Saturday, December 14, 2013

Relaxation and Meditation Therapy

            One of the goals for medical treatment ought to be to try to offer as many proven avenues for health as possible for all clients.  One of the options should come in the form of two different programs from the realm of complementary and alternative medicine.  One is a relaxation therapy program and the other is a meditation therapy program.  Although they are related, there are some differences between the two.
            Relaxation therapy option specifically focuses on somatic relaxation techniques which uses muscle relaxation through the application of internal observation to help produce an overall relaxed mental and physical sensation (Freeman, 2009).  Although Edmund Jacobson’s Progressive Relaxation Therapy (JPRT) is common, it is understood that the schedules of many of clients would require the Abbreviated Progressive Relaxation Training (APRT) originally developed by Joseph Wolpe (Freeman, 2009), which as the name indicates more direct in it's approach.
            Similarly, a meditation program could include Clinically Standardized Meditation (CSM), Respiratory One Method (ROM), and Mindfulness Meditation (MM).  Through the use of these forms the hope is to help clients rest their minds and experience the physical benefits that have been recognized by meditation practitioners for thousands of years (Freeman, 2009).
            Consider the results of some of these studies from around the world:
One study, for example, was conducted in South Korea and worked with 25 patients who were struggling with atopic dermatitis, which is also known as atopic eczema (Bae, Oh, Park, Noh, Noh, Kim, & Lee, 2012).  After a month of treatment, those who participated in progressive muscle relaxation noticed a significant improvement in the irritation of the skin (Bae, et al, 2012).  These participants also noted a drop in anxiety and an overall improvement to their sleep (Bae, et al, 2012).  The physical responses to the ability to be able to relax gave these participants a new set of life-long skills.
            An additional study completed in Sweden also found that eczema patients saw improvement in their condition through relaxation therapy (Utterström, & Lonne-Rahm, 2009).  This study specifically worked with women struggling with eczema and stress.  The researchers found that relaxation therapy not only reduced the amount of perceived stress in the lives of these women but that it actually reduced their eczema.
            A study with 49 participants compared meditation and a general health improvement program.  They found that although both groups saw an improvement in stress levels, only the meditation group noticed an improvement in their level of eczema (Rosenkranz, Davidson, MacCoon, Sheridan, Kalin, & Lutz, 2013).  Given this additional evidence, I would recommend that we encourage Louisa to take advantage of both of our programs in order to gain as many new skills as possible.
            One randomized clinical trial divided 168 participants with rheumatoid arthritis into three groups receiving relaxation therapy, cognitive behavioral therapy, or education concerning arthritis (ARUK, 2013).  At a 12-month follow-up,  the education and relaxation group reported improvement in their pain levels while the cognitive behavioral group did not (ARUK, 2013). 
            A second randomized clinical trial divided 68 participants into two groups.  One was a control group and the other received training in relaxation therapy and imagery techniques.  At a six-month follow up the relaxation group was able to demonstrate significant improvement in arm function and mobility (ARUK, 2013).  
          Additionally, meditation tends to be effective for pain and arthritis when it is part of a more comprehensive program (ARUK, 2013).  One study demonstrated that participants in meditation reported a decrease in pain, along with other groups in the same study (ARUK, 2013).  Although the other patients participated in cognitive behavioral, emotion regulation, and education therapies, the key is to understand that if we can leverage a variety of treatments for patients, then they have a heightened chance of success (ARUK, 2013). 
As an example, please note that a study conducted by Arizona State University found that participants in cognitive behavioral therapy or meditation both saw improvement in pain reduction and their coping skills related to pain (Zautra, Davis, Reich, Nicassario, Tennen, Finan, Kratz, Parrish, & Irwin, 2008).  
            Memory flashbacks are one of the primary indicators of Post Traumatic Stress Disorder (PTSD) (Bourne, Mackay, & Holmes, 2013).  Several studies have shown that relaxation therapy is often an effective means in which to assist those struggling with PTSD and flashbacks (Nemeroff, Bremner, Foa, Mayberg, North, & Stein, 2009).  Researchers understand that part of the reason that relaxation therapy helps with PTSD is because relaxation techniques can minimize the influence of physical cues from the surrounding environment (Church, & Brooks, 2013).  Therefore, it is very likely that if we can help limit the access of some memories and mental pathways, the intensity of the reaction to the stimulus and the flashbacks should begin to lessen in approximately two weeks (Church, & Brooks, 2013).
In a similar way meditation can be an extremely useful therapy for PTSD.  Studies have shown that mindfulness meditation is especially effective for PTSD (Lang, Strauss, Bomyea, Bormann, Hickman, Good, & Essex, 2012).  Researchers understand that meditation helps the practitioner improve control over their own thoughts, their focus, and judgments.  This in turn allows the patient to better control invasive thoughts and memories, and minimizes distorted thinking (Lang, et al, 2012).  This type of therapy would allow a PTSD patient gain more control over his mind and minimize the amount of flashbacks as well as their influence over him.  An encouraging note is that researchers recognize that combined and comprehensive therapy programs have a culminating affect for some patients (Sharpless, & Barber, 2011).  
            Although relaxation therapy and meditation programs would be excellent for many, they will not fit everyone.  As noted, in some instances these programs are better seen as an additional support, or a success multiplier.  If we are able to assist patients, and encourage them into greater levels of health then we have been successful.  The challenge for all of us is to try to ensure that we are offering as many evidence-based care options as we can.

References
Arthritis Research UK (ARUK) (2013).  Practitioner-based complementary and alternative therapies for the treatment of rheumatoid arthritis, osteoarthritis, fibromyalgia and low back pain.  Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CEsQFjAD&url=http%3A%2F%2Fwww.arthritisresearchuk.org%2F~%2Fmedia%2Ffiles%2Farthritis-information%2FAdditional-items%2FCAT-report-2013.ashx&ei=5J19UunOE8nBkwX-nYGQBQ&usg=AFQjCNE-_YeHbVJrOdrGc_2DxlnkPefkOA&sig2=UfXwBiq9mtOdlJ5VIpdyCg&bvm=bv.56146854,d.dGI
 
Bae, B., Oh, S., Park, C., Noh, S., Noh, J., Kim, K., & Lee, K. (2012). Progressive muscle relaxation therapy for atopic dermatitis: objective assessment of efficacy. Acta Dermato-Venereologica92(1), 57-61. doi:10.2340/00015555-1189  http://ehis.ebscohost.com/eds/pdfviewer/pdfviewer?sid=7971ed4b-5c9d-48fa-b75f-b3631a117bfb%40sessionmgr13&vid=17&hid=106
 
Bourne, C., Mackay, C., & Holmes, E. (2013). The neural basis of flashback formation: the impact of viewing trauma. Psychological Medicine43(7), 1521-1532.  http://xt6nc6eu9q.search.serialssolutions.com/?genre=article&atitle=The+neural+basis+of+flashback+formation%3a+the+impact+of+viewing+trauma&title=PSYCHOLOGICAL+MEDICINE&issn=00332917&isbn=&volume=43&issue=7&date=20130701&aulast=Bourne%2c+C&spage=1521&pages=1521-1532&rft.sid=EBSCO:Social+Sciences+Citation+Index:000320449300017
 
Church, D., & Brooks, A. (2013). ORIGINAL RESEARCH: CAM and Energy Psychology Techniques Remediate PTSD Symptoms in Veterans and Spouses. Explore: The Journal of Science and Healing, doi:10.1016/j.explore.2013.10.006  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S1550830713003029
 
Freeman, L.W. (2009) Mosby's complementary & alternative medicine: A research-based approach. (3rd ed). St. Louis, MO: Mosby.  
 
Lang, A. J., Strauss, J. L., Bomyea, J., Bormann, J. E., Hickman, S. D., Good, R. C., & Essex, M. (2012). The Theoretical and Empirical Basis for Meditation as an Intervention for PTSD. Behavior Modification, 36(6), 759-786.  http://bmo.sagepub.com.proxy1.ncu.edu/content/36/6/759.full.pdf+html
 
Nemeroff, C. B., Bremner, J. D., Foa, E. B., Mayberg, H. S., North, C. S., & Stein, M. B. (2009). Posttraumatic Stress Disorder: A State-of-the-Science Review. Focus: The Journal of Lifelong Learning in Psychiatry7(2), 254.  http://focus.psychiatryonline.org.proxy1.ncu.edu/article.aspx?articleid=52899
 
Rosenkranz, M., Davidson, R., MacCoon, D., Sheridan, J., Kalin, N., & Lutz, A. (2013). A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain Behavior and Immunity27174-184. doi:10.1016/j.bbi.2012.10.013  http://www.sciencedirect.com.proxy1.ncu.edu/science/article/pii/S0889159112004758
 
Sharpless, B. A., & Barber, J. P. (2011). A clinician's guide to PTSD treatments for returning veterans. Professional Psychology: Research and Practice42(1), 8-15. doi:10.1037/a0022351  http://ehis.ebscohost.com/eds/detail?sid=7971ed4b-5c9d-48fa-b75f-b3631a117bfb%40sessionmgr13&vid=11&hid=17&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=pdh&AN=2011-04544-002
 
Utterström, A., & Lonne-Rahm, S. (2009). Body balance reduces eczema in stress-related atopic dermatitis. Health (1949-4998)1(4), 290. doi:10.4236/health.2009.14047  http://www.scirp.org/journal/health/
 
Zautra, A. J., Davis, M. C., Reich, J. W., Nicassario, P., Tennen, H., Finan, P., Kratz, A., Parrish, B., & Irwin, M. R. (2008). Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. Journal of Consulting and Clinical Psychology76(3), 408-421. doi:10.1037/0022-006X.76.3.408  http://ehis.ebscohost.com/eds/detail?vid=5&sid=7971ed4b-5c9d-48fa-b75f-b3631a117bfb%40sessionmgr13&hid=102&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=pdh&AN=2008-06469-005


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