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Make time for nothing.

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Today's world is becoming increasingly busy and stressful. Doing something relaxing has been shown as the most effective strategy for managing the effects of stress on both the body and mind.

"There is more to Life than increasing its speed"--Mohandas (Mahatma) K. Gandhi.

Despite growing evidence that stress is one of the major contributors to ill health and pathology, little emphasis is given to implementing relaxation into our lifestyles. Indeed, the opposite seems evident --lifestyles are busier, faster and people are working longer hours. This results in fewer hours in the day to unwind and let go of tension.

United Kingdom (UK) researcher Gardner Merchant calls this "hurry sickness", ie "a behaviour pattern characterised by continual rushing and anxiousness; an overwhelming and continual sense of urgency." (1) Founder of the Roosevelt University Stress Institute Jonathan Smith states: "We're psychologically addicted to the idea that success equals busyness, and most people today live with high levels of stress hormones in their bodies, so even when they relax, they feel anxious." (2)

Although statistics show health care has come far in finding ways to keep people out of hospital, chronic diseases are continuing to increase worldwide. (3) And evidence on the relationship between stress and disease is alarming. (4) The majority of health promotion projects focus on weight-loss programmes, smoking cessation and alcohol consumption, yet stress has been identified as one of the most common precursors to addictive disorders. (5) The 2012 Australian Psychological Association survey found one in five Australians experienced severe stress that was having a major impact on their mental and physical health. Forty per cent of participants found the inability to maintain a balanced, healthy lifestyle a major source of stress. The most effective strategy for managing stress was reported to be doing something relaxing. (6)

Although there is some research into the use of relaxation methods for medical disorders, there is very little literature related to relaxation as a health promotion intervention. Pharmaceutical companies create drugs that produce the relaxation response in the form of anxiolytics, antihypertensives and other medications that work specifically to produce parasympathetic stimulating effects.

It is impossible to eliminate all of life's stressors. However, relaxation techniques can go a long way to counteracting the damaging effects of stress. By using these techniques, the body's parasympathetic nervous system is stimulated and people may respond better to stressful situations.

Ancient wisdom

Throughout the ages, different cultures have developed their own ways of relaxing. The ancient Egyptians attended festivals and banquets, accompanied by sensual and erotic activities and varying forms of music. They spent hours pampering their bodies with oils and herbal mineral treatments. (7)

Yoga and meditation have been part of Indian Hindu culture for thousands of years. These ancient practices travelled to the West during the 1960s and 70s and are now widely practised around the world. (8)

In Japan, women have attended Onsen hot springs, believed to have rejuvenating healing powers, for hundreds of years. (9) The Japanese also founded reiki or "chi", a healing modality practice that balances vital energy to remove stress and stimulate relaxation. (10) The Chinese have been using acupressure for stress relief for over 4000 years. (11)

Chi gong and tai chi--slow moving martial arts that help direct the mind and produce relaxation--are other Chinese practices. (12) Chinese Buddhist monks routinely meditate to quieten their minds. Native American Indians used totem meditations and drumming to relax, transcend the material world and obtain divine wisdom. (13) Relaxing with nature is part of a healing lifestyle in Hawaii. (14) Brazilians spend much of the day relaxing--"vadiar" as they call it. This has become part of the cultural norm. (15)

American physician Edmund Jacobson was one of the first to explore the effects of relaxation methods in Western medicine. In the early 1920s, he found exercises such as deep breathing and repetitive sound mantras resulted in deep relaxation in the body. (16) Founder of Harvard's Mind/Body Medical Institute Herbert Benson described this effect as the "relaxation response", ie the direct opposite of the "fight or flight" stress response. The relaxation response can be evoked using various relaxation techniques, such as autogenics, progressive muscle relaxation and meditation. (17)

Research behind the theory

There has been much research into the effect of relaxation on the body and mind systems. In a 2007 review of psychological stress, American psychologist Shelton Cohen said: "Despite having supporting evidence and a widespread public belief that psychological stress leads to disease, the biomedical community remains [sceptical] of this conclusion." (18)

Many studies report that conditions like asthma, non-insulin-dependent diabetes, insomnia, arthritis and other common ailments, some exacerbated by psychosomatic symptoms, benefit from traditional relaxation methods. (19,20,21,22) Evidence obtained from three different systematic reviews shows mindfulness-based stress reduction has a significant effect on chronic disease, (23) back pain (24) and quality of life. (25)

It is estimated 100 million Americans suffer from chronic pain. (26) Two systematic reviews found relaxation techniques showed some success in reducing chronic pain. (27,28) Relaxation techniques have also been shown to have some effectiveness with cardiovascular conditions. When a cardiac rehabilitation programme was combined with relaxation response training, participants experienced significant reductions in blood pressure, decreases in lipid levels, and increases in psychological functioning when compared to participants' status before the programme. (29) A 2008 Cochrane Review looking at 25 clinical randomised trials concluded that relaxation techniques reduced blood pressure in the trial subjects by a small amount (average 5/3mmHg). (30) Another trial in 2007 showed Iyengar yoga increased cardiac parasympathetic nervous modulation among healthy yoga practitioners. (31)

Emotional stress has been known to precipitate or exacerbate both acute and chronic asthma. Various studies show that yoga techniques and relaxation breathing exercises seem beneficial, in addition to the medical management of asthma. (32,33,34) Most recently, studies are now starting to show the positive effects the relaxation response has on the immune system and cellular processes such as mitochondrial resilience. (35,36)

Much research points to the use of relaxation techniques in mental health. (37) A meta-analysis of 27 studies showed relaxation to have a medium to large effect in the treatment of anxiety. (38,39) Some studies have shown the advantages of relaxation techniques to assist with phobias, panic disorders (40) and anger management. (41) Studies are also being conducted at Harvard University on the effects of prayer and healing based on prayer in terms of evoking the relaxation response. (42)

A meta-analytic review of research articles on music to decrease arousal due to stress was conducted on 22 quantitative studies. Results demonstrated that music alone and music-assisted relaxation techniques significantly decreased arousal. (43) Creating fun activities certainly allows for relaxation and rest. Following an immediate short increase in heart rate, the act of laughing results in a period of relaxation with corresponding deceases in blood pressure, pulse and respiration rate. (44,45) There are also many studies on the positive effects of meditation and yoga on quality of Life. (46,47,48)

Over the past 20 years, the National Institute of Health in the United States has granted more than US$24 million to study the effects of transcendental meditation on cardiovascular disease. (49) Renowned establishments such as the American Medical Association and the American Psychological Association have been involved in studies. (50) International organisations such as the American Institute of Stress and the International Stress Management Association (UK) are pushing for more publicity and research into stress management.

Using relaxation techniques

Traditionally, pharmaceuticals have been used as the first port of call for anxiety and depression-related stress and very little emphasis has been placed on behavioural and psychological methods of management. Benson states: "We must keep in mind the absolute need for the surgical and the pharmaceutical, but with 60 per cent of doctor visits stress-related, we have to take behavioural health very seriously." (51)

Many complementary and alternative medicine practitioners already advocate for the use of relaxation techniques and incorporate them into their models of care. However, GPs and practice nurses are the first point of contact for most patients. It would seem appropriate, then, for these health professionals to be the ones to discuss relaxation techniques with patients, as part of an holistic wellness programme.

Often people are unaware of the dangers of stress and how healthy lifestyle practices can help manage stress. Health professionals can recommend relaxation groups or services, and supply the information to clients. The Relaxation and Stress Reduction Workbook is an excellent resource, containing exercises and techniques health professionals can share with their clients. (52) Education is pivotal and often health professionals, likewise, require a degree of training and education before disseminating information to patients.

Relaxation therapies can also be practised as lifestyle interventions that maintain good health and mental wellness. These simple techniques are easy to learn and apply, affordable and highly effective. All techniques can be practised individually or as part of a programme. All one needs to do is select a technique/method that is enjoyable and tailored to one's own needs. Relaxation techniques can be used in addition to treatment already authorised by a medical professional.

To measure the outcomes/success of any intervention, health professionals could use tools such as Cohen's Perceived Stress Scale, the Holmes-Rahe Life Stress Inventory, Quality of Life Inventory or Depression and Anxiety Stress Scales (DASS).

There is more scope for research in this area, as many articles point to the lack of strength in clinical trials due to inconsistencies, poor research design and lack of funding. (53,54) Unfortunately, many relaxation techniques have been labelled as too Eastern medicine-based, "spiritual" or "hocus pocus". Health professionals and the community need to change their attitudes as the research continues to strengthen. Often healthy living messages are portrayed through the media, community health promotion events and at a local level through health care professionals. There will need to be a transformation in a way that persuades and encourages people to consider the long-term rewards of relaxation, including the ease of practice.

Conclusion

People are constantly seeking new methods to manage their health and the increasing pace of their lives. Relaxation methods already in use for thousands of years provide a mechanism that can counteract the effects of stress on both the body and mind. Health professionals are in a powerful position to consider these techniques for their patients, in conjunction with more conventional practice methods. There is scope to educate health professionals further so they can confidently recommend techniques to clients and provide resources or contacts for these services. On a national level, encouraging relaxation practices through health promotion campaigns could have a significant impact on the rates of stress-related illness. However, a substantial attitude change towards relaxation therapies, including more funding for research and education, would be needed to enable this to happen.

"When we relax our bodies deeply, and accompany that with deep relaxation of the mind, we return to a state of deep, physiological rest. Deep physiological balance. And in that balance, the body is ideally poised to heal itself. Our biochemistry in balance, our physiology in balance, all our natural healing mechanisms in balance. Switched on, balanced, active and potent. Natural healing arising out of deep physiological rest"--Australian author and cancer survivor Ian Gawler. (55) *

* References for this article can be found at www.nzno.org.nz/kai_tiaki/reference.

Natasha Old, RN, BN, AdDip Mind/Body Med, Cert IV Kinesiology, is a clinical nurse specialist at Tweed Hospital, New South Wales, Australia.
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Title Annotation:viewpoint; managing stress
Author:Old, Natasha
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Jun 1, 2014
Words:1921
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