flight response. Ongoing symptoms of pain conditions do not need to be met by this alarm-type response. If we can calm ourselves, we can also calm our nervous system, reduce our stress, and give ourselves a chance to find other ways to cope with our pain, fatigue, and other symptoms.

We calm our system through relaxation strategies. A state of relaxation is the opposite of the “fight or flight response” and changes how you deal, emotionally and physically, with stress. Relaxation is a very effective tool for managing pain and several symptoms that are also experienced by people with chronic pain, including fatigue, problems with sleep, stress, and depressed mood.

Relaxation is helpful for pain because:

□ Tense muscles make pain worse. Your body naturally protects itself by tensing muscles around an area that hurts or that it needs to protect. When your muscles are tense for too long, your pain may increase. Relaxation helps decrease this muscle tension that occurs when feeling pain. □ Relaxation is also a way to counter the well-known negative effects stress has on pain and other physical problems (counteracts the “fight-or-flight” response). □ Relaxation also has a beneficial effect on the areas of the brain that are involved in sensing and reducing pain.

Relaxation can also be helpful for other symptoms because:

□ It is common to feel tense when you feel depressed or anxious. Relaxation helps decrease physical and mental tension that can make depression and anxiety worse. □ Relaxation can help you sleep better. □ Relaxation is a good way to take a break or “time-out” from stressful situations or emotions. It is a helpful activity you can do to take care of yourself. □ People are usually better at planning and problem solving when they feel relaxed compared to when they fell stressed.

Autogenic (10 minutes)

o Focuses on diminishing physiological arousal o Trains the body to relax and calm physiological processes

Deep Breathing Exercise (4-5 minutes):

o Also sometimes called belly breathing. o Focuses on your breathing to help you relax. o One of the easiest and most effective relaxation skills o Allows us to breath more deeply

Guided imagery (6 minutes)

o Uses mental imagery of calm and relaxing places to induce relaxation o Uses all of your senses to produce the most vivid mental image possible so that full distraction from stress can lead to profound relaxation

Body Scans (5-7 minutes)

o Mentally scanning each part of your body, searching for stress/tension and letting it go. o At the end of the scan, the body has been freed of tension.

Mindfulness meditation (2 minutes)

o Focusing ones attention on the here and now o Allowing negative thoughts to flow through and out of one’s mind without evoking stress/upset

Mini progressive muscle relaxation (4 minutes)

o Rapid techniques for achieving the relaxation response. o Often used after mastering other longer techniques o Can be more easily applied in real-world settings outside the home

Importance of Practice

o Practicing relaxation regularly, even when you are feeling well, can have beneficial effects, including reducing the number and severity of painful episodes and building energy. The more you use relaxation, the more benefit from it you’ll discover.

• This skill, like all the skills described in PainGuide, is most helpful when practiced.
• It is best to practice relaxation exercises often. We recommend that you practice a relaxation exercise once a day for 10-30 minutes.
• Even practicing for a couple of minutes a day helps you learn this skill, and using it becomes more and more automatic.
• It’s also best, when you’re learning a new skill, to practice it when your symptoms arenotat their worst.
• Try to find a quiet place to relax. Being in a calm and quiet place makes it easier to relax.
• You can practice relaxation with or without the assistance of guided recordings.
• The more you practice, the more this tool will benefit you and help you when your symptoms are bothersome.
• Track the time you spend practicing on your self-management log. You may also rate your stress level before and after practicing, using a 0-10 rating (0 = not at all stressed to 10 = worst stress/discomfort imaginable)

Overcoming Barriers to Practice

Taking time to relax and to practice relaxation when life is so busy may not make sense to you. But, it’s an important way for you to help manage your pain and stress. Below are some common barriers and challenges people face when learning to control their body’s relaxation response.

I don’t have time to practice

Your ability to relax can improve with regular practice.Try doing it just a few days or nights for a few minutes each week to start.With time, it may become easier for you to relax as you learn how to do it. You may start looking forward to your “relaxation time”

I want to relax, but other people need me

Sometimes, other people need you, leaving you little or no time for yourself.Explain to them that having time for yourself to relax may help reduce your pain, raise your energy level, and ease your stress. To protect this time, you may want to talk with them about how much they can ask of you and when.Making time for yourself may feel selfish at first, but it is important that you make time to take care of you. The PainGuideCommunication modulecan help you find ways to talk to others about this concern.

I’m not sure I’m relaxing the right way

If the approaches discussed here aren’t working for you, there are other books, tapes, and classes that can help you learn more ways to relax.In addition to practicing some form of relaxation most days, a good way to tell if you are being effective is to write down what you are doing. (See the PainGuide Worksheet for Relaxation)

I don’t feel comfortable when I relax

If you are not used to being quiet with yourself, it’s possible you may become anxious or more aware of any bodily discomfort at first instead of feeling calm and rested.This new awareness of your body is normal, especially if you’re used to feeling tense. A small number of people may get very emotional and upset when they try certain relaxation techniques. If this happens to you, feel free to stop the relaxation technique. Talk with your healthcare provider about what you are feeling.

For some people, it is hard to sit or lie still when they are first practicing relaxation.If this is true for you, you might try doing a moving relaxation exercise.This might include doing some gentle stretches and focusing on your breathing or doing deep breathing practice while taking a slow and relaxing walk. As you get more and more comfortable with your relaxation practice, you can incorporate new things, such as being still.

It’s hard making relaxation a priority

In order for the relaxation response to work, you need to practice regularly. If you are having problems practicing, think about the benefits of relaxation for you. But, go easy on yourself.It may take practice to make relaxation a regular part of your life.

A Note for Family and Friends

How you can help:

When people we care about are struggling with their symptoms, it’s normal to want to help them.Helping someone with pain to relax or practice a relaxation technique, even for just a few minutes, may have important health benefits.You may find these techniques helpful for you too!You can support the person with pain by:

· Helping with daily chores and tasks so he or she has more time to take care of herself or himself. · Doing a relaxation exercise together: o Deep breathing o Stretching o Muscle relaxation o Meditation · \*\*Encourage the person you care about to take time to enjoy other calming activities such as:\*\* o Going for a walk o Watching a movie o Playing with a pet o Calling a friend or family member o Listening to music or audio story ·T alk with the person with pain to see if it makes sense to schedule relaxation time on the calendar so that they remember to do it.

Other relaxation resources:

There are many additional resources available to help you find a relaxation practice that works well for you.Consider the following options:

· Meditation or relaxation apps are available for free or for purchase to download to your smartphone or other device. · Check out relaxation resources at your local library. Your library may have relaxation CDs or DVDs in addition to books about relaxation or meditation. · If you work at a desk job, consider installing a simple reminder “pop up” to take a deep breathing break a few times a day. · Community classes, such as beginner yoga classes, can help you learn to expand your relaxation practice to include movements and stretches if you are mostly doing your relaxation while sitting or lying down.