Mitchell's Simple Physiological Relaxation and Jacobson's Progressive Relaxation Techniques: A comparison

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RESEARCH REPORT

M i tc he1 I ’s S i m ple Physiological Relaxat ion and Jacobson’s Progressive Relaxation Techniques: A comparison

Victoria L Salt Kathleen M Kerr

Key Words Relaxation, blood pressure, breathing, heart rate

Summary This study aimed to compare the short-term physiological effects of Mitchell’s simple physiological relaxation and Jacobson’s progressive relaxation.

Twenty-four normotensive subjects, 14 men and ten women, participated in the six-week study. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), respiratory rate (RR) and heart rate (HR) were monitored by conventional methods. Each subject underwent a baseline period to ascertain pre-study parameter values, following which subjects were randomly assigned to three groups. Each group received two 25-minute sessions of each of the relaxation techniques, and two sessions of the control condition of 25 minutes supine lying. The sequence of intervention differed among the three groups. Physiological parameter measurements were taken immediately before and after intervention.

Following intervention with simple physiological relaxation, there were significant reductions in SBP and HR (both p < 0.001), and DBP and RR (both p < 0.01); following intervention with progressive relaxation, there were significant reductions in SBP, DBP and HR (all p < 0.01), and RR (p < 0.001). There were no significant differences between the two interventions. Following the control condition of supine lying, there were significant reductions in HR (p < 0.05) and RR (p < 0.001) only. Both relaxation techniques reduced SBP to a significantly greater extent than supine lying (p < 0.05), and progressive relaxation reduced RR to a significantly greater extent than supine lying (p < 0.05). The order in which the intervention was received had no confounding effect on the results. Recommendations are made for further research.

Introduction ‘Of increasing concern to contemporary society is the impact of stress on the health and subsequent life of modern-day people’ (Peddicord, 1991). The rising interest is reflected in the media, and in the increasing amount of research into particular strategies for promoting stress reduction, namely relaxation techniques.

Stress is an adaptation response to environ- mental agents or stimuli recognised as ‘stres~ors~, resulting in the ‘fight-or-flight’ (ergotropic) response. The body’s initial reaction to a stressor is a complex of reactions initiated by the hypo- thalamic stimulation of the sympathetic division

of the autonomic nervous system and the adrenal medulla (Tortora and Agnostakos, 1990). The heart rate and strength of cardiac muscle contraction increase, as does the level of vasoconstriction, thereby increasing cardiac output and blood pressure. In response to an increased demand for oxygen, the respiratory rate is elevated and the airways widen to accommodate more air. In today’s society, the body often undergoes these ergotropic responses in inappropriate situations where it is unable to discharge stress: frustration, pain, jealousy and anger can all act as triggers in both social and professional environments. Continued arousal results in stress-related diseases (Mitchell, 1997).

Selye (1974) investigated the physiological mechanism of adaptation to stress. From his studies on long-term over-stressed animals, he established a stress index that comprised some major pathological results of over-stress, including enlargement of the adrenal cortex, atrophy of lymphatic tissues, and bleeding ulcers. He has further applied this to humans, and defined certain pathological consequences of long-term stress as ‘diseases of adaptation’. Stomach ulcers, cardiovascular disease, hypertension, connective tissue disease and headaches were all classified as such.

Mason (1985, cited Hertling and Jones, 1990) suggested that emotional stimuli, being the most common stressors, produce changes in the endocrine, autonomic, and musculoskeletal systems. Although all systems are exposed equally to stress, it is believed that the weakest area is most vulnerable to diseases of adaptation.

Sternbach (1986) described a mechanism following the onset of stress-related disorders and resultant failure in the homoeostatic mechanism, thereby preventing the body from returning to a baseline level of function. Frequent stressful stimuli may, for example, lead to mild hypertension. This results in adaptation, with the system readjusting to the elevated level. Similarly, Brown (1977, cited Hertling and Jones, 1990) suggested that the musculoskeletal system undergoes similar adaptation. With continued stress, muscle tension becomes sustained a t higher levels,

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suggesting that the regulatory mechanism controlling muscle tone becomes inefficient.

Hess (1978, cited Hertling and Jones, 1990), produced changes associated with the fight-or- flight response by stimulating part of a cat’s brain within the hypothalamus. By stimulating another area within the hypothalamus, he demonstrated trophotropic responses opposite to the fight-or- flight response, which Benson (1972) named the ‘relaxation response’. The physiological changes that resulted included decreases in oxygen consumption, heart rate and respiratory rate, and allowed vasodilation t o occur, consistent with generalised parasympathetic nervous system activity. Therefore, it appeared that relaxation may decrease or eliminate many of the physiological behaviours indicative of stress (Peddicord, 1991).

In 1989, the Consumers’ Association quoted that 7% of middle-aged adults in the United Kingdom suffered from mild hypertension - a sustained diastolic pressure between 90 and 104 mm Hg, placing them therefore at increased risk of cardiovascular disease, myocardial infarct and stroke, to name but a few consequences. However, in mild hypertension the risk is relatively low, and the unwanted effects of pharmacological treatment may outweight the benefit (Patel, 1973). Several other treatments may have beneficial effects and also encourage patient autonomy. Education has a primary role, and advice regarding weight, smoking, alcohol consumption, salt intake and exercise are essential. Psychological methods, including relaxation training and behavioural therapy must also be considered; research into this area has found relaxation to be of benefit, and as a result, such techniques are not only used as preventive medicine, but have also been incorporated into the majority of cardiac rehabilitation programmes within hospitals in the United Kingdom (Harvey, 1994). However, there still appears to be a necessity for further research within the field, in order t o provide patients with the optimum programme.

The current emphasis on health care is on autonomy, in which individuals make informed decisions about their management and take responsibility for their own health care (Doughty, 1991; Mulcahy, 1991, cited Webber and Prior, 1993). Numerous relaxation techniques are capable of evoking the relaxation response, and might potentially be incorporated into self- management programmes.

There has been a recent revival of ancient Asian disciplines such as yoga, tai chi and Zen awareness. Western modifications include Yogi’s

transcendental meditation, and the Alexander technique which readjusts body alignment by increasing awareness of posture and positioning. Jacobson’s progressive relaxation and Mitchell’s simple physiological relaxation are two methods commonly used by physiotherapists, and form the focus of the present study.

Jacobson’s progressive relaxation, the most popular approach in the US (Hertling and Jones, 1990) is based on muscular quiescence and involves alternate tensing and relaxing of skeletal, facial and respiratory muscles, which is used to induce physical and mental relaxation. The technique demands a systematic sequence of isometric contractions, followed by relaxation, which progresses slowly throughout the body. Progression occurs only when relaxation of one part of the body has been achieved. Mitchell’s simple physiological relaxation, used extensively in the UK, is based on the group action of muscles in eliminating muscle tension (McKenna, 1978). Patients are instructed to contract muscles antag- onistic to the tense muscle groups, subsequently to ‘stop’ contracting them, and then to register the change in position of the body part. Reciprocal relaxation is achieved in the tense muscles by contraction of the antagonists, a phenomenon which is controlled by the central nervous system.

Research into the area of relaxation has substantiated many of the early claims of its essential role within society (Jacobson, 1939; Benson, 1972; Patel, 1973; Seer and Raeburn, 1979; Agras et al, 1980; Van Montfrans et al, 1990). However, there appears to be no evidence of research into the effectiveness of Mitchell’s simple physiological relaxation, even though it is widely used in physiotherapy practice.

This study aims to investigate the effectiveness of Mitchell’s simple physiological relaxation, . and to compare it with a previously validated technique, namely Jacobson’s progressive relaxation (Renfroe, 1988; Bindemann et al , 1991; Puskarich et al, 1992; Gift et al, 1992). The parameters selected for investigation were systolic and diastolic blood pressure, heart rate and respiration rate, which previous research has suggested have the potential for change through the relaxation response (Benson, 1972; Hess, 1978, cited Hertling and Jones, 1990; Peddicord, 1991).

Method Twenty-four normotensive subjects underwent sessions of Mitchell’s physiological relaxation, Jacobson’s progressive relaxation and the control condition of supine lying, to determine the effects of these conditions on blood pressure, heart rate and respiratory rate.

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Subjects Ten women and fourteen men, with a mean age of 32 years, participated in the study.

General information regarding lifestyles, diet, exercise tolerance, and perceived stress levels was obtained from a short questionnaire. All subjects worked at managerial level in the same company; their ages ranged from 25 to 45 years.

Exclusion criteria included established diagnosis of hypertension or hypotension; family history of diabetes, renal failure, stroke, myocardial infarct, cardiovascular disease and angina pectoris; present medical treatment; and previous relaxation training.

Subjects weie aware of the nature of the study, but not of the expected outcomes.

Procedure All subjects attended three sessions during the week before intervention, during which resting baseline measures of blood pressure, heart rate and respiratory rate were taken. Subjects were asked to eat a light breakfast at least two hours before measurement, and not to participate in exercise immediately before data collection, for the duration of the study.

Measurements of blood pressure, heart rate and respiratory rate were taken during baseline data collection, prior to each experimental condition intervention, and following each intervention. After collection of baseline data, subjects were randomly assigned to one of three groups, each of which underwent the three experimental conditions in different sequence. Group A: Mitchell’s relaxation; control supine lying; Jacobson’s relaxation. Group 3: Control supine lying; Jacobson’s relaxation; Mitchell’s relaxation. Group C: Jacobson’s relaxation; Mitchell’s relaxation; control supine lying.

Each group received two 25-minute sessions of each intervention protocol, as it has been shown that sizeable effects can be seen after only two treatment sessions (Agras et al , 1980). Following the completion of two sessions of intervention in one week, a one-week rest period was imple- mented, to minimise any carry-over effect from one type of intervention to another. This ensured that each set of data collected was the result of a single intervention, over the six-week study period.

For the experimental procedure, and while measurements were taken, subjects lay supine on a carpeted floor, with legs uncrossed, and head and neck supported by a single pillow. To

minimise variability, the same location was used for the duration of the study, and all measurements were taken by the same person (Bali, 1979). Data were collected at the same time each day, and in the same order of blood pressure, heart rate and respiratory rate. Instructions for both relaxation techniques were recorded, in order that all subjects received the same information in the same manner (Bindemann et al, 1991; Gift et al , 1992).

Measurement Protocol For the baseline measurements, and for the pre- intervention measurements, subjects rested supine for five minutes, after which measurements were taken.

Prior to the study, blood pressure measurement was practised to ensure reliability of measures within a 5% variation. Systolic and diastolic blood pressure were measured on the dominant arm, using a manual sphygmomanometer, incorporating a technique based on the recommendations of past research (Bali, 1979; Sinconolfi et al , 1984; Van Montfrans et a l , 1990). Heart rate was measured over 30 seconds by palpating the pulse at the radial artery (Leggat et al, 1981), and respiratory rate was measured by visually recording inspiratory excursions over one minute.

Mitchell’s Simple Physiological Relaxation A tape recording of Mitchell’s simple physiological relaxation was made, based on a script of the check list of orders recommended by Mitchell (1977). The recording consisted of facts considered important by Mitchell, detailing instructions and how they must be interpreted by the subject if relaxation was to be achieved. This was then followed by a script which provided simple orders, working through the tense body, replacing tension with relaxation. Instructions regarding diaphragmatic breathing were also included.

Jacobson’s Progressive Relaxation A recording was made of a relaxation tool known as ‘the relaxation lesson’ (Jacobson, 1939). This is a variation of Jacobson’s pioneering relaxation technique. It works on the initial theory that contraction of muscle groups induces relaxation. ‘The relaxation lesson’ initially gives orders to the subject regarding diaphragmatic breathing, followed by an ordered scheme of instructions incorporating contraction and relaxation of all major muscle groups.

Control Supine Lying The resting supine position was maintained for 25 minutes. Whereas in the other interventions instructions were given about whether the eyes

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should be open or closed, it was felt necessary meters before and after intervention, and if sign- to provide subjects with the option throughout ificant differences existed among the three this intervention, as no confounding effect has experimental interventions. been discovered regarding either (Puskarich et al, 1992). Results

Analysis Means and standard errors (SE) were calculated and data were subjected to statistical analysis using the computer package SPSS. One-way analyses of variance were conducted to determine any significant differences among the three experimental groups at baseline measurements, immediately before intervention, and with respect to the order of intervention.

T-tests were employed to determine if there were significant differences in the measurement para-

Data for the physiological parameters of systolic and diastolic blood pressure, heart rate and respiratory rate were recorded for all subjects as baseline data, and before and after the three experimental conditions. Prior to statistical analysis of data, a descriptive analysis of data was performed. This consisted of the provision of mean values for each of the physiological parameters, under each of the conditions, accompanied by a value for standard error of the mean, as displayed in table 1. The descriptive data suggested that almost all physiological parameters were reduced following the three interventions.

Table 1: Descriptive analysis of data - mean SE and mean of physiological parameters for each experimental condition

SBP mm HG DBP mm Hg HR pulsedmin RR resps/min Mean (SE mean) Mean (SE mean) Mean (SE mean) Mean (SE mean)

~

Baseline 124.35 (2.90)

Post Mitchell 11 8.63 (2.24) Pre Jacobson 124.25 (2.99) Post Jacobson 1 17.37 (2.99) Pre control lying 123.13 (2.88) Post control lying 121.58 (2.71)

Pre Mitchell 125.70 (2.99) 73.06 (1.52) 67.81 (1.57) 19.59 (1.35) 73.50 (1.54) 68.21 (1.64) 19.37 (1.30) 70.21 (1.66) 63.77 (1.05) 14.63 (0.67) 72.58 (1.61) 67.79 (1.50) 19.46 (1.33) 69.56 (1.66) 61.88 (1.04) 14.94 (0.75) 73.25 (1.54) 67.58 (1.74) 19.83 (1.32) 71.54 (1.45) 64.54 (1.03) 17.21 (1.23)

Table 2: ANOVA comparisons of baseline and pre-intervention variables among conditions (F ratio and p values)

SBP mm HG DBP mm Hg HR pulses/min RR resps/min F ratio (p value) F ratio (p value) F ratio (p value) F ratio (p value)

Baseline 2.33 (p = 0.12) 1.1 8 (p = 0.33) 0.43 (p = 0.65) 1.01 (p = 0.38) Pre Mitchell 2.39 (p = 0.12) 1.14 (p = 0.34) 0.28 (p = 0.78) 1.30 (p = 0.29) Pre Jacobson 2.18 (p = 0.14) 0.81 (p = 0.46) 0.31 (p = 0.74) 1.20 (p = 0.32) Pre control lying 1.90 (p = 0.17) 1.34 (p = 0.28) 0.55 (p = 0.59) 0.85 (p = 0.44)

Table 3: Paired t-tests investigating differences in SBP, DBP, HR and RR following intervention

SBP mm HG DBP mm Hg HR pulses/min RR respdmin Diff (2 tail sig) Diff (2 tail sig) Diff (2 tail sig) Diff (2 tail sig)

~

Mitchell 7.17 (p < 0.001) 3.29 (p 0.01) 4.44 (p < 0.001) 475 (P<O.Ol) Jacobson 6.88 (p < 0.01) 3.02 (p < 0.01) 5.92 (p < 0.01) 4.52 (p < 0.001) Control lying 1.54 (p = 0.07 1.71 (p = 0.24) 3.04 (p < 0.05) 2.63 (p < 0.001)

Table 4: T-tests investigating differences in parameter reductions among interventions

SBPmm HG DBP mm Hg HR pulses/min RR resps/min Diff (2 tail sig) Diff (2 tail sig) Diff (2 tail sig) Diff (2 tail sig)

Control v Mitchell 5.63 (p < 0.05) 1.58 (p < 0.381) 1.40 (p < 0.23) 2.13 (p < 0.057) Control v Jacobson 5.33 (p < 0.05) 1.31 (p < 0.443) 2.88 (p < 0.096) 1.90 (p < 0.05) Mitchell v Jacobson 0.29 (p = 0.824 0.28 (p = 0.701) 1.48 (p < 0.247) 0.23 (p < 0.555)

Key to all tables: SE = standard error.

SBP = systolic blood pressure. DBP = diastolic blood pressure. HR = heart rate. RR = respiratory rate.


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Figure 1 shows a comparison of the baseline and pre-intervention measures for systolic and diastolic blood pressure, heart rate and respiratory rate. Observation suggested that the data for each of the four sets of measures were similar. To determine whether any significant differences existed among the groups at baseline (before the trial), and prior to each intervention, a one-way analysis of variance was conducted, the results of which are displayed in table 2. The analysis indicated that there were no significant differences among the three groups for the selected physiological parameters at baseline and prior t o intervention.

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Fig 1 : Comparison of baseline and pre-intervention measures

Figure 2 demonstrates the differences in the measurement parameters before and after intervention for each of the conditions. Table 3 gives the numerical values of the mean reductions in the physiologi’cal parameters after intervention for each of the conditions. Paired t-tests indicated that both Mitchell’s simple physiological relaxation and Jacobson’s progressive relaxation significantly reduced all four physiological parameters. The control intervention of supine lying produced significant reductions in respiratory rate and heart rate only.

The results of paired sample t-tests to determine if significant differences in the reductions recorded in the four physiological parameters existed among the three interventions are displayed in table 4. When Mitchell’s simple physiological relaxation was compared to the control intervention of supine lying, the Mitchell method resulted in greater reductions in all physiological measures, but the difference was significant only in the reduction in systolic blood pressure (p < 0.05). Similarly, Jacobson’s progressive relaxation produced greater reductions in the physiol-

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ogical measures than the control intervention, and the differences were significant with respect to systolic blood pressure (p < 0.05) and respiratory rate (p < 0.05). There were no significant differences in the reductions in the physiological parameters between Mitchell’s simple physiological relaxation and Jacobson’s progressive relaxation.

Despite formulating generalised conclusions with regard to the interventions and their capabilities, it was felt necessary to investigate order effect, to identify if the reduction in parameter measurements was related to the order of intervention received. Analysis of variance indicated that the order in which the interventions were received did not influence the extent of the reductions in the physiological parameters following intervention of the three experimental conditions (p values for analysis of differences in the measurement parameters for different orders of intervention were all greater than 0.05).

Discussion Following analysis of the findings of this study, some generalised conclusions may be drawn. All subjects were equal at baseline with respect to physiological parameter measurements, and therefore could be considered as constituting a homogeneous sample. Furthermore, following randomisation, no significant differences existed between the three experimental groups prior to any of the intervention measures, confirming the homogeneity of the sample, and the randomisation of allocation. The sequenced order of interventions had no significant confounding effect upon the changes in the measured physiological parameters related to the respective conditions, all of which ensured that differences recorded were as a result of the intervention received.

The results of the study indicated that, although there was a general tendency for each of the intervention procedures to elicit reductions in circulatory and respiratory activity, there were variations between interventions in the extent of such changes. In brief, the study found that relaxation techniques produced greater reductions in the measured physiological parameters than the control intervention of supine lying, although the differences were not always significant.

There was a significant reduction in heart rate and respiration rate following all three interventions. It is possible that the observed effects were a consequence of reduced physical activity, as heart rate is known to be correlated with the level of activity (Astrand and Rodahl, 1977). At rest approximately two-thirds of blood volume is

stored in the veins, as non-active tissues require less nutrients than active tissues, and produce less metabolic waste. Parasympathetic activity increases, liberating acetylcholine and reducing heart rate. Heart rate is the body’s principal mechanism of short-term control of blood pressure, so if the peripheral resistance remains constant (as it does at rest), one might expect a decrease in heart rate to be accompanied by a decrease in blood pressure. In the present study, a five-minute rest was given prior to measurement, and as heart rate returns to pre-exercise levels in approximately two minutes (McArdle et al, 1986), it is unlikely that further reductions in blood pressure would result from rest alone. The findings from this study supported this, in that supine lying elicited relatively small reductions in blood pressure, compared to the significant reductions following both relaxation interventions. These differences may thus be explained by the actual relaxation techniques.

At rest oxygen consumption decreases drastically, accompanied by reductions in carbon dioxide elimination (Tortora and Agnostakos, 1990). Simultaneously, the hypothalamus stimulates the parasympathetic nervous system resulting in decreased rate and depth of respiration. Recent studies (Leggat et al, 1981; Van Dixhoorn et al, 1990; Sudsuang et al, 1991) have suggested that decreased respiratory rate may have a major effect on parasympathetic activity. As respiratory activity is linked with cardiac activity - physio- logically with regard to nervous regulation within the brain stem, and mechanically uia its effect on venous return - it seems probable that respiratory activity has a significant role in promoting generalised parasympathetic activity.

Both physiological and progressive relaxation techniques incorporate basic breathing control in the form of diaphragmatic breathing. If parasympathetic dominance is initiated in response to respiratory changes, this may suggest that the specific emphasis on respiration incorporated into relaxation techniques initiates a more immediate and prolonged parasympathetic response than rest alone, resulting in greater physiological changes. Peddicord (1991) claimed that breathing techniques can be used alone for stress reduction, and need not be incorporated into generalised relaxation techniques to elicit the relaxation response. However, as yet there is no conclusive evidence in support of this theory. Although the respiration factor may have contributed to the significant reductions in blood pressure following the relaxation interventions, it does not fully explain why the control intervention did not also result in a significant reduction in blood pressure. One can only surmise that the reduction in the


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control respiratory rate, although significant, was not great enough to influence blood pressure significantly.

Although there was no significant difference between Mitchell’s simple physiological relaxation and Jacobson’s progressive relaxation with regard to their effect on the measured physiological parameters, it was noted that the two techniques did elicit slightly different patterns in the responses to intervention. Thus when the two relaxation techniques were compared, there was a trend for Mitchell’s simple physiological relaxation to elicit greater reductions in systolic blood pressure, diastolic blood pressure and respiratory rate, and a trend for Jacobson’s progressive relaxation to reduce heart rate to a greater extent.

The trend for greater reduction in both systolic and diastolic blood pressure associated with Mitchell’s simple physiological relaxation may be a function of the greater reduction in respiratory rate following this intervention. However, the philosophy underlying the two techniques may also have an influence. Mitchell’s simple physiological relaxation is based on postural realign- ment and conscious appreciation of joint position, whereas Jacobson’s progressive relaxation demands alternate isometric contraction and relaxation of major muscle groups. Studies into the effect of isometric contraction, using loaded isometric contractions (the handgrip apexcard- iographic test) have resulted in increased sympathetic activity, increased heart rate and contractility, and increased arterial pressure, particularly systolic blood pressure (Federici et al, 1993; Leosco et al, 1993, cited Jiminez et al, 1994; Wenger 1993; Costa and Baggioni, 1994; Jiminez et al, 1994). The findings of the present study contradict these claims as Jacobson’s progressive relaxation, involving isometric contractions, produced significant reductions in systolic and diastolic blood pressure, and support the findings of previous investigations into the effect of progressive relaxation on blood pressure (Bali, 1979; Agras et al , 1980; Van Montfrans e t al, 1990). It may be that while the fundamental technique of Jacobson’s progressive relaxation was capable of producing significant reductions in blood pressure, the isometric element of the technique made it slightly less effective in this respect than Mitchell’s simple physiological relaxation. These differences might become more apparent with a larger sample size.

In spite of the small differences detected between the two relaxation techniques, the conclusions of this study were that both Mitchell’s physiological relaxation and Jacobson’s progressive relaxation caused significant reductions in heart

rate, respiratory rate, systolic and diastolic blood pressure, and that the two techniques were comparable. Although previous studies (Bali, 1979; Agras et al, 1980; Van Montfrans et aE, 1990) have established the effectiveness of progressive relaxation, this is the first study to provide evidence to substantiate the claims for success by the proponents of the Mitchell approach.

With the knowledge that both techniques are equally effective, it is possible for clinicians to select the most appropriate method for any specific situation. Mitchell (1977) claimed that simple physiological relaxation is particularly suited, and can be adapted to, a number of situations - insomnia, laboured breathing, ante-natal, post-natal and labouring mothers, osteo-arthritis of the neck and lumbar spine, and for use with psychiatric patients - as it encourages conscious awareness of the relaxed posture, and, as the name implies, it is a relatively simple technique. This last claim was supported by informal comments made by seven of the subjects in the present study who volunteered that they preferred the Mitchell approach, as it required less concentration, and was an easier method to follow.

Jacobson’s progressive relaxation has claimed success in management of anxiety in cancer patients (Bindemann et al, 19911, in the treatment of epilepsy (Puskarich et al, 1992), and in the management of anxiety and dyspnoea in asthma patients (Renfroe, 1988; Gift et al, 1992). Conversely, the progressive relaxation technique is now considered inappropriate for ante-natal and labouring mothers as it does not seem a valid preparation for uterine contractions, and does not provide the patient with any control over such contractions (Mitchell, 1997; McKenna, 1978). These claims have not been substantiated. Progressive relaxation is contra-indicated in patients who are hypertensive, or who have had a myocardial infarction, due to the possible effect of isometric contractions on blood pressure. It appears that numerous hospitals have withdrawn the use of progressive relaxation in cardiac rehabilitation regimes, for fear of eliciting adverse effects (Harvey, 1994). Isometric exercise may induce myocardial synergies in patients with coronary artery disease, and augment symptoms of angina (Leosco, 1993, cited Jiminez et al, 1994). However, Wenger (1993) recommended that isometric exercise should be encouraged once the patient has attained a reasonable aerobic capacity. Clinicians should also consider other relaxation techniques, such as breathing control and transcendental meditation in an effort to match the technique to the situation.


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Conclusions This study used a design which is unique in the field of research into the effectiveness of relaxation techniques, to compare the effects of Jacobson’s progressive relaxation, Mitchell’s simple physiological relaxation, and a control condition of supine lying. Results indicated that both relaxation techniques produced significant reductions in heart rate, respiratory rate, and systolic and diastolic blood pressure, and that neither technique was superior to the other. The control condition of supine lying produced significant reductions in heart rate and respiratory rate alone. Further research is required to substantiate the numerous claims for the effectiveness of various relwation techniques, and to determine the most effective techniques for specific situations.

Authors Victoria Salt BSc MCSP graduated from the University of Nottingham School of Physiotherapy in July 1995. This report is from a study she carried out as part of her undergraduate degree. She is now working for the North Staffordshire Hospital Trust, Stoke on Trent.

Kate Kerr PhD BA MCSP Cert€d PostGradDipHE is a lecturer at the University of Nottingham School of Physiotherapy.

This article was received on June 25, 1996, and accepted on November 27, 1996.

Address for Correspondence Dr K M Kerr, University of Nottingham, School of Physiotherapy, Hucknall Road, Nottingham NG5 1 PG.

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675-680.


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Mitchell's Simple Physiological Relaxation and Jacobson's Progressive Relaxation Techniques: A comparison