Kevin Leehey, M.D.
Child, Adolescent, and Adult Psychiatry
Board Certified

1980 E. Ft. Lowell Road, Suite 150 | Tucson, Arizona 85719
Phone: (520) 296-4280 | Fax: (520) 296-3835

This newsletter is for your information only and is not a substitute for talking with your psychiatrist, medical doctor, and/or therapist.

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The Relaxation Response

The Relaxation Response (RR) is a combined physiologic (body), mental (mind, psychological, emotional), and even spiritual state of calmness and relaxation we can become more skilled at reaching, with practice, when we want it. The word response is used because we can intentionally recreate this slowed down, comfortable, "present", aware but at ease feeling. The RR was first described by Herbert Benson MD who wrote a popular book titled The Relaxation Response in 1975. RR has been expanded upon by him and many others since then. The basic principle is that the RR is the body and mind's counterpoint or antidote to the damaging effects of too much stress which causes an excess of the fight, flight or freeze responses to real and perceived danger, fear, and overwhelming emotions and situations. Proponets and research indicate that all stress influenced illnesses can be lessened by daily (and as needed) use of the Mind/Body's natural Relaxation Response. Like any skill, we can improve with practice. 
Most often I advise use of RR, as at least a part of the treatment plan, for all forms of Anxiety, but also Depression, mood instability, anger, substance use recovery, personal and interpersonal conflicts, sleep and eating issues, for a healthy coping mechanism, and for personal growth for any of us. Many health conditions may have a stress basis (high blood pressure, irritable bowel, insomnia), component (asthma, certain rashes, headaches, fibromyalgia), or cause extra stress directly or indirectly to the patient or loved ones (cancer, dementia, strokes, severe infections, heart disease). The RR may help a lot or at least partly. A RR routine combined with better sleep, nutrition, and exercise habits can go a long way toward better health and mental health.

A key theme of this article is that there are many ways to learn and use the RR and they all work similarly. Chances are that at least one technique below will work for you even if others do not work for you or seem too alternative or too Eastern or mystical or "weird" or outside your experience or religious perspective. Try any one or several of these methods, they go together well, and all get you to the same relaxation response. Google RR or any of these methods below for more information, how to, and even videos. Any of these 8 methods below done ten to 30 minutes once or twice a day can be helpful.

Meditation may be the most studied and proven technique for RR. There are many ways to meditate. Some are tied to Eastern religions like Buddhism though many are secular. Some focus on a sound, word, Mantra, thought or breathing as a method to learn to disengage and redirect thoughts, to simply refocus your awareness on the chosen object of attention each time you notice your mind wandering. Rather than pursuing random thoughts, you simply let them go. Mindfulness meditation techniques encourage the practitioner to notice (but not focus upon) or observe wandering thoughts as they drift through the mind. The intention is not to get involved with the thoughts or to judge them, but simply to be aware of each as it arises and to watch them come in and pass out of awareness. Through mindfulness meditation, you can see how your thoughts and feelings tend to move in particular patterns. Over time, you can become more aware of the human tendency to quickly judge experience as "good" or "bad" (pleasant or unpleasant). With practice, an inner balance develops. Practice of mindfulness and other meditation techniques can include learning Quiet Mind and Being In The Now (Be Here Now). Meditation can also be active such as "walking meditation", even gardening, doing art, running, swimming laps, etc.

Yoga includes a philosophy, physical practices, meditation, and positions (asanas), and has its roots in various schools, disciplines, and Indian religious and spiritual traditions that seek to transform body and mind. Our focus here is on the modern western growth of practicing yoga to improve health and overall well being - wellness. This includes, stretching, exercise, tone, balance, fitness, breathing, and can include meditation and generally encourages healthier living that benefits health and mental health.

Breathing techniques or exercises promoting the RR come in many forms and levels. I quote first from WebMD and then from which explains the basic and important Abdominal Breathing Technique:

"Deep breathing is one of the best ways to lower stress in the body. This is because when you breathe deeply, it sends a message to your brain to calm down and relax. The brain then sends this message to your body. Those things that happen when you are stressed, such as increased heart rate, fast breathing, and high blood pressure, all decrease as you breathe deeply to relax. You can do different breathing exercises to see which work best for you."
"Breathing exercises such as this one should be done twice a day or whenever you find your mind dwelling on upsetting thoughts or when you are experiencing pain. Place one hand on your chest and the other on your abdomen. When you take a deep breath in, the hand on the abdomen should rise higher than the one on the chest. This ensures that the diaphragm is pulling air into the bases of the lungs. After exhaling through the mouth, take a slow deep breath in through your nose imagining that you are sucking in all the air in the room and hold it for a count of 7 (or as long as you are able, not exceeding 7). Slowly exhale through your mouth for a count of 8. As all the air is released with relaxation, gently contract your abdominal muscles to completely evacuate the remaining air from the lungs. It is important to remember that we deepen respirations not by inhaling more air but through completely exhaling it. Repeat the cycle four more times for a total of 5 deep breaths and try to breathe at a rate of one breath every 10 seconds (or 6 breaths per minute). In general, exhalation should be twice as long as inhalation. The use of the hands on the chest and abdomen are only needed to help you train your breathing. Once you feel comfortable with your ability to breathe into the abdomen, they are no longer needed. Abdominal breathing is just one of many breathing exercises. The more it is practiced, the more natural it will become.

Guided Imagery employs a calm voice or video to guide you to imagining your own special relaxing, calm, comfortable, often beautiful and peaceful place to be - to go there in your mind. It could be a hammock on the beach with a gentle breeze and soft waves lapping the shore and the gentle smell of hibiscus. Or the scent of lavender with the soft light of Provence and ..... Well, you get the idea. With practice you can go there anytime, anyplace, all on your own.

Self-Hypnosis often uses elements of guided imagery, focused concentration, and/or progressive muscle relaxation to reach the RR and may include focus on a goal. Many free examples exist on line. One example follows : "Fix your gaze on a top corner of the room. Do not move your head in order to do so but just raise your eyes and keep them there and stare fixedly at the corner. Take deep breaths in through your mouth, pause at each in-breath, and then let them out through your nose. That's right. All the way out. Then just concentrate on your breathing while you just relax. You don't have to close your eyes now although you might feel you wish to do so. Feel your feet on the ground and your chair supporting the weight of your body as you just relax. Let the sounds around you drift off into the distance as you close your eyes. Concentrate on your breathing and, in your mind's eye, see yourself relaxing in your special favorite place. Perhaps you can imagine strolling in the fields on a warm summer's day, and you can feel the gentle breeze on your cheeks. Or it may be that you are on a beach and you can hear the water lapping the shore. Whatever it is, make it your very own special place that you can return to in this way whenever you want. Tell yourself that this is the feeling you wish to keep while you continue to work or study, that sounds around you are of no concern and they can just drift away while you concentrate on your particular task. When you have completed this short exercise, not only will you feel more relaxed and less troubled by the noises around you, you will also be able to concentrate and work more efficiently than you were able to before."

Progressive Muscle Relaxation can be done listening to a calm peaceful voice, sound, or music in person, online, or in your mind directing you to begin by laying or sitting comfortably, quietly, and mentally envisioning and relaxing first the muscles and joints of your toes, then forefoot, then ball of your foot, arch, heel, ..... and so on toward the top of your head. Although clearly this can help sleep onset, for our purpose here in the daytime the point is the RR calm experience.

Contemplative Prayer is described in similar but differing ways by different faiths. For our purpose in providing a way toward the RR, I quote first from the Catechism: "The Christian tradition comprises three major expressions of the life of prayer: vocal prayer, meditation, and contemplative prayer. They have in common the recollection of the heart. Meditation engages thought, imagination, emotion, and desire. This mobilization of faculties is necessary in order to deepen our convictions of faith, prompt the conversion of our heart, and strengthen our will to follow Christ. Christian prayer tries above all to meditate on the mysteries of Christ, as in the rosary. This form of prayerful reflection is of great value, but Christian prayer should go further: to the knowledge of the love of the Lord Jesus, to union with him." "St. Teresa answers: 'Contemplative prayer in my opinion is nothing else than a close sharing between friends; it means taking time frequently to be alone with Him who we know loves us.' "In this inner prayer we can still meditate, but our attention is fixed on the Lord himself." And briefly from another Christian source, "One must clear the mind of outside concerns so that God's voice may more easily be heard." Please feel free to explore this from your perspective.

Biofeedback uses instruments that measure our body's physiologic functions to give us information and awareness so that we can learn to influence or better control these functions and thereby our body and mind. A simple example is using a sensor on a fingertip to detect local finger temperature. Relaxing will lower and stressing will raise the temperature. Similar techniques can influence heart rate, breathing rate, and blood pressure. Neurofeedback uses measured brain waves via an EEG linked to a computer to show in various ways our brain state such as alert, relaxed, attentive, agitated etc. We can learn to adjust these states while connected and then to re-create the experience, such as the RR, at will.

Massage, Accupuncture, Acupressure, Tai Chi and other techniques can also assist in learning the Relaxation Response. The key points of this Medical Memo are that learning and using the RR is not difficult, there are many ways to get there, and that by using the method that fits and works best for you, you can, at least help, treat Anxiety and more, even much more for some.


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