You know the situation; you try to sleep so you end up more alert, you try to forget something and you can't get it out of your mind. But, have you ever experienced a situation where you try to relax only to become more tense and anxious? It's enough to make your therapist down tools and look for another job. After all, relaxation is a core principle of most therapy dealing with anxiety and anxiety-related disorders, so if that makes a patient anxious or prone to panic, where do we turn?
Don't panic - I'm exaggerating. The situation is actually quite well known but its explanation less so. Relaxation-induced anxiety or panic seems to arise from a sense of losing control. As anyone who has ever been through relaxation will know, the spreading sensation of muscle relaxation and, is a curious feeling when first attempted. In my own experience, I've found one or two people in any group have some difficulty relinquishing control. They'll often take a sneaky peek to see what others are doing. They remain a little tense, a little vigilant and just a bit suspicious as to where all this is leading. Usually, after the first session it gets easier. For various reasons however, some people just can't tolerate formal relaxation sessions and for a very few, it seems to make them worse. For them, a perceived loss of control is almost invariably accompanied by increased vigilance and higher anxiety.
In the therapeutic context it's important for a patient to equate their anxiety with physical tension, increased respiration, heart rate and other physical symptoms. By encouraging the patient to recognize these symptoms and take corrective action, the symptoms of anxiety reduce to tolerable levels. So, what's happening in cases where relaxation has the opposite effect?
It's not uncommon for therapists to view such effects as simply another manifestation of anxiety. However, these ironic processes, as they have been described, may simply be an extension of perfectly normal mental processes. The psychologist Daniel M. Wegner and colleagues, suggests our mental controls succeed and fail because of two processes in the brain. One of these he calls the intentional process and the other the ironic process. For example, when we try to relax we may think about restful thoughts or images. This is a conscious effort and it's easy to interrupt. While this process is active, another unconscious system is also operating that searches for reasons to fail to achieve relaxation. If the person is burdened by distractions, stresses, or other forms of mental activity, not only can it undermine what we intend but it can push into our conscious mind the very thing we're trying to avoid or counteract.
In describing Wegner's research, I've rather brutally cut back on the finer points, but as Wegner himself suggests, the logical conclusion of his findings are that mental load and stress are exactly the wrong conditions for the practice of relaxation therapy. People who attempt the self-help route to stress reduction, need to be aware of the fact that relaxation-induced stress can happen. If attempts to relax are met with more arousal, and that arousal is met with more attempts to relax, the person could find themselves locked into a cycle of self-induced anxiety.
For the therapist, attempts to make their patient motivated towards relaxation may be problematic. In such cases it may be better to modify the standard approach that excludes relaxation training but focuses more on relaxing specific muscle groups and use of imagery.
Wegner, D. M., Broome, A., Blumberg, S.J. (1997) Ironic Effects of Trying to Relax Under Stress. Behavior, Research & Therapy. Vol. 35. 11-21.