HealthpsychRR

The Relaxation Response

Daniel M. Burrello

Any discussion of health psychology must first address the matter of human belief on the organic systems. This necessitates a solid definition of the placebo effect.
Until the advent of the modern age of medicine and its reliance upon the understanding of viral and bacteriological diseases, the techniques of �medicine were primarily such methods as leeching, puking and purging, eunuch fat, and cupping. All medicine was belief based and any healing that did occur was due to the body�s own regenerative capacities and certainly not anything that the �doctors� of that era were doing. In fact, one would have to say that people recovered in spite of any medical interventions of the day.
As Pasteur and Koch made their discoveries and medicine began to rely less and less upon belief, the idea of the placebo came to mean �all in your head.� This derogation of the term does not take into account the fact that many medicines are regularly discounted because their results are a 60% percent effectiveness rate, �not greater than the placebo� This statement says two things. One, that the medical affect is not reliably better than one�s own belief and�the statement that is generally ignored�that the belief system has brought about significant physical change and healing. And so, one must understand the role of belief in healing.
When perusing a cross section of the literature one sees that there are a number of different disorders in which the placebos are 70-90% effective in treatment. The list includes impotence, fatigue, dizziness, weight loss, constipation, cough, postoperative swelling, rheumatoid arthritis, congestive heart failure, pregnant nausea, bronchial asthma, anginopectoris, herpes zoster (cold sores), duodenal ulcers and treatment of almost every form of pain is effective utilizing belief based techniques (Bensen, 1998 p. 6).
Amazingly, even false pregnancy can be brought about due to strong belief. If a woman actually believes that she is pregnant it can bring about symptomatic pregnancy when there is nothing at all there (Bensen, 1998 p. 7).
Even death itself can be affected by belief. Many cases in the voudon (voodoo) religion have been noted. The victim dies due to a ritual performed and the string belief in the power of the ritual and the shamanic figure involved.
According to a study by the late Ned Cassem at Harvard, 100% of patients in the study who believed that they would die on the operating table did (Bensen 1998, p.7).
Often even the opinions and beliefs of the caregivers have an impact on the resulting curative power of a procedure. Angina pectoris, pain in the chest and sometimes radiating pain down a left arm is brought on by exercise, overeating, excessively overworking the cardiac muscle and even emotion. The symptoms are usually alleviated by rest and sometimes nitroglycerine. The diagnoses for this painful condition was first given by William Heberden (Enersen, 2001) in 1774, so there is a long precedent for the diagnosis and for recorded treatment. 200 years of treatment by cobra venom, Vitamin E, xanathines, ridiculous surgical procedures, all of which do not work, but due to physician belief and subsequent patient belief, they had a 70-90% effectiveness rate (Bensen, 1998 p.8).
When scientific medicine and the biomedical paradigm became dominant, the reliance on belief became unnecessary for most diseases. After all, one doesn�t necessarily have to believe in the effectiveness of a tetanus shot to keep lockjaw at bay. Unfortunately, a discounting of the effectiveness of belief as an augmentation to modern medicine has more than likely caused much unneeded suffering and even death.
In this way, the relaxation response is the definitive technique in the field of health psychology. The idea that what we think affects us in physical ways is the very root of the technique.
When Dr. Herbert Bensen, M.D. first coined the term �relaxation response� some thirty years ago, the current belief was still a complete separation, or at least no close relation, between mind and body, between the Eastern and the Western mindset, and between such ideas as spirituality and science. Now, thanks to the efforts of countless therapists and clinician�s work we see a clear connection between both believe and health. (Bensen, 1998 p. 2).
As a cardiologist, Bensen was set on the idea that high blood pressure was caused by the kidneys and balked at the Transcendental Meditation practitioners who asked him to study them. His chief study was in what would now be designated as biofeedback. He was teaching monkeys to lower their blood pressure utilizing operant conditioning. Certain TM practitioners began to ask for him to use them for study regarding the power of the mind to cause change in the body.
He at last relented and the entire field of research opened. Bensen connected the research subjects to intra-arterial lines, electrocardiograms, scalpel electroencephalogram, breath collectors measuring oxygen consumption, metabolism, and CO2 elimination and respiratory rate.
Even the initial findings were remarkable: there was a decrease during the meditative state of the subject�s metabolic rate of between twelve and seventeen percent below resting (Bensen 1998 p. 3). The respiratory rate also dropped twenty-five percent, from sixteen breaths per minute to ten or eleven.
Of course, the technique used in relaxation response therapy are very old indeed and, though we think of Bensen as the originator of the relaxation response research, to be fair, Robert Keith Wallace and Archie Wilson in California were doing the same research at the same time.
Bensen sees the actual mindset of modern methods of medicine as a two legged stool, prone to disturbance and collapse in that it is missing a vital part for balance and effectiveness.
The first leg of the stool is the application of modern pharmaceuticals as both prophylactic and treatment. The second is the used of surgical application and other physical procedures. The third is the patient�s self treatment. Bensen (1998, p. 2) posits that neither of the former methods can be effective without the strong belief in self-healing that we use constantly to augment even the most materialistic of surgical somatic intrusions.
The idea that the mind affects the body is no longer, of course, a matter of debate except in the most environmentalist of arena (as is the rounded shape of the planet in some circles). Countless studies have demonstrated the connection. The novel matter at hand is more the effect that the mind has on the effectiveness of other more traditional treatments and its definite connection to hypertension in Homo sapiens of every stripe.
Human beings, despite any proofs to the contrary continue to be faithful creatures, ready and eager to believe strongly in forces outside the immediate perception which act constantly upon them. This belief can be both extremely harmful and extremely healing depending on the chosen paradigm. Negatively based systems of faith yield negative results. In direct contrast, positive belief systems tend to yield positive results in the physical world. In his study of the benefits of the transcendental meditation movement during the sixties and seventies, Benson (1998, p.3) found that the physical effects of the meditation were a heightened state of relaxation and that relaxation caused a specific number of beneficial physical changes for the practitioners.
Of course, during that time and into the present, the western belief system, still trapped (as it was, and in some places continues to be) in a belief system based primarily on extremely fundamentalist, nearly paranoid, fear-based religio-economic structures, was reticent to embrace a methodology of mental exercise originating in eastern thought and religion. What Bensen did was to strip nearly all religious content from his method of practice without loosing the beneficial techniques. He dubbed this practice the relaxation response.
After all, who could object to a quiet time in one�s life? Christian scripture even illustrates its fathers as having practices a certain degree of meditation, such as Enoch�s meditations �walking with God� in Genesis five (JKV).
�We found exactly the same within Judaism, dating to the time of the second temple. In Christianity, dating almost to the time of Christ, where the instructions were, amongst the desert fathers in the second, third and fourth centuries, focus on your breathing, and on each outbreath, repeat the word Jesus, as you experience love, disregarding other thoughts when they came to mind (Bensen 1998, p.4).�
At first, he and his associates saw the techniques as a four-fold approach but later defined it in two (Battino, 2000, p. 136):
1. Focus on a mantra�like vocalization to bring the mind into the breath.
2. Passive disregard of other thoughts.
A further breakdown of this dual technique, the approach Bensen teaches to his patients, is as follows:
Step 1. Pick a focus word or short phrase that is firmly rooted in ones belief system.
Step 2. Sit quietly in a comfortable position
Step 3. Close the eyes.
Step 4. Relax the muscles.
Step 5. Breathe slowly and naturally, and as one does, repeat the focus word, phrase, or prayer silently to oneself during exhalation
Step 6. Assume a passive attitude. One does not worry about how well one is doing with the technique and when other thoughts intrude, simply repeat to oneself, �Oh well�, and return to the repetition.
Step 7. Continue for ten to twenty minutes.
Step 8. One does not stand immediately. One continues sitting quietly for a minute or so, allowing other thoughts to return. One then opens one�s eyes and sits for another minute before rising.
Step 9. One practices once or twice daily (Battino 2000, p.136).
In Herbert�s version, one pays particular attention to one�s breathing. This is also the method recommended by Suzuki (1970, p.12). Concentration upon breathe is nearly without emotional response and allows the mind to do something rather than wander. During this time, the practice of mantra or voice repetition use utilized. This practice is ancient and certainly Eastern, even though it can also be found in the Lakota sun dance and in the chants of the Gregorian�s.
One could surely spend that time chanting the name of the Christ figure or �Yahweh� if need be, as long as the chanting is without the need of constant conscious demand. The watching of the mind is the main endeavor here. And how does one watch the mind and what does one do when the misbehaving consciousness wanders away? As a gentle parent one simply guides it back without judgment. This act of using passive action without judgment can be a learning experience in itself. And as it is the absolute antithesis of the mind set of the �Type A� personality, (shown to be a solid risk factor in heart related illness) it can be an agent in lowering the blood pressure.
Critics of the relaxation response are often motivated by fear of the Eastern origins of the technique and, as we have seen with our look into the power of belief, some have had negative experiences with relaxation response therapy. This is a difficulty and nearly a catch twenty-two situation. How can one help a client with such a technique, even if it has been individualized to fit their belief system if they are wary of its origins? Perhaps a session of pre-relaxation relaxation is in order. After all, one must be readily trusting and free of paranoid expectation to utilize the method.
Another area of concern is how the therapist can establish the readiness of a client for such a powerful technique, that depends so much on the personal beliefs of the individual. Certainly a session or two of prequalification is in order before beginning the regime and then constant monitoring throughout the course.
As we have seen in the study of the relaxation response in particular, and health psychology in general, what one thinks has great bearing on how one feels and not only that, but it has a great effect on the physical health of the body. Certainly, in any paradigm of treatment, this concept, human belief, must be a consideration for the health and safety of the client and for quick recovery and further growth beyond treatment.

References

Battino, R. (2000) . Guided Imagery and Other Approaches to Healing. Carmarthen, UK: Crown House
Benson, H. (2000) . The Relaxation Response. New York: Harper Torch.
Benson, H. (1998) . Comprehensive Cancer Care: Integrating Complementary & Alternative Therapies/Timeless Healing: The Role of Belief in Cancer Treatment. [Article on the Web site Center for Mind/Body Medicine]. Retrieved July 26, 2004, from the World Wide Web: http://www.cmbm.org/conferences/ccc98/transcripts/benson.html
Enersen, O.D. (2001) . William Heberden [Article on the website whonamedit] . Retrieved August 16, 2004 from the World Wide Web: http://www.whonamedit.com/doctor.cfm/28.html
Suzuki, S. (1970) . Zen mind beginner�s mind. Tokyo: Weatherhill.