and relax the mind and body. Through such techniques as deep breathing, biofeedback, progressive muscle relaxation, and visualization people learn to control.
Relaxation Training Patten, S. B., Metz, L. M. & Reimer, M. A. (2000). Biopsychosocial correlates of major depression in a multiple sclerosis population. Multiple Sclerosis, 6, 115–120. Rao, S. M. (1991) A manual for the brief, repeatable battery of neuropsychological tests in multiple sclerosis. New York, NY: National Multiple Sclerosis Society. Rao, S. M. (1995). Neuropsychology of multiple sclerosis. Current Opinion in Neurology, 8, 216–220. Rao, S. M., Leo, G. J., Bernardin, L., & Unverzagt, F. (1991a). Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology, 41, 685–691. Rao, S. M., Leo, G. J., Ellington, L., Nauertz, T., Bernardin, L., & Unverzagt, F. (1991b). Cognitive dysfunction in multiple sclerosis. II. Impact on employment and social functioning. Neurology, 41, 692–696. Roca, M., Torralva, T., Meli, F., Fiol, M., Calcagno, M. L., Carpintiero, S. et al. (2008). Cognitive deficits in multiple sclerosis correlate with changes in fronto-subcortical tracts. Multiple Sclerosis, 14, 364–369. Sadovnick, A. D., Remick, R. A., Allen, J., Swartz, E., Yee, I. M. L., Eisen, K. et al. (1996). Depression and multiple sclerosis. Neurology, 46, 628–632. Sanfilipo, M. P., Benedict, R. H. B., Weinstock-Guttman, B., & Bakshi, R. (2006). Gray and white matter brain atrophy and neuropsychological impairment in multiple sclerosis. Neurology, 66, 685–692. Sicotte, N. L., Kern, K. C., Giesser, B. S., Arshanapalli, A., Schultz, A., Montag, M. et al. (2008). Regionsla hippocampal atrophy in multiple sclerosis. Brain, 131, 1134–1141. Smith, K., McDonald, I., Miller, D., & Lassman, H. (2005). The pathophysiology of multiple sclerosis. In A. Compston, et al. (Eds.), McAlpine’s multiple sclerosis (4th ed.). Philadelphia, PA: Elsevier. Summers, M. M., Fisniku, L. K., Anderson, V. M., Miller, D. H., Cipolotti, L., & Ron, M. A. (2008). Cognitive impairment in relapsing-remitting multiple sclerosis can be predicted by imaging performed several years earlier. Multiple Sclerosis, 14, 197–204. Vollmer, T. (2007). The natural history of relapses in multiple sclerosis. Journal of the Neurological Sciences, 256, S5–S13. Vukusic, S., & Confavreux, C. (2007). Natural history of multiple sclerosis: risk factors and prognostic indicators. Current Opinion in Neurology, 20, 269–274. Weinshenker, B. G., Bass, B., Rice, G. P., Noseworthy, J., Carriere, W., Baskerville, J. et al. (1989). The natural history of multiple sclerosis: A geographically based study. I. Clinical course and disability. Brain, 112, 133–146. Zivadinov, R., De Masi, R., Nasuelli, D., Monti Bragadin, L., Ukmar, M., Pozzi-Mucelli, R. S. et al. (2001a). MRI techniques and cognitive impairment in the early phase of relapsing-remitting multiple sclerosis. Neuroradiology, 43, 272–278. Zivadinov, R., Sepcic, J., Nasuelli, D., De Masi, R., Monti Bragadin, L., Tommasi, M. A. et al. (2001b). A longitudinal study of brain atrophy and cognitive disturbances in the early phase of relapsing-remitting multiple sclerosis. Journal of Neurology, Neurosurgery, & Psychiatry, 70, 773–780.
Relational Learning ▶ Paired-Associate Learning
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Relaxation Training DANIEL L. S EGAL , L EILANI F ELICIANO University of Colorado at Colorado Springs Colorado Springs, CO, USA
Definition Relaxation training refers to a diverse group of strategies designed to help people voluntarily release tension and relax the mind and body. Through such techniques as deep breathing, biofeedback, progressive muscle relaxation, and visualization people learn to control fear and anxiety, and to improve stress and pain management.
Current Knowledge Relaxation training was originally created in the early 1930s by Edmund Jacobson as a means to decrease nervous system arousal and promote well being. Deep breathing is the foundation for all relaxation techniques and involves the act of breathing deeply into the lungs by flexing the diaphragm rather than breathing shallowly by flexing the rib cage. Deep breathing is crucial to these skills because controlling breath intake can prevent a person from breathing too rapidly and shallowly, thus avoiding hyperventilation. Biofeedback is a technique that uses electrodes and other monitoring instruments to measure and relay information about muscle tension, heart rate, sweat responses, skin temperature, or brain activity. Its purpose is to develop self-regulation skills that play a role in improving health and well-being. Progressive muscle relaxation involves relaxing the muscles in a progressive or step-by-step manner. The main principles of progressive muscle relaxation are to purposefully tense the muscles so as to recognize the feeling of tension and then to relax the muscles letting the tension flow out of the body. The person typically begins this technique with either his or her head, hands, or feet and then moves down or up the body respectively. A full session of
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progressive relaxation takes around 20 min. Uses of imagery and visualization are other common relaxation training techniques in which the person closes the eyes and creates a relaxing scene in the mind’s eye, or it can be used to enhance the tensing of individual muscle groups (e.g., person imagines squeezing a lemon in his or her fist rather than just clenching the fist to tense hand muscles). In contrast to progressive muscle relaxation, autogenic training, created by Johannes Schultz, is a passive technique in which the person is given a number of posthypnotic suggestions, is taught to focus on a specific body part (usually the extremities), and concentrate on feeling sensations of warmth or heaviness in that area. Autogenic training works through self-hypnosis to promote a sense of being at peace. Of all relaxation training techniques, autogenic training has the least empirical support for effectiveness. When trying a new relaxation technique, several important features are for the person to sit with feet flat on the floor or recline in a comfortable position free from distraction, to practice the technique for at least several minutes and then extend the time as it becomes more comfortable, and to practice the technique regularly as a way to solidify the new skill. It is also important in this type of activity for the individual to be an active participant in the training and be committed to regular practice to receive full benefit. In the psychotherapeutic setting, relaxation training is most often used by practitioners of a behavioral or cognitivebehavioral orientation. Relaxation training is typically used as part of the intervention package for anxiety disorders, anger management, stress reactions, sleep difficulties, and some medical conditions such as headaches, asthma, bruxism or teeth grinding, hypertension, tremor disorders, and chronic pain. Relaxation training has been effectively used with individuals of all ages (childhood through older adulthood), with individuals with early stage dementia, and it can be conducted individually or in a group setting. Successful relaxation training brings about a general feeling of calmness, both physically and mentally. Muscle relaxation has a widespread effect on the central and autonomic nervous systems and therefore can be seen as a physical as well as psychological treatment.
Cross References ▶ Behavioral Therapy ▶ Cognitive Behavior Therapy ▶ Psychotherapy
References and Readings Chung, W., Poppen, R., & Lundervold, D. A. (1995). Behavioural relaxation training for tremor disorders in older adults. Biofeedback and Self-Regulation, 20, 123–135. Lehrer, P. M., Woolfolk, R. L., & Sime, W. E. (Eds.). (2007). Principles and practice of stress management (3rd ed.). New York: Guilford. Luebbert, A., Dahme, B., & Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: A meta-analytical review. Psycho-oncology, 10, 490–502. Shalek, M., & Doyle, S. (1998). Relaxation revisited: An adaptation of a relaxation group geared toward geriatrics with behaviour problems. American Journal of Alzheimer’s Disease, 13, 160–162. Smith, J. C. (2005). Relaxation, meditation & mindfulness: A mental health practitioner’s guide to new and traditional approaches. New York: Springer. Suhr, J., Anderson, S., & Tranel, D. (1999). Progressive muscle relaxation in the management of behavioural disturbance in Alzheimer’s disease. Neuropsychological Rehabilitation, 3, 31–44.
Release of Psychological Test Materials ▶ Detroit Edison v. NLRB (1979)
Reliable Change Index G RANT L. I VERSON University of British Columbia & British Columbia Mental Health & Addiction Services Vancouver, BC, Canada
Definition Jacobson and Truax (1991) proposed a psychometric method for determining if a change on a psychological test is reliable. That is, does the change represent a real improvement or deterioration in the patient’s clinical condition – or does it simply reflect measurement error? This method involved the calculation of a ‘‘reliable change index’’ (RCI). The original formula used by Jacobson and Truax has been debated, and modified several times, over the years (Hageman & Arrindell, 1993, 1999a, 1999b; Hsu, 1989, 1999; Speer, 1992; Speer & Greenbaum, 1995). The reliable change ‘‘index’’ is the derived score from this
