Psychological Reports, 1975,36, 595-597. @ Psychological Reporrs 1975
ANXIETY REDUCTION THROUGH SELF-ADMINISTERED RELAXATION1 HAROLD
H. DAWLEY, JR.
Veterans Administration Hospital New Orleans, Louisiana Stmzmary.-Possible usefulness o € self-administered instructions for relaxation is illustrated by the case of a bright, 40-yr.-old male who reported chronic anxiety.
The therapeutic potential of self-administered behavioral techniques is slowly being realized. Dawley, Floyd, and Smith (1974) reviewed 37 studies pertaining to self-administered, minimal therapist contacc, and automated behavior therapy and concluded that available research clearly indicates that behavioral procedures can successfully be self-administered. Several books (Mahoney & Thoresen, 1974; Watson & Tharp, 1972; Wenrich, Dawley, & General, in press; Thoresen & Mahoney, 1974) are oriented toward self-directed behavior therapy. One of the first studies of self-administered behavior therapy was reported by Migler and Wolpe ( 1967). In their study, the patient recorded his own relaxation instructions and successfully carried out his own desensitization at home. Relaxation training is an integral part of many behavioral procedures and, as such, can also be self-administered. Denholtz (1970) reported the successful use of tape-recorded relaxation instructions between treatment sessions to enhance therapeutic effectiveness. Allen (1973) found self-administered relaxation and study counseling as effective as group relaxation and study counseling (therapist present) in the reduction of cest anxiety. The average patient spends a large amount of time which is not utilized therapeutically. This is true for the psychiatric as well as the medical patient. Self-administered behavior therapy (relaxation in particular) offers potential for expanding creacmenc services for both inpatient and outpatient care. Selfadministered relaxation is ideally suited for problems in which anxiety is a major component and easily lends itself for use in "homework assignments between therapy sessions. In general, self-administered relaxation can provide benefits as a treatmenc in icself or it can be used in conjunction with additional therapeutic techniques. CASESTUDY The patient was a bright, 40-yr.-old married male with a lengthy history of chronic anxiety and related discomforts. When he was seen initially, he had been unemployed for a long period of time, had recently attempted suicide, and 'Requests for reprints are t o be sent to Harold H. Dawley, Jr., Ph.D.. Psychology Service, Veterans Administration Hospital, 1601 Perdido Street, New Orleans, Lousiana 70146.
596
H. H. DAWLEY, JR.
was generally quite anxious and depressed. Scores on the State-Trait Anxiety Inventory (Spielberger, Gorsuch, & Lushene, 1970) indicated a State score of 74 and a Trait score of 64, both of which are indicative of a high level of anxiety. The outward manifestations of anxiety such as face flushed and perspiration on forehead were also observed during this time. The treatment plan centered around reducing his anxiety and assisting him in achieving a more satisfactory over-all adjustment. Treatment began with a 1-hr. session in which the procedures for self-administered relaxation training were explained. The patient was also provided with excerpts from You Must Relax (Jacobson, 1962) and cassette tapes on relaxation training (Lazarus, 1970). H e was instructed to read the material provided and to go conscientiously through the exercises presented on the relaxation tapes. One week was allowed for familiarizing himself with the procedures involved. He was then instructed to carry out self-administered relaxation for a 4-wk. period by listening to the tapes at home and carrying out the exercises on his own. At the completion of this 4-wk. period, he reported that he felt more relaxed and less anxious. StateTrait anxiety was again measured at this time. The patient's State anxiety level decreased from 74 to 43, and his Trait anxiety level was reduced from 64 to 5 5 . The patient also reported and appeared to be more relaxed. He further stated that he felt that he had mastered the technique of self-relaxation described on the tapes and was able to relax himself on his own. Aside from an occasional severe situational stress temporarily raising his anxiety level, 5 mo. after the completion of his 4 wk. of self-administered relaxation training, he reported the continued success in controlling excessive anxiety by self-administered relaxation exercises. His behavior remained the same at lo-, 15, and 20-1110. follow-ups. By the 10th month follow-up the patient reported that he had obtained a job 4 mo. earlier that he was satisfied with and generally appeared co be maintaining an adequate over-all adjustment. This behavior was maintained at the 15th and 20th month follow-ups.
DISCUSSION Self-administered relaxation training offers an effective treatment procedure for reducing chronic anxiety and related discomforts. During the 4-wk. treatment period, State anxiety decreased by 31 points and Trait anxiety by 9 points. At the end of the 4-wk. treatment period, at a time when the patient was more susceptible to counseling, the GED was successfully passed, he enrolled in a local junior college under the GI Bill, and obtained a part-time job. His total income from the GI Bill and part-time work provided a suitable income on which he could support himself and his family while, at the same time, learning a trade. His developed proficiency in muscle relaxation enabled him to continue on and complete 15 mo. (as of last follow-up) of a 2-yr. training program as well as obtain and maintain steady employment for a 14-mo, plus period.
ANXIETY A N D SELF-ADMINISTERED RELAXATION
597
Perhaps the major value of self-administered relaxation training lies in its playing a supportive role in relation to other therapeutic techniques. The major value of this procedure is its ease, practicality, and efficiency. Self-administered relaxation can "set the stage" for the application of additional techniques which may not otherwise be applied. Relaxation tapes are readily available commercially, and for that matter, can also be prepared by either the patient or the therapist. Self-administered relaxation may be utilized in conjunction with medical treatment for lowering high blood pressure as well as in reducing preoperative tension in patients getting ready for surgery. Self-administered relaxation training can also be of benefit to psychiatric patients and "normal" individuals suffering from a variety of discomforts. In short, self-administered relaxation has therapeutic value in itself or when used in conjunction with additional behavioral techniques such as systematic desensitization, assertive training, and related methods. self-administered relaxation is not offered as a panacea but rather as an efficient, practical procedure for expanding and extending existing treatment services. REFERENCES
ALLEN,G. J. Treatment of test anxiety by group-administered and self-administered relaxation and study counseling. Behavior Therapy, 1973, 4. 349-360.
DAWLEY, H. H., FLOYD, L. N., & SMITH, C . A. Self-administered, minimal therapist contact, and automated behavior therapy: an annotated bibliography. JSAS Catalog of Selected Documeets in P~ychology.1974, 4 , No. 16. DENHOL'IZ, M. The use of rape recordings between therapy sessions. Journal o f Behavior Therapy and Experimental Psychiatry, 1970, 1 , 139-143. JACOBSON, E. Y O U must releu. New York: McGraw-Hill, 1962. KAHN, M., & BAKER, B. Desensitization with minimal therapist contact. Journal o f Abn o r m 1 Psychology, 1968, 73, 198-200. LAZARUS, A. Daily living: coping with fen~ionrand anxieties. Chicago: Instructional Dynamics, 1970. MAHONEY, M. J., & THORESEN, C. E. Self-control: power to ;he person. Belmont: Brooks/Cole, 1974. MIGLER, B., & WOLPE,J. Automated self-desensitization: a case report. Behavior Research tznd Therapy, 1967, 5 , 133-135. SPIELBERGER, C., GORSUCH, R..& LUSHENE, R. State-Trait Anxiety Inventory. Palo Alto, Calif.: Consulting Psychologists Press, 1970. THORESEN, C. E., & MAHONEY, M. J. Behavioral self-control. New York: Holt, Rinehart & Winston, 1974. WATSON.D. L., & THARP,R. G . Self-directed behavior: self-modification for personal adjustment. Belmont : Brooks/Cole, 1972. WENRICH, W. W., DAWLEY, H. H., & GENERAL, D . Self-directed systematic desensitiztztion: behavior therapy for the client, student and therapist. Kalamazoo: Behaviordelia, in press.
Accepted February 7 , 1975.
ANXIETY REDUCTION THROUGH SELF-ADMINISTERED RELAXATION1 HAROLD
H. DAWLEY, JR.
Veterans Administration Hospital New Orleans, Louisiana Stmzmary.-Possible usefulness o € self-administered instructions for relaxation is illustrated by the case of a bright, 40-yr.-old male who reported chronic anxiety.
The therapeutic potential of self-administered behavioral techniques is slowly being realized. Dawley, Floyd, and Smith (1974) reviewed 37 studies pertaining to self-administered, minimal therapist contacc, and automated behavior therapy and concluded that available research clearly indicates that behavioral procedures can successfully be self-administered. Several books (Mahoney & Thoresen, 1974; Watson & Tharp, 1972; Wenrich, Dawley, & General, in press; Thoresen & Mahoney, 1974) are oriented toward self-directed behavior therapy. One of the first studies of self-administered behavior therapy was reported by Migler and Wolpe ( 1967). In their study, the patient recorded his own relaxation instructions and successfully carried out his own desensitization at home. Relaxation training is an integral part of many behavioral procedures and, as such, can also be self-administered. Denholtz (1970) reported the successful use of tape-recorded relaxation instructions between treatment sessions to enhance therapeutic effectiveness. Allen (1973) found self-administered relaxation and study counseling as effective as group relaxation and study counseling (therapist present) in the reduction of cest anxiety. The average patient spends a large amount of time which is not utilized therapeutically. This is true for the psychiatric as well as the medical patient. Self-administered behavior therapy (relaxation in particular) offers potential for expanding creacmenc services for both inpatient and outpatient care. Selfadministered relaxation is ideally suited for problems in which anxiety is a major component and easily lends itself for use in "homework assignments between therapy sessions. In general, self-administered relaxation can provide benefits as a treatmenc in icself or it can be used in conjunction with additional therapeutic techniques. CASESTUDY The patient was a bright, 40-yr.-old married male with a lengthy history of chronic anxiety and related discomforts. When he was seen initially, he had been unemployed for a long period of time, had recently attempted suicide, and 'Requests for reprints are t o be sent to Harold H. Dawley, Jr., Ph.D.. Psychology Service, Veterans Administration Hospital, 1601 Perdido Street, New Orleans, Lousiana 70146.
596
H. H. DAWLEY, JR.
was generally quite anxious and depressed. Scores on the State-Trait Anxiety Inventory (Spielberger, Gorsuch, & Lushene, 1970) indicated a State score of 74 and a Trait score of 64, both of which are indicative of a high level of anxiety. The outward manifestations of anxiety such as face flushed and perspiration on forehead were also observed during this time. The treatment plan centered around reducing his anxiety and assisting him in achieving a more satisfactory over-all adjustment. Treatment began with a 1-hr. session in which the procedures for self-administered relaxation training were explained. The patient was also provided with excerpts from You Must Relax (Jacobson, 1962) and cassette tapes on relaxation training (Lazarus, 1970). H e was instructed to read the material provided and to go conscientiously through the exercises presented on the relaxation tapes. One week was allowed for familiarizing himself with the procedures involved. He was then instructed to carry out self-administered relaxation for a 4-wk. period by listening to the tapes at home and carrying out the exercises on his own. At the completion of this 4-wk. period, he reported that he felt more relaxed and less anxious. StateTrait anxiety was again measured at this time. The patient's State anxiety level decreased from 74 to 43, and his Trait anxiety level was reduced from 64 to 5 5 . The patient also reported and appeared to be more relaxed. He further stated that he felt that he had mastered the technique of self-relaxation described on the tapes and was able to relax himself on his own. Aside from an occasional severe situational stress temporarily raising his anxiety level, 5 mo. after the completion of his 4 wk. of self-administered relaxation training, he reported the continued success in controlling excessive anxiety by self-administered relaxation exercises. His behavior remained the same at lo-, 15, and 20-1110. follow-ups. By the 10th month follow-up the patient reported that he had obtained a job 4 mo. earlier that he was satisfied with and generally appeared co be maintaining an adequate over-all adjustment. This behavior was maintained at the 15th and 20th month follow-ups.
DISCUSSION Self-administered relaxation training offers an effective treatment procedure for reducing chronic anxiety and related discomforts. During the 4-wk. treatment period, State anxiety decreased by 31 points and Trait anxiety by 9 points. At the end of the 4-wk. treatment period, at a time when the patient was more susceptible to counseling, the GED was successfully passed, he enrolled in a local junior college under the GI Bill, and obtained a part-time job. His total income from the GI Bill and part-time work provided a suitable income on which he could support himself and his family while, at the same time, learning a trade. His developed proficiency in muscle relaxation enabled him to continue on and complete 15 mo. (as of last follow-up) of a 2-yr. training program as well as obtain and maintain steady employment for a 14-mo, plus period.
ANXIETY A N D SELF-ADMINISTERED RELAXATION
597
Perhaps the major value of self-administered relaxation training lies in its playing a supportive role in relation to other therapeutic techniques. The major value of this procedure is its ease, practicality, and efficiency. Self-administered relaxation can "set the stage" for the application of additional techniques which may not otherwise be applied. Relaxation tapes are readily available commercially, and for that matter, can also be prepared by either the patient or the therapist. Self-administered relaxation may be utilized in conjunction with medical treatment for lowering high blood pressure as well as in reducing preoperative tension in patients getting ready for surgery. Self-administered relaxation training can also be of benefit to psychiatric patients and "normal" individuals suffering from a variety of discomforts. In short, self-administered relaxation has therapeutic value in itself or when used in conjunction with additional behavioral techniques such as systematic desensitization, assertive training, and related methods. self-administered relaxation is not offered as a panacea but rather as an efficient, practical procedure for expanding and extending existing treatment services. REFERENCES
ALLEN,G. J. Treatment of test anxiety by group-administered and self-administered relaxation and study counseling. Behavior Therapy, 1973, 4. 349-360.
DAWLEY, H. H., FLOYD, L. N., & SMITH, C . A. Self-administered, minimal therapist contact, and automated behavior therapy: an annotated bibliography. JSAS Catalog of Selected Documeets in P~ychology.1974, 4 , No. 16. DENHOL'IZ, M. The use of rape recordings between therapy sessions. Journal o f Behavior Therapy and Experimental Psychiatry, 1970, 1 , 139-143. JACOBSON, E. Y O U must releu. New York: McGraw-Hill, 1962. KAHN, M., & BAKER, B. Desensitization with minimal therapist contact. Journal o f Abn o r m 1 Psychology, 1968, 73, 198-200. LAZARUS, A. Daily living: coping with fen~ionrand anxieties. Chicago: Instructional Dynamics, 1970. MAHONEY, M. J., & THORESEN, C. E. Self-control: power to ;he person. Belmont: Brooks/Cole, 1974. MIGLER, B., & WOLPE,J. Automated self-desensitization: a case report. Behavior Research tznd Therapy, 1967, 5 , 133-135. SPIELBERGER, C., GORSUCH, R..& LUSHENE, R. State-Trait Anxiety Inventory. Palo Alto, Calif.: Consulting Psychologists Press, 1970. THORESEN, C. E., & MAHONEY, M. J. Behavioral self-control. New York: Holt, Rinehart & Winston, 1974. WATSON.D. L., & THARP,R. G . Self-directed behavior: self-modification for personal adjustment. Belmont : Brooks/Cole, 1972. WENRICH, W. W., DAWLEY, H. H., & GENERAL, D . Self-directed systematic desensitiztztion: behavior therapy for the client, student and therapist. Kalamazoo: Behaviordelia, in press.
Accepted February 7 , 1975.
