Relaxation technique

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Relaxation technique
ICD-9-CM 94.33

A relaxation technique (also known as relaxation training) is any method, process, procedure, or activity that helps a person to relax; attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, stress or anger. Relaxation techniques are often employed as one element of a wider stress management program and can decrease muscle tension, lower blood pressure, and slow heart and breath rates, among other health benefits. [1]

Contents

Relaxation therapy, the application of relaxation techniques, can be applied in various settings to complement treatment for stress, anxiety, depression, and pain. It addresses both psychological and physiological effects of stress such as increased heart rate, sweating, and muscle tension. [2] There are many variations of relaxation techniques, including progressive muscle relaxation, autogenic training, guided imagery, biofeedback-assisted relaxation, and other techniques. [3] [4] [5] [6]

Thus, relaxation techniques are useful for either emotional pain caused by stress, anger, anxiety, and mood of depression, or chronic pain caused by strains, single-side muscle use, awkward position, restriction of movement in certain areas of the spine, improper form during physical activity, and stressful posture. [7] Multiple relaxation techniques share a fundamental principle to decrease muscle tension and lower physical or mental pain. [7]

Relaxation techniques are generally safe for healthy individuals. [8] Occasional instances exist where individuals have reported negative experiences after receiving relaxation techniques. [9]

Background

Current and past researchers have explored the relationship between physical and mental disorders through various methods and investigated the effects of relaxation techniques. The subsequent literature review presents a brief and succinct overview of the latest research discoveries, providing a background for the understanding of relaxation techniques.

Claude Bernard, a scientist in 1865, observed that maintaining a constant internal environment, our internal milieu, when facing changes in external environment and conditions is critical for life and well-being. [10]

Additionally, chronic stressors can have negative consequences, and they are especially prevalent in humans, potentially due to their high cognitive ability, which may cause ongoing stress responses to various adverse life and work circumstances. [11] The connection between psychosocial stressors and chronic illness is intricate and influenced by various factors, such as the type, quantity, and duration of stressors, along with an individual's biological susceptibility (like genetics and inherent characteristics) and their learned ways of coping. [11]

Previous studies have indicated that relaxation techniques, including but not limited to deep breathing, guided imagery, meditation, and progressive muscle relaxation, are effective ways to reduce stress, indicating that relaxation techniques are effective in promoting relaxation both physically and psychologically. [12]

Research released in the 1980s indicated stronger ties between stress and health and showed benefits from a wider range of relaxation techniques than had been previously known. This research received national media attention, including a New York Times article in 1986. [13]

A more recent study found that participants who practiced progressive muscle relaxation, deep breathing, and guided imagery experienced a statistically significant increase in relaxation compared to the control group. [14] While there was no significant difference in relaxation levels before training, all intervention groups demonstrated significantly higher levels of relaxation after training compared to the control group. [14] Additionally, there was a linear association between progressive muscle relaxation & guided imagery and physiological relaxation, while the deep breathing group initially showed increased physiological arousal before quickly returning to baseline levels. [14] These findings support existing research findings on the effectiveness of relaxation techniques, which can effectively enhance relaxation states both psychologically and physiologically.

Uses

People use relaxation techniques for the following reasons, among others:[ medical citation needed ]

Thus, relaxation techniques are used and designed to help individuals reduce tension and anxiety, both physically and psychologically, by inducing the body's "relaxation response," characterized by a slower respiratory rate, reduced blood pressure, and a slower heart rate. [15] The main techniques are progressive muscle relaxation, autogenic training, guided imagery, and biofeedback-assisted relaxation.

Techniques

Progressive muscle relaxation (PMR)

Progressive muscle relaxation (PMR) is one of the most important and easy-to-learn relaxation techniques developed by Dr. Edmund Jacobson in the 1920s, setting the foundation for the development of relaxation techniques. [16] It involves the effective and repetitive relaxation of 14 different muscle groups and has been used to treat anxiety, tension headaches, migraines, TMJ, neck pain, insomnia, bipolar disorder, anxiety, backaches, high blood pressure, etc. [17] PMR is a two-step practice that involves creating tension in specific muscle groups and then releasing it to build awareness of the sensations of tension and deep relaxation. [18] It is recommended to repeat the process several times and to practice regularly to induce physical muscular relaxation at the first signs of stress.

After the initial practice of PMR, several muscle groups may still require additional tensing and relaxation to achieve maximum effects. Decreasing the degree of muscle tension is typically recommended by Dr. Edmund to “train” the body for immediate and continuous response. [17]

The following steps are recommended to perform effective PMR. [16]

  1. First, to practice PMR, find a comfortable place where you will not be disturbed for 10-15 minutes.
  2. Begin by focusing on each muscle group and tensing them for five seconds while breathing in, then releasing and relaxing the muscle while noticing the feeling of relaxation.
  3. Repeat this process for each muscle group while gradually reducing the amount of tension used to deepen the sense of relaxation.
  4. Transition to the next muscle group once you feel relaxed in the current one.
  5. It is recommended to start at one part of the body and move systematically, and to not hold your breath or tense muscles that cause discomfort.

Guided imagery

Guided imagery (GI) is a well-established technique for reducing stress and anxiety. It involves replacing distressing memories with positive mental imagery through a process of sensory engagement and behavioral and physiological responses. [4] The technique is guided by an instructor or audio recording that directs participants to imagine a peaceful or pleasant setting, often involving rich sensory experiences such as sounds, smells, and visual details. [19]

By actively engaging the senses and focusing on specific contextual details, guided imagery enables individuals to generate vivid and realistic mental images that create a strong sense of presence and immersion in the imagined scenario, which helps to divert attention away from negative thoughts and feelings, and fosters a sense of relaxation and tranquility. [20] When used in combination with progressive muscle relaxation (PMR), the PMR-GI approach is a highly effective method for managing the symptoms of nausea and vomiting, as well as improving patients' overall mental well-being. [21]

Nature-based vs traditional GI

Studies have identified several connections between exposure to natural environments and health outcomes. [22] [23] Specifically, there is compelling evidence linking nature exposure to enhancements in cognitive function, brain activity, blood pressure, mental health, physical activity, and sleep. [24] However, it may not always be feasible to alleviate anxiety symptoms by spending time in natural settings, depending on the situation and context. [25] Studies have demonstrated that incorporating nature-based GI interventions can overcome the barriers of limited access to natural environments and enhance the effectiveness of GI interventions. [25] Nature-based GI techniques have been shown to be highly effective in managing anxiety, while also offering the advantages of being affordable and highly accessible, providing a great alternative to traditional GI. [25]

Biofeedback is a technique that enables individuals to make subtle changes in their body, such as the relaxation of muscles, which can help alleviate pain and decrease tension. [26] With the aid of an electronic device that provides feedback and real-time information on changes in heart rate, blood pressure, or muscle tension, individuals can learn to monitor their level of relaxation and recognize and regulate their body's response to stress. [26] Biofeedback-related relaxation techniques are found by researchers to decrease test anxiety in nursing students, significantly reduce average blood glucose, A1C, muscle tension, and lower hypertension. [27] [28] [29]

Other techniques

Various techniques are used by individuals to improve their state of relaxation. Some of the methods are performed alone; some require the help of another person (often a trained professional); some involve movement, some focus on stillness; while other methods involve different elements.

Certain relaxation techniques known as "formal and passive relaxation exercises" are generally performed while sitting or lying quietly, with minimal movement, and involve "a degree of withdrawal". [6] These include:

Movement-based relaxation methods incorporate exercises such as walking, gardening, yoga, tai chi, qigong, and more. Some forms of bodywork are helpful in promoting a state of increased relaxation. Examples include massage, acupuncture, the Feldenkrais Method, myotherapy, reflexology and self-regulation.[ medical citation needed ]

Some relaxation methods can also be used during other activities, for example, autosuggestion and prayer. At least one study has suggested that listening to certain types of music, particularly new-age music and classical music, can increase feelings associated with relaxation, such as peacefulness and a sense of ease. [30]

A technique growing in popularity is flotation therapy, which is the use of a float tank in which a solution of Epsom salt is kept at skin temperature to provide effortless floating. Research in USA and Sweden has demonstrated a powerful and profound relaxation after twenty minutes. In some cases, floating may reduce pain and stress and has been shown to release endorphins.

Even actions as simple as a walk in the park have been shown to aid feelings of relaxation, regardless of the initial reason for the visit. [31]

A new relaxation technique course, developed specifically for medical students in universities, was found to be effective in reducing anxiety, burnout, and depression, leading to significant improvements in academic performance and evaluated parameters. [32] Introducing this particular course is important because the prevalence of stress-related mental disorders in medical students is significantly higher than in the general public. [32]

Side effects

Relaxation techniques are generally deemed safe for healthy individuals, with most research studies reporting no adverse side effects. [33] However, there have been occasional instances where individuals have reported negative experiences such as heightened anxiety, intrusive thoughts, or fear of losing control. [34]

In particular, some relaxation techniques may not be suitable for individuals with certain medical or psychiatric conditions. [35] In rare cases, these techniques may even exacerbate existing symptoms. For instance, there have been reports that certain relaxation methods can trigger or worsen symptoms in individuals with epilepsy, psychiatric disorders, or a history of abuse or trauma. [36]

See also

Related Research Articles

<span class="mw-page-title-main">Panic attack</span> Sudden periods of intense fear

Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, otherwise defined as a rapid, irregular heartbeat, sweating, chest pain or discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a sense of impending doom or loss of control. Typically, these symptoms are the worst within ten minutes of onset and can last for roughly 30 minutes, though they can vary anywhere from seconds to hours. While they can be extremely distressing, panic attacks themselves are not physically dangerous.

Stress management consists of a wide spectrum of techniques and psychotherapies aimed at controlling a person's level of psychological stress, especially chronic stress, generally for the purpose of improving the function of everyday life. Stress produces numerous physical and mental symptoms which vary according to each individual's situational factors. These can include a decline in physical health, such as headaches, chest pain, fatigue, sleep problems, and depression. The process of stress management is a key factor that can lead to a happy and successful life in modern society. Stress management provides numerous ways to manage anxiety and maintain overall well-being.

<span class="mw-page-title-main">Biofeedback</span> Gaining awareness of biological processes

Biofeedback is the technique of gaining greater awareness of many physiological functions of one's own body by using electronic or other instruments, and with a goal of being able to manipulate the body's systems at will. Humans conduct biofeedback naturally all the time, at varied levels of consciousness and intentionality. Biofeedback and the biofeedback loop can also be thought of as self-regulation. Some of the processes that can be controlled include brainwaves, muscle tone, skin conductance, heart rate and pain perception.

Autogenic training is a relaxation technique first published by the German psychiatrist Johannes Heinrich Schultz in 1932. The technique involves repetitions of a set of visualisations accompanied by vocal suggestions that induce a state of relaxation and is based on passive concentration of bodily perceptions like heaviness and warmth of limbs, which are facilitated by self-suggestions. Autogenic training is used to alleviate many stress-induced psychosomatic disorders.

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Self-healing refers to the process of recovery, motivated by and directed by the patient, guided often only by instinct. Such a process encounters mixed fortunes due to its amateur nature, although self-motivation is a major asset. The value of self-healing lies in its ability to be tailored to the unique experience and requirements of the individual. The process can be helped and accelerated with introspection techniques such as Meditation.

Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioral therapy and applied behavior analysis. When used in applied behavior analysis, it is based on radical behaviorism as it incorporates counterconditioning principles. These include meditation and breathing. From the cognitive psychology perspective, cognitions and feelings precede behavior, so it initially uses cognitive restructuring.

<span class="mw-page-title-main">Breathwork (New Age)</span> Term used in alternative medicine

Breathwork is a term for various breathing practices in which the conscious control of breathing is said to influence a person's mental, emotional, or physical state, with a therapeutic effect.

Progressive muscle relaxation (PMR) is a method of deep muscle relaxation that does not involve any medications, meaning it is a non-pharmacological intervention. The idea behind progressive muscle relaxation is that there is a relationship between a person's mind and body. The body responds to its environment by creating certain mind or body states such as anxiety, stress, and fear. When the body is in these states, the muscles tense up. Progressive muscle relaxation aims to reverse these body states back to more neutral, relaxed states.

Desensitization is a psychology term related to the treatment or process that diminishes emotional responsiveness to a negative or aversive stimulus after repeated exposure. This process typically occurs when an emotional response (feeling) is repeatedly triggered, but the action tendency associated with the emotion proves irrelevant or unnecessary.

Chronic headache, or chronic daily headache (CDH), is classified as experiencing fifteen or more days with a headache per month. It is estimated that chronic headaches affect "4% to 5% of the general population". Chronic headaches consist of different sub-groups, primarily categorized as chronic tension-type headaches and chronic migraine headaches. The treatments for chronic headache are vast and varied. Medicinal and non-medicinal methods exist to help patients cope with chronic headache, because chronic headaches cannot be cured. Whether pharmacological or not, treatment plans are often created on an individual basis. Multiple sources recommend multimodal treatment, which is a combination of medicinal and non-medicinal remedies. Some treatments are controversial and are still being tested for effectiveness. Suggested treatments for chronic headaches include medication, physical therapy, acupuncture, relaxation training, and biofeedback. In addition, dietary alteration and behavioral therapy or psychological therapy are other possible treatments for chronic headaches.

Sport psychology is defined as the study of the psychological basis, processes, and effects of sport. Sport is defined as any physical activity where the individuals engage for competition and health. Sport psychology is recognized as an interdisciplinary science that draws on knowledge from many related fields including biomechanics, physiology, kinesiology and psychology. It involves the study of how psychological factors affect performance and how participation in sport and exercise affect psychological, social, and physical factors. Sport psychologists teach cognitive and behavioral strategies to athletes in order to improve their experience and performance in sports.

<span class="mw-page-title-main">Relaxation (psychology)</span> Emotional state of low tension and an absence of arousal

In psychology, relaxation is the emotional state of low tension, in which there is an absence of arousal, particularly from negative sources such as anger, anxiety, or fear.

<span class="mw-page-title-main">Psychological stress</span> Feeling of strain and pressure

In psychology, stress is a feeling of emotional strain and pressure. Stress is a form of psychological and mental discomfort. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the environment. Excessive amounts of stress, however, can increase the risk of strokes, heart attacks, ulcers, and mental illnesses such as depression and also aggravate pre-existing conditions.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Audio therapy is the clinical use of recorded sound, music, or spoken words, or a combination thereof, recorded on a physical medium such as a compact disc (CD), or a digital file, including those formatted as MP3, which patients or participants play on a suitable device, and to which they listen with intent to experience a subsequent beneficial physiological, psychological, or social effect.

Pain psychology is the study of psychological and behavioral processes in chronic pain. Pain psychology involves the implementation of treatments for chronic pain. Pain psychology can also be regarded as a branch of medical psychology, as many conditions associated with chronic pain have significant medical outcomes. Untreated pain or ineffective treatment of pain can result in symptoms of anxiety and depression, thus it is vital that appropriate pain management occur in a timely fashion following symptom onset.

Cancer phobia, also known as carcinophobia, is a common phobia and an anxiety disorder characterized by the chronic fear of developing cancer. It can manifest in tremendous feelings of sadness, fear, panic, and distress. In some cases, the phobia can be so extreme that it prevents the individual from living a normal life.

Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.

<span class="mw-page-title-main">Science of yoga</span> Scientific basis of modern yoga as exercise

The science of yoga is the scientific basis of modern yoga as physical exercise in human sciences such as anatomy, physiology, and psychology. Yoga's effects are to some extent shared with other forms of exercise, though it differs in the amount of stretching involved, and because of its frequent use of long holds and relaxation, in its ability to reduce stress. Yoga is here treated separately from meditation, which has effects of its own, though yoga and meditation are combined in some schools of yoga.

References

  1. Goleman, Daniel (May 13, 1986). "Relaxation: Surprising benefits detected". The New York Times . Retrieved May 23, 2006.
  2. Norelli, Samantha K.; Long, Ashley; Krepps, Jeffrey M. (2023), "Relaxation Techniques", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30020610 , retrieved 2023-04-15
  3. Toussaint, Loren; Nguyen, Quang Anh; Roettger, Claire; Dixon, Kiara; Offenbächer, Martin; Kohls, Niko; Hirsch, Jameson; Sirois, Fuschia (2021-07-02). Taylor-Piliae, Ruth (ed.). "Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation". Evidence-Based Complementary and Alternative Medicine. 2021: 1–8. doi: 10.1155/2021/5924040 . ISSN   1741-4288. PMC   8272667 . PMID   34306146.
  4. 1 2 Naparstek, Belleruth (2008). Staying Well with Guided Imagery. Grand Central Publishing. ISBN   978-1-59995-636-7. OCLC   1034613276.
  5. "Biofeedback - Mayo Clinic". www.mayoclinic.org. Retrieved 2023-04-15.
  6. 1 2 Smith, Jonathan C. (2007). "Ch. 3: The Psychology of Relaxation". In Lehrer, Paul M.; Woolfolk, Robert L.; Sime, Wesley E. (eds.). Principles and Practice of Stress Management (3rd ed.). Guilford Press. p.  38. ISBN   9781606238288.
  7. 1 2 Irnich, Christine (2013). "Relaxation techniques". Myofascial Trigger Points. pp. 245–252. doi:10.1016/b978-0-7020-4312-3.00024-6. ISBN   9780702043123.
  8. Chou, Roger; Deyo, Richard; Friedly, Janna; Skelly, Andrea; Hashimoto, Robin; Weimer, Melissa; Fu, Rochelle; Dana, Tracy; Kraegel, Paul; Griffin, Jessica; Grusing, Sara; Brodt, Erika D. (2017). "Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline". Annals of Internal Medicine. 166 (7): 493–505. doi: 10.7326/M16-2459 . PMID   28192793. S2CID   20451068.
  9. "Relaxation Techniques for Health". NCCIH. Retrieved 2023-04-15.
  10. Bernard C. An Introduction to the Study of Experimental Medicine. Transl. HC Greene. New York: Collier; 18651961.
  11. 1 2 Schneiderman, Neil; Ironson, Gail; Siegel, Scott D. (2005). "Stress and Health: Psychological, Behavioral, and Biological Determinants". Annual Review of Clinical Psychology. 1: 607–628. doi:10.1146/annurev.clinpsy.1.102803.144141. PMC   2568977 . PMID   17716101.
  12. Lehrer P. M., Woolfolk R. L. Principles and Practice of Stress Management. New York, NY, USA: Guilford Press; 2021.
  13. Goleman, Daniel (May 13, 1986). "Relaxation: Surprising benefits detected". The New York Times . Retrieved May 23, 2006.
  14. 1 2 3 Toussaint, Loren; Nguyen, Quang Anh; Roettger, Claire; Dixon, Kiara; Offenbächer, Martin; Kohls, Niko; Hirsch, Jameson; Sirois, Fuschia (2021). "Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation". Evidence-Based Complementary and Alternative Medicine. 2021: 1–8. doi: 10.1155/2021/5924040 . PMC   8272667 . PMID   34306146.
  15. "Relaxation Techniques for Health". NCCIH. Retrieved 2023-04-15.
  16. 1 2 Toussaint, Loren; Nguyen, Quang Anh; Roettger, Claire; Dixon, Kiara; Offenbächer, Martin; Kohls, Niko; Hirsch, Jameson; Sirois, Fuschia (2021-07-02). Taylor-Piliae, Ruth (ed.). "Effectiveness of Progressive Muscle Relaxation, Deep Breathing, and Guided Imagery in Promoting Psychological and Physiological States of Relaxation". Evidence-Based Complementary and Alternative Medicine. 2021: 1–8. doi: 10.1155/2021/5924040 . ISSN   1741-4288. PMC   8272667 . PMID   34306146.
  17. 1 2 Jacobson, Edmund (1974). Progressive relaxation; a physiological and clinical investigation of muscular states and their significance in psychology and medical practice. University of Chicago Press. OCLC   1330616184.
  18. "VA.gov | Veterans Affairs". www.va.gov. Retrieved 2023-04-15.
  19. "Guided Imagery/Guided Mental Imagery", Encyclopedia of Pain, Berlin, Heidelberg: Springer Berlin Heidelberg, 2007, p. 835, doi:10.1007/978-3-540-29805-2_1687, ISBN   978-3-540-43957-8 , retrieved 2023-04-15
  20. Rees, Barbara L. (1995). "Effect of Relaxation with Guided Imagery on Anxiety, Depression, and Self-Esteem in Primiparas". Journal of Holistic Nursing. 13 (3): 255–267. doi:10.1177/089801019501300307. PMID   7650352. S2CID   29229003.
  21. Kapogiannis, August; Tsoli, Sofia; Chrousos, George (2018-03-01). "Investigating the Effects of the Progressive Muscle Relaxation-Guided Imagery Combination on Patients with Cancer Receiving Chemotherapy Treatment: A Systematic Review of Randomized Controlled Trials". Explore. 14 (2): 137–143. doi:10.1016/j.explore.2017.10.008. ISSN   1550-8307. PMID   29506956. S2CID   4923110.
  22. Kaplan, Stephen (September 1995). "The restorative benefits of nature: Toward an integrative framework". Journal of Environmental Psychology. 15 (3): 169–182. doi:10.1016/0272-4944(95)90001-2. S2CID   4993000.
  23. Ulrich, Roger S.; Simons, Robert F.; Losito, Barbara D.; Fiorito, Evelyn; Miles, Mark A.; Zelson, Michael (September 1991). "Stress recovery during exposure to natural and urban environments". Journal of Environmental Psychology. 11 (3): 201–230. doi:10.1016/S0272-4944(05)80184-7.
  24. Jimenez, Marcia P.; DeVille, Nicole V.; Elliott, Elise G.; Schiff, Jessica E.; Wilt, Grete E.; Hart, Jaime E.; James, Peter (2021-04-30). "Associations between Nature Exposure and Health: A Review of the Evidence". International Journal of Environmental Research and Public Health. 18 (9): 4790. doi: 10.3390/ijerph18094790 . ISSN   1660-4601. PMC   8125471 . PMID   33946197.
  25. 1 2 3 Nguyen, Jessica; Brymer, Eric (2018-10-02). "Nature-Based Guided Imagery as an Intervention for State Anxiety". Frontiers in Psychology. 9: 1858. doi: 10.3389/fpsyg.2018.01858 . ISSN   1664-1078. PMC   6176042 . PMID   30333777.
  26. 1 2 "Biofeedback - Mayo Clinic". www.mayoclinic.org. Retrieved 2023-04-15.
  27. Prato, Catherine A.; Yucha, Carolyn B. (March 2013). "Biofeedback-Assisted Relaxation Training to Decrease Test Anxiety in Nursing Students". Nursing Education Perspectives. 34 (2): 76–81. doi:10.5480/1536-5026-34.2.76. ISSN   1536-5026. PMID   23763019. S2CID   35253272.
  28. doi : 10.2337/diacare.28.9.2145
  29. doi : 10.1097/00005082-200505000-00012
  30. Smith, Jonathan C. (2007). "Ch. 3: The Psychology of Relaxation". In Lehrer, Paul M.; Woolfolk, Robert L.; Sime, Wesley E. (eds.). Principles and Practice of Stress Management (3rd ed.). Guilford Press. pp.  46–7. ISBN   9781606238288.
  31. Irvine, KN; Warber, SL; Devine-Wright, P; Gaston, K (2013). "Understanding urban green space as a health resource: A qualitative comparison of visit motivation and derived effects among park users in Sheffield, UK". International Journal of Environmental Research and Public Health. 10 (1): 417–42. doi: 10.3390/ijerph10010417 . PMC   3564151 . PMID   23340602.
  32. 1 2 Wild, Katharina; Scholz, Michael; Ropohl, Axel; Bräuer, Lars; Paulsen, Friedrich; Burger, Pascal H. M. (2014-12-17). "Strategies against Burnout and Anxiety in Medical Education – Implementation and Evaluation of a New Course on Relaxation Techniques (Relacs) for Medical Students". PLOS ONE. 9 (12): e114967. Bibcode:2014PLoSO...9k4967W. doi: 10.1371/journal.pone.0114967 . ISSN   1932-6203. PMC   4269409 . PMID   25517399.
  33. Chou, Roger; Deyo, Richard; Friedly, Janna; Skelly, Andrea; Hashimoto, Robin; Weimer, Melissa; Fu, Rochelle; Dana, Tracy; Kraegel, Paul; Griffin, Jessica; Grusing, Sara; Brodt, Erika D. (2017). "Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline". Annals of Internal Medicine. 166 (7): 493–505. doi: 10.7326/M16-2459 . PMID   28192793. S2CID   20451068.
  34. Goessl, V. C.; Curtiss, J. E.; Hofmann, S. G. (2017). "The effect of heart rate variability biofeedback training on stress and anxiety: A meta-analysis". Psychological Medicine. 47 (15): 2578–2586. doi:10.1017/S0033291717001003. PMID   28478782. S2CID   4710497.
  35. Hopper, Susan I.; Murray, Sherrie L.; Ferrara, Lucille R.; Singleton, Joanne K. (2019). "Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults". JBI Database of Systematic Reviews and Implementation Reports. 17 (9): 1855–1876. doi: 10.11124/JBISRIR-2017-003848 . PMID   31436595. S2CID   201275251.
  36. "Relaxation Techniques for Health". NCCIH. Retrieved 2023-04-15.