The Relaxation Response

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The term, “Relaxation Response” was coined by Dr. Herbert Benson, professor, author, cardiologist, and founder of Harvard’s Mind/Body Medical Institute. The response is defined as your personal ability to encourage your body to release chemicals and brain signals that make your muscles and organs slow down and increase blood flow to the brain. In his book "The Relaxation Response", Dr. Benson describes the scientific benefits of relaxation, explaining that regular practice of the Relaxation Response can be an effective treatment for a wide range of stress-related disorders.

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The Relaxation Response is essentially the opposite reaction to the “fight-or-flight” response and is beneficial as it counteracts the physiological effects of stress. It is characterized by the following:

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• decreased metabolism, heart rate, blood pressure, and rate of breathing;

• a decrease or “calming” in brain activity;

• an increase in attention and decision-making functions of the brain;

• changes in gene activity that are the opposite of those associated with stress.

• increase in the body’s output of nitric oxide – a molecule associated with good health, including antibacterial and antiviral responses and also beneficial changes in the cardiovascular system—can be induced by the relaxation response.

 

Currently, chronic stress is a major source of illness. We tend to activate the fight-or-flight response multiple times during a typical day, usually because of situations that are annoying and stressful, but not life threatening. These include traffic jams, long lines in the grocery store, and deadlines. But all those surging stress hormones can take a toll on the body. Over time, such low-grade chronic stress can lead to high blood pressure, increased heart rate, and muscle tension.  Over 75% of Americans who responded to an online survey said that their stress levels are so high that they feel unhealthy (American Psychological Association, 2010), on top of that we have the stress from COVID-19 and the current health and economic crisis. So Dr. Benson’s research seems highly relevant.

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“Modern medicine currently relies on two major therapeutic approaches: medication and procedures such as surgery. Until recently, little emphasis has been given to mind-body approaches. But as scientific evidence continues to establish the significance of mind-body interactions, a third major approach to medical treatment should evolve: one characterized by self-care through mastery of mind-body interactions. The Relaxation Response should prove an important element of this very promising approach.

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We believe that mind-body science has now reached a stage where it should be accepted as the third major treatment and prevention option, standing as an equal alongside drugs and surgery in the clinical medical pantheon.” Dr. Herbert Benson, “The Relaxation Revolution”

 

According to Dr. Benson, learning to elicit the Relaxation Response is a great skill that can help us deal with life's unexpected stressors, heal ourselves, and achieve better health. Practicing just once or twice daily can be enough to counteract the stress response and bring about deep relaxation and inner peace.

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There are many methods to activate the Relaxation Response including visualization, progressive muscle relaxation, acupuncture, massage, breathing techniques, prayer, meditation, tai chi, yoga/stretching, and self-care routines such as skincare and aromatherapy. Medical professionals rarely have time for long meditations or organized activities. For this reason, we focus on products and practices that can be done at home or on the go. Especially effective are practices that are part of an established routine.

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THE BENSON-HENRY PROTOCOL (more detailed instructions are provided at the end)

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PHASE ONE: Relaxation Response Trigger

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Step 1: Pick a focus word, phrase, image, or short prayer. Or focus only on your breathing during the exercise.

Step 2: Find a quiet place and sit calmly in a comfortable position.

Step 3: Close your eyes.

Step 4: Progressively relax all your muscles.

Step 5: Breathe slowly and naturally. As you exhale, repeat or picture silently your focus word or phrase, or simply focus on your breathing rhythm.

Step 6: Assume a passive attitude. When other thoughts intrude, simply think, “Oh well,” and return to your focus.

Step 7: Continue with this exercise for an average of 12 to 15 minutes (don’t use an alarm but rather place a clock near you and monitor it).

Step 8: Practice this technique at least once daily.

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The best time to practice the Relaxation Response is first thing in the morning for 10-20 minutes. It should be practiced daily for at least eight weeks. According to Dr. Benson, “establishing a daily routine is essential for your improvement.”

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PHASE TWO: Visualization

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For eight to ten uninterrupted minutes you should remember a state of perfect wellness you experienced and enjoyed in the past. This technique is called “remembered wellness” and it activates the mechanism underlying the placebo effect. In essence, this process of remembering prior wellness through visualization techniques serves to counter remembered illness. Sometimes pain has been with us so long and had exerted such a powerful, negative influence that our nerves, brain synapses, and even our genetic responses have been programmed to produce pain. The mind-body healing treatment is designed to reverse that process, so that we could become re-hardwired to have more controllable and less severe pain or discomfort.

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This technique is borrowed from Cognitive Behavioral Theory and is another name for Restructuring. In essence, you will restructure your thinking processes to expect good health rather than bad. This way you will in effect condition your mind to expect health and decondition your mind to expect illness.

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BENEFITS

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Scientific studies show that this method can be effective for the following conditions:

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• Angina Pectoris

• Anxiety

• Depression

• Hypertension (high blood pressure)

• Infertility

• Insomnia

• Menopausal, perimenopausal, and breast cancer hot flashes

• Nausea

• Pain—general Pain—variations (backpain, headache, etc)

• Parkinson’s disease

• Phobias

• Premature aging

• Premature ventricular contractions (extra or skipped                                                                          heartbeats) and palpitations (heart pounding)

• Premenstrual syndrome (PMS)

 

(In his book “Relaxation Revolution: The Science and Genetics

of Mind Body Healing”, Dr. Benson provides detailed instructions

how to use mind-body healing for each of these conditions as well

as a plethora of scientific studies supporting the effectiveness of

the treatments.

I CAN SEND YOU THESE INSTRUCTIONS UPON REQUEST).

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Investigations employing this two-phase method have demonstrated

the same healthful physiologic changes elicited by Transcendental

Meditation (the most studied type of meditation).

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In addition to these diseases and symptoms, clinical and research evidence mounts that mind-body approaches can be effective in treating many other complaints. These include allergic skin reactions, bronchial asthma, congestive heart failure, constipation, cough, diabetes mellitus, dizziness, drowsiness, duodenal ulcers, fatigue, herpes simplex (cold sores), hostility and anger, immune problems, impotency, obesity, postoperative swelling, and post-traumatic stress disorder (PTSD).

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In fact, any condition that is caused or exacerbated by stress can be helped by a well-designed mind body approach. Furthermore, because all health conditions have some stress component, it is no overstatement to say that virtually every single health problem and disease can be improved with a mind-body approach.

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Research at Harvard, published in July 2008 in the peer-reviewed online journal of the Public Library of Science, PLoS ONE, shows conclusively that the mind can indeed influence the body down to the genetic level. Its key implication is that we can consciously “switch on” healthful genetic expression. We may not be able to change our genes per se, but you can use your mind to change your genetic activity. More specifically, gene signatures that were switched on or off by the relaxation response were associated through past research with clear health benefits. As indicated earlier, these benefits included more healthful regulation of the immune system, lower psychosocial stress levels, less destructive oxidative stress, and a reduced tendency toward premature aging. Also, the gene activity we observed is associated with healthful gene activity that is the opposite of that found in many cardiovascular diseases and other conditions.

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Another study revealed that the participants who were experienced in eliciting the relaxation response through meditation had thicker regions of the brain’s cortex in those decision-making regions associated with attention and also sensory, cognitive, and emotional processing. The greater cortical thickness in the older participants’ brains suggests that meditation might offset age-related cortical thinning.

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THE NATURAL HEALING CYCLE

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Healing can result from the natural, self-restorative powers of

the body, the vis medicatrix naturae identified by the ancient

Greek physician Hippocrates. Current research suggests that

the speed of this natural recovery could be impeded or hastened

by the state of the patient’s mind. If the patient is under emotional

stress, believes that recovery is unlikely, or is otherwise in the

grip of negative emotions, healing can be delayed or blocked.

In contrast, if the patient enjoys a calm and positive mental state,

natural recovery might take place more quickly.

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“With the wave of new research, we have moved beyond the idea of regarding relaxation response techniques as “unconventional.” The current scientific support requires that they be accepted as mainstream, along with pharmaceuticals and surgery.”  Dr. Herbert Benson

 

EXPECTATION AND BELIEF – THE PLACEBO EFFECT

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The power of expectation—the kind of expectation that embraces a deep belief that what is expected will actually occur—has long been recognized as a significant mental and emotional force. But is there any scientific foundation for placing expectation and belief on such a high pedestal? More specifically and personally, just how powerful can your personal beliefs and expectations be in the healing process?

Hundreds of investigations, involving a wide variety of diseases and health problems, have demonstrated the power of the human mind over disease. In these studies, the design includes a control group (no treatment), a placebo group (receiving mock treatment), and an intervention group (receiving medical treatment). In many of them, the placebo/belief worked as well as the drug/surgery.

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“Just as an antibiotic drug may stop an infection or surgery may eliminate a malignancy, so the mind—your mind—has the capacity to treat or even cure many of your serious physical and emotional complaints.” Dr. Herbert Benson

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Despite the existence of ample and convincing research, many people still have reservations about mind-body medicine due to cultural conditioning and mainstream beliefs. To banish your doubts and gain access to mind-body healing, you may have to change some of your basic assumptions about medical treatment.

Reductionism refers to the tendency to try to explain or reduce complex life processes to simplistic, mechanical, or very limited components. Medical reductionism involves a basic assumption that only certain specific physical treatments will be effective in responding to illnesses. Like most patients and physicians these days, you may be trapped in a restricted, reductionistic mindset that says, “A real cure for a serious illness is possible only through drugs, surgery, or some other physical procedure. Any suggested treatment apart from these physical responses is ‘unscientific’ and will probably be ineffective.”

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One of the reasons for the prejudice against mind-body medicine comes from the confounding of expectations/beliefs and spiritual beliefs concerning a higher power. This is unfortunate because the two are completely separate. Psychologists, for example (my field of specialization), have long ago accepted the power of expectations and beliefs and routinely adopt them in their study designs. Beliefs are part of our cognitive apparatus and they play enormous role in goal setting, choice, and performance. For example, self-efficacy, a term coined by the famous Stanford psychologist Albert Bandura, and indicating how strongly we believe in our success on a task, is more predictive for performance than actual ability/competence. This finding, along with a ton of similar results from medical experiments, shows that what we expect/belief can be more powerful than “objective” external factors.

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Another reason for the skepticism regarding the placebo effect is the wave of new-age “alternative” practices that often use the concept of belief in an unscientific way, as in “the law of attraction” and “energy healing” (based on an unsubstantiated belief that such things exist and really work). It is important to separate the wheat from the chaff, rather than just to lump all belief-related therapies and discard them altogether. As in any other field, there are practices based on good science, and those based on bad science or quackery.

So let’s see what good science has to say about this phenomenon:

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The mind body research in this area may encompass one or more of these belief-related phenomena:

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• a belief of the patient that a particular treatment can work;

• a belief of the healer/physician that a particular treatment can work;

• a trusting relationship between the patient and the healer—a belief in each other; 

• a sense of expectancy—or a highly positive, future-oriented mindset—that a particular approach to healing will improve or cure a particular disease or symptom.

 

As these expectation-belief factors come into play in the mind and emotions, healthful

physiologic changes occur in the body, all the way down to the molecular level.

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HOW DOES PLACEBO WORK: THE MECHANISM

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Pain

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The most abundant research findings on expectations/beliefs come from the field of pain management. Scientist from Emory University, Columbia University, the University of Maryland, and the University of Michigan confirmed that  the placebo effect—with an emphasis on belief and expectation of pain relief— operates in the body through the release of natural opioid mechanisms,

which alleviate pain. These mechanisms include an increase in the concentration of neurotransmitters (endorphins) in chronic pain patients who were able to avail  themselves of the power of belief and expectation in pain relief.

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These researchers concluded that “verbally induced expectation plays a crucial  role in each of these experimental conditions, even after the pharmacological  preconditioning with ketorolac.”

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Depression

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A number of researchers have recognized that depression could be alleviated in up to 50 percent of patients not just by the common remedy, drugs, but by the expectation and belief associated with the placebo effect.

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A mechanism that contributes to this power of the placebo in depression involves the release of the neurotransmitter serotonin, which must be present in sufficient quantities in the body to ward off depressive states. Researchers have determined through sophisticated brain research technology that when the placebo effect results in recovery from depression, specific changes occur in the brain in frontal and cingulate cortical activity.

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Furthermore, the impact of the placebo on depression is not a short-lived phenomenon. A 2008 review article in the Journal of Psychiatric Research showed that, in eight placebo-controlled antidepressant trials involving 3,063 depressed patients, 79 percent receiving the placebo experienced a lessening of their depressive symptoms and suffered no relapse while undergoing more than 12 weeks of placebo treatment.

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Angina

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A review of interventions for angina pectoris that were initially thought to be effective but later were debunked, made the stunning finding that the inert substances or surgeries—which patients and also physician-researchers truly believed would alleviate pain—typically reduced pain in 70 to 90 percent of patients when they were first applied. But when other physician-researchers began to question or disbelieve the efficacy of the treatments, the effectiveness rate decreased to 30 to 40 percent. The review revealed that the expectation-belief placebo effect was present in an average of 82.4 percent of the patients with angina.

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Parkinson’s Disease

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In the classic Fuente-Fernandez study (2004), patients who receive a placebo pill produced the substance delivered by the actual medication. In some instances, the placebo worked better than the actual medication. Later studies and review articles have confirmed that when a researcher verbally induces expectations in a test subject that motor movement in Parkinson’s disease will improve, the motor movement actually does improve. It seems that belief alone can make the body produce dopamine (what PD patients are missing).

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SUMMARY

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Altogether, results suggest that some patients respond better to mind body interventions than others who would benefit more from medications. One conclusion is that mind-body interventions work best in conjunction with traditional approaches relying on drugs/surgery/therapy.

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PHASE 1: EIGHT STEPS RELAXATION RESPONSE PROTOCOL IN DETAILS

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Step 1: Pick a focus word, phrase, image, or short prayer for your relaxation response session. Or choose just to focus on your breathing. Any word or phrase with neutral or positive connotations—such as one or peace—will be fine for this purpose. Just remember that if you choose only one word, you should draw it out during your entire exhaled breath as you silently repeat it. If possible, the word, phrase, or prayer you select should be emotionally soothing and should conform to your deepest beliefs or worldview. For example, a Christian might pick Lord Jesus; a Jew, Echod; a Hindu or Buddhist, Om; or a Muslim, Insha’Allah. There is a twofold reason for these criteria: First, it is easier to form and reinforce a positive habit if you are repeating words that you believe in. Second, expectation or belief that a technique will work in our mind and body is more likely to cause that technique to work.

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Step 2: Find a quiet place where you are unlikely to be interrupted, and sit calmly in a comfortable position.

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Step 3: Close your eyes.

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Step 4: Progressively relax all your muscles, beginning with your toes and feet and moving up through your entire body, shoulders, and face. Spend a minute or two with this relaxation exercise.

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Step 5: Breathe slowly and naturally. As you exhale, repeat silently your focus word, phrase, or prayer, or picture the image you have chosen. Or focus on your breathing rhythm, if you have chosen a breath focus for this exercise.

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Step 6: Assume a passive attitude throughout the session. Don’t worry about how you are doing; you can be sure that just by following these eight steps, you are changing your physiology from a stress response to the relaxation response. When other thoughts come to your mind—as they are sure to do—simply think, “Oh well,” and turn away from the distraction and back to your focus word, phrase, prayer, or breathing. Do not become concerned if you notice that your particular health symptoms, such as a headache or other pain, briefly intensify during your first few sessions. This reaction is normal, because as your mind becomes more sensitized and focused, your aches and pains may naturally come to the fore.

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Step 7: Continue with this exercise for 12 to 15 minutes. The average time for most beginning patients to achieve the maximum health benefits from this Phase One treatment is within this range. After a patient has practiced this procedure for several weeks, the health benefits can often be achieved more quickly, though we still recommend that patients keep 12 to 15 minutes as their treatment goal for each session.

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Step 8: Practice this technique at least once daily, preferably in the morning before breakfast or in the afternoon or early evening just before dinner. Make a commitment to this daily practice for at least 30 consecutive days, which is approximately the time necessary for a new habit to be established.

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If you are observing the basic guidelines for eliciting the relaxation response, you can rest assured, in light of the extensive scientific studies, that the technique is working—no matter how you may feel on a day-to-day basis.

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It is important not to overthink or evaluate the process since this can create anxiety. I like the analogy of brushing teeth. Most of us are concerned to one extent or another with dental hygiene, but we don’t dwell on the tooth-cleaning process. We just work away with that brush every day. Almost no one evaluates the brushing, to say, “That was a good brush!” or, “Too bad—that was a bad brush.” We simply do it!

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In addition to the immediate benefits, such as increased calm or reduced pain, you can experience positive long-term effects such as increased mental capacity, more effective decision-making and better memory. Studies have demonstrated that the repetitive mental technique for eliciting the relaxation response can cause beneficial changes in the attention and executive control parts of the subjects’ brains.

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PHASE 2: VISUALIZATION

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Experiencing Phase One on a regular basis—that is, simply evoking the relaxation response daily—will often lead to significant healing without any further action. But you will increase your chances for maximum healing by adding Phase Two—the visualization phase—to your mind-body medicine kit.

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In Phase Two, you will continue to intensify your Phase One relaxation response experience by focusing on calming, soothing memories or other mental imagery. Typically, these memories and images will be linked to your belief system.

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Procedure

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Sit quietly with your eyes closed and picture what it was like to be free of the disease or symptom that you are experiencing. If your problem is back pain, for instance, you might remember yourself as a younger person, moving, walking, twisting your upper body, or jogging easily, with no discomfort. This mental exercise will help you remember and even relive a state of wellness that you enjoyed in the past.

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If you can’t recall a time when you were symptom free, just visualize what you think or imagine it would be like to move about without the pain. Or if you have trouble forming mental images, focus on your body right now, in your present circumstances. Imagine you are standing up and then moving easily and smoothly to the other side of the room, or climbing up and down a nearby flight of stairs, or performing some other physical act—but without any pain or discomfort.

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Picture yourself engaging in any physical act that you would like to be able to do without pain or other symptoms. You might see yourself throwing a ball, swinging a tennis racket, gardening, playing some pickup basketball, or kicking a soccer ball with a child or grandchild. Your choice of mental picture should be personal; select an activity that you enjoy doing but have found you can’t do because of your symptoms. The main idea in Phase Two is to identify your particular symptom or disease, but then to see yourself completely healed of that symptom or disease.

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Hold these dynamic inner images in your mind for 8 to 10 minutes and play with them in your imagination. Construct a kind of mental motion picture where you are the healthy central character.

After the 8-to-10-minute period, continue to sit quietly for about a minute with your eyes closed, but this time, allow “regular” thoughts to reenter your mind. Then open your eyes and continue sitting quietly for about another minute. Finally, return to your normal activities.

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Here is a video of Dr. Benson teaching the Relaxation response https://www.youtube.com/watch?v=nBCsFuoFRp8

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Here is an article listing several techniques for activating the Relaxation response. Use the guided practice offered for free https://www.helpguide.org/articles/stress/relaxation-techniques-for-stress-relief.htm

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