Relaxation training is often used as a part of cognitive-behavioral therapy for headache and chronic pain management. Pain can produce both physiological and emotional stresses, which together feed into a cycle and result in heightened perception of pain and cause modification of the physiology of the body in ways that increase pain (such as muscle tension or spasm and constriction of blood vessels).
Relaxation training focuses on becoming aware of tension within the mind and body. Then, systematic relaxation methods (such as diaphragmatic breathing, progressive muscle relaxation, guided imagery) are used to reduce tension and to change the perception of physical pain.
The foundation of all relaxation techniques is diaphragmatic breathing. When we are fully asleep or relaxed, we breathe correctly. Our abdomens expand when we inhale and contract when we exhale. Many of us restrict our breathing to our upper chest when awake or under stress. It often helps to repeat a relaxing word, such as “calm” or “peaceful.” Individuals should limit the pace of breathing to 6 to 8 breaths per minute.
Progressive muscle relaxation (PMR) is a widely used method that teaches individuals to relax their muscles through a two-step process: (1) deliberately apply tension to certain muscle groups, and (2) stop the tension and notice how the muscles relax as the tension flows away. Frequently, 14 muscle groups from head to toe are used in this procedure.
Guided imagery is the use of mental images (such as a peaceful scene) to create a sense of relaxation and reduce stress. Individuals decide their destination (such as the beach or the mountains). They make the image as rich as possible, using all five senses. For example, if they imagine the beach, they allow themselves to see the clouds floating in the sky, to hear the waves rolling in, to feel the warm sand under their feet, to smell the ocean mist, and to taste the salt on their tongue. Finally, they are asked to carry this experience with them throughout their day.
Autogenic relaxation is another meditational form of relaxation, which focuses on specific self-instructions, such as “My whole body feels comfortable, relaxed, heavy, and warm” and “I feel quite quiet.” The therapist gives a series of relaxing phrases in the first person. Individuals repeat the phrase and are given an opportunity to generate that feeling in their bodies.
Mindfulness processes include nondefensive, moment-to-moment, and nonjudgmental awareness. They help individuals pay attention to current experiences of pain or psychological distress without suppressing or elaborating those experiences. This approach may help decrease over-focus on pain, which only intensifies the pain and emotional distress.