Overview of fish oil (omega 3) as a natural remedy for depression and whether fish oil works for treating depression.

What is fish oil (omega 3)?

Fish contain a type of oil called omega-3. Fish oil is also available in capsule form as a dietary supplement.

How does it work?

Polyunsaturated fats are important for brain function. The body uses fish oils in a person's diet to make these polyunsaturated fats.

Is it effective?

Countries with a low consumption of fish have been reported to have a higher rate of depression. Furthermore, some studies have found that depressed patients have a reduced amount of omega-3 in their blood. The reduced omega-3 could be either a cause or an effect of the depression. While these studies suggest that omega-3 may play a role in depression, no studies have directly tested whether taking fish oils helps depression. However, one study did find it helped people with bipolar disorder.

Are there any disadvantages?

None are known.

Where do you get it?

Fish oil capsules are available from supermarkets and health food shops. Eating a variety of fish 3-5 times per week will also give you a sufficient amount of omega-3.

Recommendation

Given the lack of scientific evidence, fish oils cannot currently be recommended for depression.

Key references

Maidment ID. Are fish oils an effective therapy in mental illness- an analysis of the data. Acta Psychiatrica Scandinavica 2000; 102: 3-11.

Stoll AL, Severus E, Freeman MP et al. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of General Psychiatry 1999; 56: 407-412.

back to: Alternative Treatments for Depression

A short essay with a new perspective on co-dependency.

Life Letters

Dear Colleague,

We have spoken repeatedly about the perils of co-dependency along with the value of self-love. To love oneself is vital to health and well being we maintain. We must all learn to cherish that which most belongs to us - our very selves. But what of others? Some small part of me asks.

You have lectured sweet Maria, lovingly scolded her, and pathologized her generosity, reducing her giving spirit to a modern day illness.

What acts of kindness have we witnessed that manifest her sickness? Her willingness to open her home to friends, family, and even strangers? Her hours of labor freely given on behalf of others for no pay? Her love offerings of hot meals, financial assistance, and the countless errands she has ran for shut-ins? The sacrifices she has made on behalf of her own and other people's children? The numerous favors she so willingly grants? This is the life-long pattern that has conjured up your diagnosis - the personality disorder of co-dependency.

How will we heal her? Teach her to look away from the suffering around her? Instruct her to place her own needs above those who are needier? Encourage her to direct her energy inward, so that she can grow to be all that she can be? Advise her to indulge herself more often, inform her that she should give less and play more?

And when we have healed her, my wise friend, the world will have one less co-dependent. But what else will it have lost? I wonder...

next:Life Letters: To a Wounded Angel...

Covering a holistic approach to treating Schizophrenia. Discussion of psychotherapies, social skills and vocational training, self-help groups and family interventions.

What non-drug treatments are available for schizophrenia?

'We now have the revolutionary insight that schizophrenia - rather than causing an inevitable downhill deterioration - actually entails a slow uphill progression of recovery" (Arnold Kruger, Schizophrenia: Recovery and Hope, 2001).

There is no instant cure for schizophrenia but people can and do recover. The experience of schizophrenia is unique to each person and as a result, each person's experience of recovery is unique - what might work well for one person may not work so well for another. It's vital, therefore to learn about all the different treatment options available to you so that you can play an active role in your recovery. For an excellent depiction of 'roadways to recovery', click here.

A holistic approach

The holistic approach as it is applied to the treatment of schizophrenia, means "assessing how schizophrenia is affecting all aspects of an individual's being. The emotional, psychological, social and physical aspects should all be considered - the focus is not exclusively on the illness. This approach recognises that a person who has schizophrenia may be particularly prone to a range of health problems as a result of their illness and while treating these may not affect the symptoms of schizophrenia, it will improve overall quality of life"1. Preventative measures (taking sensible precautions), are very much a part of this approach and include keeping an eye out for any general health problems, monitoring dietary habits, caffeine and nicotine intake, sleep patterns, exercise and leisure activities.

Additional pathways to recovery

Although medication is almost always necessary in the treatment of schizophrenia, it is not usually enough by itself. As mentioned earlier, it is important to seek out additional resources, such as 'talking therapies', social and employment rehabilitation services, and living arrangements that may be helpful at various stages of recovery. It is also extremely important for individuals, family members and health providers to make decisions together about treatment plans and goals to work toward. Below are some forms of activities that may be useful in the recovery process.

Psychosocial interventions

Education

Education for the individual and the family about schizophrenia is essential. Providing education and information enables the family as well as the person with schizophrenia to take an active role in the recovery and rehabilitation process, and to do so from an empowered position.

Social and living skills training

Social and living skills training is an effective means of enabling individuals with schizophrenia to re-learn a variety of skills necessary for living independently. Social and living skills training can be used with individuals and with groups and provides opportunities for people to acquire skills they have not been able to develop due to particular life circumstances, re-learn skills which were lost or reduced due to the disabling effects of schizophrenia or particular life circumstances and enhance existing skills to enable more effective functioning.

Vocational training and rehabilitation

Work has the potential to be a 'normalising' experience and to provide benefits such as enhanced personal satisfaction, increased self-esteem, additional income, financial independence, social interaction and recreational and companionship opportunities. Most importantly, it is frequently identified as a goal of people with schizophrenia. Any person with schizophrenia who expresses an interest in gaining employment, or who may benefit from employment, should receive vocational services.

Talking therapies

There are several different 'talking therapies' to choose from. They range in their approaches, from aiming to ease distress and improve coping skills though to seeking to help people understand their own thoughts, feelings and patterns of behaviour. Some of these talking therapies are listed below.

Counselling: Counsellors listen without judgement and help individuals to explore issues which are important in the recovery process. Counsellors do not give advice but should act as a guide for individuals in working things out for themselves.

Psychotherapy: Psychotherapy is a learning process that is accomplished largely by the exchange of verbal communication. Psychotherapy has many different orientations but can generally be categorised into three broad groups: psychodynamic (which is based on the teachings of Freud), behavioural (which aims to modify behaviour) and humanistic (which aims to increase self-understanding). While behaviour modification can be very helpful for some people, research into the use of psychodynamic therapy for people with schizophrenia has consistently failed to support its effectiveness. Furthermore, there is some evidence to suggest that psychodynamic therapy is harmful and therefore it is not recommended.

Cognitive Therapy: Cognitive therapy is also known as cognitive behavioural therapy (CBT). Cognitive behavioural therapy is concerned with the influence of beliefs, thoughts and self-statements on behaviour. CBT for the symptoms of schizophrenia aims to heighten awareness of the inconsistency of delusions and to develop practical coping mechanisms for persistent symptoms.

Self-Help Groups: Some people find it helpful to talk about their experiences with others who can empathise because they have been through similar situations themselves. People can get practical help by working through their problems with others and develop strong support networks among peers. Self-help groups are run by Schizophrenia Ireland and cover most areas of the Republic of Ireland.

Alternative Therapies for Schizophrenia

Alternative therapies have been used by people for thousands of years and some people find them very helpful in the recovery process. Some of these therapies include: meditation (a special form of relaxation), aromatherapy (the use of essential oils), reflexology (the manipulation of pressure points on the feet), acupuncture (ancient Chinese remedy using needles and herbs), massage, t'ai chi (meditation in movement), and yoga (exercise which concentrates on breathing and stretching). You might also like to try some creative therapies, which can include art, drama, music, writing and performing. The trick is to find out which therapies you enjoy most and which you find to be most helpful, and this can only be done through trial and error (although you should have a lot of fun finding out!). It is very important to remember, however, that these therapies should be used in addition to your medication and psychosocial therapies (listed above), not instead of them.

Family Interventions

The family is considered to be an essential part of the assessment, treatment and recovery process for people with schizophrenia. For families to be effective in this role, without becoming overburdened or exhausted, they need information, support, sufficient time for professional consultation, and respite mental health services. See the fact sheet for relatives in this pack for more information on services specifically for families.

back to: Complimentary and Alternative Medicine

References

1. NSW Dept. of Health (2001) The Schizophrenias: Guidelines for a Holistic Approach to Clinical Practice, Sydney, 66

2. McEvoy, J.P., Scheifler, P.L. and Frances, A. (Eds) (1999) The Expert Consensus Treatment Guidelines for Schizophrenia: A Guide for Patients and Families, in Expert Consensus Guideline Series: Treatment of Schizophrenia 1999, Journal of Clinical Psychiatry, 60 (suppl.11), 4-80

3 & 4. NSW Dept. of Health, op.cit., 46

5. McEvoy et al., op.cit., 4

6. Ibid.

7. & 8. NSW Dept. of Health, op.cit., 46

Source: Parts of this article are replicated with the permission of Schizophrenia Ireland.

Self-Therapy For People Who ENJOY Learning About Themselves

THE DAY WE GREW UP

Most of us can remember the day we grew up.

It was the day our parents did us the favor of being so unreasonable that we said good-bye to our dependence on them forever and entered into the adult world of choices.

Looking back we realize that the unreasonable thing our parents did that day wasn't quite as awful as it seemed. After all, since they are only human, they had been at least as unreasonable many times before.

What was so special about this day was that we were ready!

We had finally matured enough to know that we could take better care of ourselves than they ever could. Before that day, we had always looked to our parents when we needed help.

Since that day, we have looked to ourselves first and to our "family of choice" after that.

OUR FAMILY OF CHOICE

Adults CHOOSE the people they count on for emotional support. We look around and decide: "Who can I rely on?"

There are some relatives, some friends, even some coworkers and professionals who have been kind, helpful, and respectful and can be counted on to treat us well.

We may not call these people "family," but in an emotional sense they are. This is our "family of choice."

IF YOU DIDN'T GROW UP

Many people are still dependent on their birth families. They and their parents conspired to continue their childhood dependency into adult life.

If this is your situation, the first thing to ask yourself is: "What do I think I still need from them"?

The second thing to ask yourself is: "What price am I paying for being unable or unwilling to provide this for myself"?

Get what you need on your own. Then you can have the best independent friendship you can possibly have with your parents.

WHO'S TAKING CARE OF WHOM?

Paradoxically, people who never let go of their parents are usually people who never had "true parents" in the first place.

A true parent is someone who realizes it is their job to take care of their children, and that it is not a child's job to take care of their parents!

They enjoy taking care of their kids, and don't resent that their kids need them.

And they want them to reach true, independent adulthood with a good chance at happiness.

If you had parents who never grew up themselves, they probably insisted that you "behave" or "succeed" or "stay out of trouble" just like all parents do.

But you were supposed to do these things for them, not for yourself.

It's as if you were their "parent," and they were desperately needy children.

BRAIN-WASHING

"What would the neighbors think of me if they saw what you did?" "If you loved me you wouldn't do things like that." "Mrs. Caruthers down the street has a NICE daughter. She's not like you." "You are going to make me lose control"! "Come on, make Mama happy. Put a big smile on your face!" After years of being treated like this, it's no wonder many adults try to justify their dependence by saying they WOULD grow up "but my parents need me too much now that they are older."

(Their parents have needed them too much since they were born!)

It's so much easier to believe that you are being benevolent than to face that you are still craving the parent you needed, never had, and, sadly but almost surely, never will have.

BREAK THAT CHAIN!

If your grandparents never grew up, your parents probably never grew up. If your parents never grew up, you probably never grew up. If you never grew up, your children may never grow up! Please break this chain! Let your generation be the one that says: "There have been too many wasted lives." Don't expect your children to take care of you in any way at all!

Do choose your own new "family of choice," and use them wisely and well!

next: Self-Love

Finding the right kind of doctor, monitoring your child's moods, getting prompt diagnosis and treatment are ways parents can help their bipolar child.

Parents concerned about their child's behavior, especially suicidal talk and gestures, should have the child immediately evaluated by a professional familiar with the symptoms and treatment of early-onset bipolar disorder.

There is no a blood test or brain scan, as yet, that can establish a diagnosis of bipolar disorder.

Parents who suspect that their child has bipolar disorder (or any psychiatric illness) should take daily notes of their child's mood, behavior, sleep patterns, unusual events, and statements by the child of concern to the parents. Share these notes with the doctor making the evaluation and with the doctor who eventually treats your child. Some parents fax or e-mail a copy of their notes to the doctor before each appointment.

Because children with bipolar disorder can be charming and charismatic during an appointment, they initially may appear to a professional to be functioning well. Therefore, a good evaluation takes at least two appointments and includes a detailed family history.

Finding the right doctor

If possible, have a board-certified child psychiatrist diagnose and treat your child. A child psychiatrist is a medical doctor who has completed two to three years of an adult psychiatric residency and two additional years of a child psychiatry fellowship program. Unfortunately, there is a severe shortage of child psychiatrists, and few have extensive experience treating early-onset bipolar disorder.

Teaching hospitals affiliated with reputable medical schools are often a good place to start looking for an experienced child psychiatrist. You can also ask your child's pediatrician for a referral or call your county medical society. Additionally, check the CABF Directory of Professional Members to see the names of doctors who practice in your area.

If your community does not have a child psychiatrist with expertise in mood disorders, then look for an adult psychiatrist who has 1) a broad background in mood disorders, and 2) experience in treating children and adolescents.

Other specialists who may be able to help, at least with an initial evaluation, include pediatric neurologists. Neurologists have experience with the anti-convulsant medications often used for treating juvenile bipolar disorders. Pediatricians who consult with a psychopharmacologist can also provide competent care if a child psychiatrist is not available.

Some families take their child to nationally-known doctors at teaching hospitals for diagnosis and stabilization. They then turn to local professionals for medical management of their child's treatment and psychotherapy. The local professionals consult with the expert as needed.

Experienced parents recommend that you look for a doctor who:

• is knowledgeable about mood disorders, has a strong background in psychopharmacology, and stays up-to-date on the latest research in the field
• knows he or she does not have all the answers and welcomes information discovered by the parents
• explains medical matters clearly, listens well, and returns phone calls promptly
• offers to work closely with parents and values their input
• has a good rapport with the child
• understands how traumatic a hospitalization is for both child and parents, and keeps in touch with the family during this period
• advocates for the child with managed care companies when necessary
• advocates for the child with the school to make sure the child receives services appropriate to the child's educational needs.

next: Impact of Bipolar Disorder on Girls
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At 3:00 a.m., millions of emotional alarm clocks go off all over the world, waking people in a panic:

"What's the point? Do I really matter to anyone? Do I have a place in other people's lives? Who knows me? Who cares? Why do I feel so unimportant?"

And even worse:

"I despise myself. I am truly worthless. I have been a burden to everyone. I hurt people. I don't deserve to live."

Some get back to sleep after an hour or two of tossing and turning. Others start their day at this early hour filled with dread. Showering, dressing, preparing breakfast (if they're able to eat at all) take monumental effort. "Keep going" they tell themselves, trying to complete simple activities that most never think twice about. Finally, in an act of incredible courage, they push themselves out the door and start off to work, struggling against emotional headwinds that make every step an exercise of will.

The prevalence of depression in the United States is alarming. According to Nemeroff (1998) (from The Neurobiology of Depression ), "5 to 12 percent of men and 10 to 20 percent of women in the U.S. will suffer from a major depressive episode at some time in their life (and) roughly half of these individuals will become depressed more than once." And these statistics do no include incidences of the less severe but lingering depression known as dysthymia.

What causes depression? Is it a biological disorder caused by neurotransmitter or hormonal imbalances? The logical consequence of faulty or pessimistic thinking? Or the inevitable outcome of childhood trauma? A whole book could be devoted to this topic, and the answer would still not be clear. The problem is that the three explanations are interrelated, and, perhaps none, alone, are completely adequate. Consider the following:

• Nemeroff reports that early emotional trauma has important and lasting neurobiological effects (at least in other species).
• Perceived inability to manage current threats affects neurotransmitter functioning (see Albert Bandura's (1995) book: Self Efficacy: The Exercise of Control [W.H. Freeman, New York]).
• Pessimistic thinking although "faulty" when applied to current situations, may not have been "faulty" during childhood, within the context of a dysfunctional family.
• Studies of identical twins separated at birth suggest that genetics play a role in depression, but don't tell the whole story.
• One child from a dysfunctional family may experience severe depression, while another remains untouched.

If this seems challenging or confusing, it is. In the depression flow chart, the arrows point in almost all directions.

Still the suffering remains. While I have no answer to the big question of causality (although I suspect all three "explanations" play a role in many depressions), there is one observation that I would like to pass along from my years of treating depression. That is: many chronically depressed clients I have worked with have had a childhood marked by the absence of voice, or what I call "voicelessness."

What is "voice?" It is the sense of agency that makes us confident that we will be heard, and that we will impact our environment. Exceptional parents grant a child a voice equal to theirs the day that child is born. And they respect that voice as much as they respect their own. How does a parent provide this gift? By following three "rules":

1. Assume that what your child has to say about the world is just as important as what you have to say.
2. Assume that you can learn as much from them as they can from you.
3. Enter their world through play, activities, discussions: don't require them to enter yours in order to make contact."

(See "Giving Your Child Voice" for more. You may want to consider your own personal history to see whether your parents followed these "rules".)

What happens when a child's feelings, thoughts, wishes, and interests are never heard? He or she feels worthless, non-existent, and incapable of having an effect on the world. A child without voice has no license to live. These feelings don't go away as a child get older, instead they go underground, replaced by eating disorders, acting out, painful shyness, or sometimes over-responsibility (a child acting like an adult).

Nor do the feelings go away when a child reaches adulthood. Maintaining a sense of self and agency is necessary for our emotional well being. But for adults who grew up voiceless, this sense is very fragile. Without "voice" people are prone to feeling hopeless and helpless. Often, the voiceless have no "place" of their own; instead they struggle to anchor themselves in other people's worlds. Unconsciously, many try to use relationships to address old wounds and repair their "self." Some try to inflate themselves like blowfish in order to feel secure and consequential (see Voicelessness: Narcissism). Others search endlessly for powerful partners who will validate their existence (see Why Do Some People Choose One Bad Relationship After Another?) or twist themselves like a pretzel in order to fit into another person's world (see Little Voices). At times these (and other) unconscious strategies succeed, but the satisfaction is rarely lasting. In everyone's life, situations occur that threaten our sense of agency (facing death is a prime example). But the "voiceless" have no ground floor, nothing or no one to catch them--the thought: "yes, but I am a good and valuable person" provides no safety net. An event usually occurs (a loss, betrayal, rejection, etc.) which re-opens the childhood wound and sends them tumbling into a bottomless pit.

Aloneness contributes to the problem. Because the emotional injury is well concealed, people do not understand. "You have family/friends, a good job," they say. "People care about you. You have no reason to feel this way." But the depressed person has good reason even if they can't verbalize it or see it themselves: a history of childhood "voicelessness."

If depression is, in part, a "voice disorder" then psychotherapy should help. And, in fact, it does (see, for example, The Effectiveness of Psychotherapy--The Consumer Reports Study by Martin E. P. Seligman). For some, correcting the faulty/pessimistic thoughts (e.g. I am a worthless person; I have no control over my life) is enough. Cognitive behavior therapy efficiently serves this purpose. Others find it important to understand the historical reasons for the absence of "voice" and the roots of their helplessness. They want to know why they struggle, and to understand how their voicelessness has affected their relationships. And, of course, they want to re-find their missing "voice." This is the realm of psychotherapy. The work of therapy does not occur in five sessions as the insurance companies would like consumers to believe. A client's voice emerges slowly in the context of a relationship with a caring therapist, often with the analgesic aid of medication. The therapist's job is to explain self-destructive thinking in the context of personal history, find the client's true voice, nurture it, and help it grow so that it can withstand the challenges of life. Once developed and applied to relationships and work, voice can be a powerful and lasting anti-depressant.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: Bill Clinton: A Case of Attention Deficit Disorder?

Character is Destiny
by Russell W. Gough

A small, practical, penetrating look at ethics: What it is, why it is, and how you can improve your own ethics or character. It's an intelligent book, but easy to read and apply. Gough knows a lot about the history of ethics, so it is interesting in that way also, with plenty of quotes from Plato, Aristotle, Socrates, and, of course, Heraclitus (whose quote is the title of the book). Trying to be a better person is an enjoyable and deeply satisfying pursuit, and this book is definitely helpful on that journey.

Success Through a Positive Mental Attitude
by Napoleon Hill and W. Clement StoneThis was written later in Hill's life, and has been given new life (and the addition of four more principles) by his association with the eminently successful Stone. The book is packed with useful principles and interesting anecdotes. It's a fun book to read. Flow: The Psychology of Optimal Experience
by Mihaly Csikszentmihalyi

Csikszentmihalyi's research is thorough, and the conclusions he draws are practical and solid. You can change the way you work and enter a concentrated, enjoyable state that increases your skill more often. This book is profound from the very first chapter. He attempts to answer the question: What is happiness? And looks at how it can be achieved. His is not a pie-in-the-sky view, but pragmatic through and through.

Learned Optimism
by Martin E. P. Seligman, Ph.D.

Learn about how depression and pessimism develop and what you can do to eliminate much of it from your life. This is one of our favorite self-help books of all time. It is destined to be a classic. Seligman gives you a little history of psychological thinking through this century, and how we came to the understanding we now have through cognitive science. He shows you how your thoughts affect your feelings, and how those feelings affect your actions, your ability to persist and succeed, your health, your relationships, and so on. He talks a lot about the research, but in an interesting way. Not at all boring or overly scientific.

 Self-Help Stuff That Works
by Adam Khan

The best of the best of self-help. One hundred and seventeen short chapters on improving your attitude, preventing unnecessary negative emotions, being appreciated by the people you love, experiencing less stress, and more. The best use of this book is to consult it when you're down: When you feel upset or worried or angry or frustrated or stressed out. Browse through it, and you'll find a chapter that resolves your bad feelings right away. Keep it easily accessible and watch the quality of your life improve over time as you change your habits one chunk at a time.

Good Mood
by Julian Simon

This is an excellent overview of the practical insights of cognitive science. And Simon adds a genuinely original contribution to the field: The idea that all our depressing thoughts spring from our universal tendency to compare ourselves or our circumstances to someone or something else. If the comparison is good, we feel good; if it is bad, we feel bad.

Of course, if you look at your own life in an overly negative or pessimistic way, your comparison may turn out worse than it really is, making you feel bad unnecessarily. And if you decide you're helpless to improve your state, that will make you depressed. From the simple idea of comparison, all the different modes of cognitive science are clarified and fit into the larger picture. Simon normally writes on economics. He wrote this book because of his own personal struggle with depression.

Man's Search for Meaning
by Viktor E. FranklFrankl was a prisoner of Hitler's concentration camps, and tells about his experiences. He also points out that he saw first hand that when a person feels his life has some meaning or purpose, that person was not only an inspiration to others, but could withstand more suffering without collapsing than a person who had no reason to try. Purpose gives strength and aliveness and meaning. It makes all the difference.How to Win Friends and Influence People
by Dale Carnegie

This is the classic book on dealing with people, whether you want to simply make new friends or change someone's behavior or persuade someone to change her mind, you'll find useful, practical principles here. When the techniques are used with honesty and sincerity, you can reach a new level of kindness and courtesy in your dealings with people. Being assertive or being your honest self does not have to negate courtesy and politeness. Carnegie's book has often been criticized as a shallow way of manipulating people. But Carnegie makes very clear that the practice of the principles is a new way of life, and if you use them only as a bag of manipulative tricks, you will reap the superficial relationships you deserve.

Feeling Good
by David D. Burns, M.D.

If depression or pessimism is a problem for you, this book needs to be in your arsenal. It is clear, practical instruction on what you can do about depression. His list of ten cognitive distortions is worth memorizing even if you don't have a problem with depression, because they are the same distortions we make when we're upset or worried or angry. Once you know what distortions to look out for, you can spot them and therefore defend yourself against their destructive influence.

Self-Help Without the Hype
by Robert Epstein

This book is short and simple and presents three powerful ways of making changes in your life without having to rely on your own memory or willpower, and without needing to be someone you're not. The content is excellent. It's got some typos, but it's worth reading. It is written One-Minute-Manager style. It is a story of a novice learning from a master. Good, simple, clear, powerful. I highly recommend it.

Unstoppable
by Cynthia Kersey

This is an excellent collection of true, inspiring stories of people who not only succeeded, but succeeded at a worthy goal. If you liked Just Keep Planting, you'll love this book. Besides the stories, there are short essays by successful people, encouraging you to cast your fears aside and go for it.

Why Marriages Succeed or Fail
by John Gottman, Ph.D.

Gottman explains exactly how to avoid what ruins marriages. About 25 years ago, he started interviewing newlyweds in his laboratory. He hooked them up to devices that measure physical responses (blood pressure, heart rate, sweat on the palms, etc.) and videotaped them while they discussed a subject that was volatile for them. He was then able to go back and study the videotapes and watch the records of blood pressure and heart rate and see how the person responded both outwardly and inwardly. And then he tracked these couples over the years. Some broke up. Some stayed together. He found something very specific that enabled him to predict, with an astoundingly high degree of accuracy, who will break up and who will stay together: How they fight.

Gottman's most important discovery, I think, is that it isn't the content of the fight that makes a difference, it's the process you use during an argument. If you use a lousy method of fighting, it doesn't matter if you're only arguing about a toothpaste tube, it can destroy your marriage.

The Evolving Self
by Mihaly Csikszentmihalyi

This book expands the work Csikszentmihalyi started in Flow, but while Flow was mainly concerned with turning individual tasks into a more flow-inducing experience, The Evolving Self teaches how to turn your whole life into an ongoing flow experience and gives some interesting historical examples of how that has been done.

Using Your Brain For a Change
by Richard Bandler

Bandler is an innovator and an original thinker in the field of psychology. This book is a transcript of Bandler live in front of an audience, cutting up and cracking jokes as he is prone to do, talking about some of his unique and often practical views on how you can change your feelings, thoughts and behavior. Change is often easier than you think if you use the right method.

How We Know What Isn't So
by Thomas Gilovich

This is an academic book, but very interesting. It is full of studies showing that the very strengths of our human brains are also the cause of many of our most common mistaken beliefs. For example, our ability to generalize and see patterns from incomplete information is a highly intelligent skill that has been difficult to develop in computers. Yet that same intelligence-producing skill is also responsible for faulty conclusions we've jumped to. Our brain is so predisposed to see patterns, it sometimes sees a pattern that actually doesn't exist. The value of this book is that once you recognize the inherent weaknesses in your brain, you can compensate for them. In fact, the scientific method was developed to do exactly that: Compensate for our own tendency to misperceive reality and keep us from fooling ourselves.

Voluntary Simplicity
by Duane Elgin

We have too much stuff, and after the continual bombardment of advertising since childhood, we are under the delusion that buying, having, owning material possessions will make us happy. Many are snapping out of the trance, and this book is a record of what people do when they realize things aren't the source of happiness.

How to Stubbornly Refuse to Make Yourself Miserable About Anything - Yes Anything!
by Albert Ellis, Ph.D.

Ellis is a pioneer in the field of cognitive therapy, and has been at it so long, he has boiled it down to some fundamental simplicities, making his work very accessible and practical. This is one of his newer books, and gets to the heart of the matter, clearly, succinctly, and in a way that you can use immediately.

Tao: The Watercourse Way
by Alan Watts

Watts is an enjoyable writer to read, and here you'll find penetrating insight into the Taoist perspective on life and why it can bring a greater peace of mind. This was the last book Watts wrote. In fact, he didn't actually finish it before he died, but what he left is worth reading. Watts often doesn't merely convey information but creates an experience, so that while you read, you understand, not just intellectually, but emotionally as well.

Endurance
by Alfred Lansing

This has become a classic story. It is the ordeal Earnest Shackleton and his crew of 27 men endured from 1914 to 1916 as they became stranded in the Antarctic wasteland. It is a story of patience and courage, of hardship and leadership, of attitude control and optimism.

Heart of the Mind
by Connirae Andreas, Ph.D. and Steve Andreas, M.A.

This book is a basic primer of neurolinguistic programming (NLP). It's easy to read and if you've never read anything about NLP, it's an eye-opener. The approach to emotional difficulties is novel, having come ultimately from Milton Erickson and his innovations in hypnotic trances. One of the creators of NLP, Richard Bandler, said that he tried to find ways of accomplishing hypnotic benefits without using hypnosis, and the result was NLP.

Mindfulness
by Ellen J. Langer

Langer's research is known all over the world for its originality. She looks deeply at the mindlessness we all share, and she explains what you personally can do about your own mindlessness.

Growth Through Reason
by Albert Ellis

This is a book of transcripts of actual Rational-Emotive Therapy sessions. It's a good look at how the theory gets put into practice and what it can do. Reading these exchanges, you get the basic ideas in a lively and interesting way.

The Structure of Magic, Vol. 1
by Richard Bandler and John Grinder

This is a technical breakdown of how we make a map of the world, and how our language reveals the map we've made, and also how you can change the way you use language to improve your map. It is pure, unadulterated genius.

Opening Up
by James W. Pennebaker, Ph.D.

Pennebaker's research has become world famous. When you share a traumatic or painful experience with someone you trust (or even merely write it out in a journal), you will enjoy better health. Opening up is healthy. Keeping yourself closed off from others is unhealthy. Pennebaker shows you why and how you can open up.

Anger: The Misunderstood Emotion
by Carol Tavris

Full of good research, this book shows that much of our commonplace understanding of anger is dangerously off-base. If you have a lot of anger in your life, this is definitely a book you could profitably read five or six times. The book debunks many myths; for instance, the myth of suppressed anger. You'll also learn how to deal with your anger in a healthy way, and how to change the way you think so you can prevent feeling angry in the first place.

What You Can Change and What You Can't
by Martin E. P. Seligman, Ph.D.

This is a top-shelf self-help book. Seligman demonstrates his broad and deep knowledge of all kinds of emotional and psychological problems like anger and anxiety, and tells you what the research has so far revealed about what you can do to improve.

Self-Help Stuff That Works
by Adam Khan

The best of the best of self-help. One hundred and seventeen power-packed short chapters on improving your attitude, preventing unnecessary negative emotions, being appreciated by the people you love, experiencing less stress, and more. The best use of this book is to consult it when you're down: When you feel upset or worried or angry or frustrated or stressed out. Browse through it, and you'll find a chapter that resolves your bad feelings right away. Keep it easily accessible and watch the quality of your life improve over time as you change your habits one chunk at a time.

Think and Grow Rich
by Napoleon Hill

This is the classic success book. With his thirteen principles, Hill explains what a person can do to find a definite chief aim in life, to gain control over his own thoughts, and to stay optimistic and persistent in the pursuit of that aim until it is achieved.

Believe and Achieve
by Samuel A. Cypert

This is a modern version, complete with new research and more modern anecdotes, covering the same 17 principles as Success Through a Positive Mental Attitude.

Playing Ball On Running Water
David K. Reynolds, Ph.D.

This book, as well as the one above, are a delineation of Reynolds' synthesis of Naikan and Morita therapies into a westernized version of self-help, called Constructive Living. This book is interesting, thought provoking, and relentlessly practical. The Constructive Living approach is especially useful for someone who has a lot of psychology training or someone who is often timid or neurotic.

Would it make a difference to you to really pay attention to your ongoing moment-by-moment experience once in a while? Find out here:
American Reading Ceremony

Momentary sources of stress are not the most dangerous. It is the stresses that last that wreak the greatest havoc. Find out how to lessen that kind of stress:
Stress Control

Select from six different chapters from the book on how to make those insights and ideas make a real difference in your life:
Making Changes Stick

When a close friend of yours or your spouse is disturbed by something, and you want to help them, what do you do? What actually helps? Find out here:

A Friend in Deed

When Steven Callahan was struggling to survive during his seventy-six days on a life raft, what did he do with his mind that gave him the strength to continue? Read about it here:
Adrift

next: Are You The One?

Chapter 54 of the book Self-Help Stuff That Works
by Adam Khan

IT'S NICE TO BE LIKED, but it is even more satisfying to be respected. And although it takes some effort, you can attain that desire. Here are three places your effort will increase the respect you get from people:

Increase your competence. People respect ability and skill, as long as you are noticeably good. This means trying to be a jack-of-all-trades doesn't work. Concentrate your efforts. Choose a useful ability and hone yourself into the Mozart of that ability. If the skill is used at your job, your increasing competence may bring you a new pay level too. Work on improving your ability whenever you can. Become a master.

Use good manners. Without using please and thank you and would you mind, without saying hi to people and learning their names and interests, you will not earn people's respect. Even if you're competent, you will be resented rather than admired.

Speak up rather than smolder. Do it with good manners, but speak. It takes courage to speak up, and people know that and respect it. But when you speak up, make requests rather than simply complaining. Don't say what you don't like about what's already been done; say what you'd like to see in the future. And think it through beforehand so you say it well.

DON'T WORRY about whether or not people like you. Concentrate on competence and good manners and saying what you need to say, and you'll get more than liking. You'll get even more than respect from others. You'll earn the reward that might matter more than any other: You'll respect yourself.

Increase your competence, use good manners, and speak up rather than smolder.

Discipline is important when you are a leader of people, a manager or a parent. Learn more about the fine art of being
An Island of Order in a Sea of Chaos

Does it bother you that some people where you work complain all the time? Do you wonder what you can do about it? Check this out:
Complaint Compunctions

next: A Terrible Thing to Waste

Learn about Relaxation Therapy and whether it's really helpful for anxiety, stress, depression, OCD, PTSD, insomnia, fibromyalgia and chronic pain.

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

• Background
• Theory
• Evidence
• Unproven Uses
• Potential Dangers
• Summary
• Resources

Background

Numerous relaxation techniques and behavioral therapeutic approaches exist, with a range of philosophies and styles of practice. Most techniques involve repetition (of a specific word, sound, prayer, phrase, body sensation or muscular activity) and encourage a passive attitude toward intruding thoughts.

Methods may be deep or brief:

• Deep relaxation methods include autogenic training, meditation and progressive muscle relaxation.

• Brief relaxation methods include self-controlled relaxation, paced respiration and deep breathing.

Other related techniques include guided imagery, passive muscle relaxation and refocusing. Applied relaxation often involves imagining situations to cause muscular and mental relaxation. Progressive muscle relaxation aims to teach people what it feels like to relax by comparing relaxation with muscle tension.

Relaxation techniques are taught by many types of health care professionals, including complementary practitioners, medical doctors, psychotherapists, hypnotherapists, nurses or sports therapists. There is no formal credentialing for relaxation therapy. Books, audiotapes or videotapes are sometimes used as teaching tools.

Theory

During stressful situations, the sympathetic nervous system increases activity, leading to the "fight-or-flight" response. Heart rate, blood pressure, breathing rate, blood supply to the muscles and dilation of the pupils often increase. It has been suggested that chronic stress may lead to negative effects on health such as high blood pressure, high cholesterol levels, upset stomach or gastrointestinal distress, and weakening of the immune system.

Harvard professor and cardiologist Herbert Benson, M.D., coined the term the "Relaxation Response" in the early 1970s to describe a state of the body that is the opposite of the stress response. The Relaxation Response is proposed to have the opposite effects of the stress response, including reduced sympathetic nervous system tone, increased parasympathetic activity, decreased metabolism, decreased blood pressure, decreased oxygen consumption and decreased heart rate. It is theorized that relaxation may counteract some of the negative long-term effects of chronic stress. Proposed relaxation techniques include massage, deep meditation, mind/body interaction, music- or sound-induced relaxation, mental imagery, biofeedback, desensitization, cognitive restructuring and adaptive self-statements. Rhythmic, deep, visualized or diaphragmatic breathing may be used.

One type of relaxation called Jacobson muscle relaxation, or progressive relaxation, involves flexing specific muscles, holding the tension and then relaxing. The technique involves progressing through muscle groups one at a time, beginning with the feet, up to the head, spending about one minute on each area. Progressive relaxation may be practiced while lying down or sitting. This technique has been proposed for psychosomatic disorders (those originating in the mind), pain relief and anxiety. The Laura Mitchell approach involves reciprocal relaxation, moving a part of the body in a direction opposite of an area of tension and then letting it go.

Evidence

Scientists have studied relaxation therapy for the following health problems:

Anxiety and stress
Numerous studies in humans suggest that relaxation therapy (for example, using audio tapes or group therapy) may moderately reduce anxiety, phobias such as agoraphobia (fear of crowds), dental fear, panic disorder and anxiety resulting from severe illnesses or before medical procedures. However, most research is not high quality, and it is not clear which specific relaxation approaches are most effective. Better evidence is needed before a strong recommendation can be made.

Depression
Early studies in humans report that relaxation may temporarily reduce symptoms of depression. Well-designed research is needed to confirm these results.

Insomnia
Several studies suggest that relaxation therapy may help people with insomnia fall asleep and stay asleep longer. Cognitive (mind) forms of relaxation such as meditation may be more effective than somatic (body) forms such as progressive muscle relaxation. Most studies are not well designed or reported. Better research is necessary before a firm conclusion can be drawn.

Pain
Most studies of relaxation for pain are poor quality and report conflicting results. Multiple types and causes of pain have been studied. Better research is necessary before a clear conclusion can be drawn.

High blood pressure
Relaxation techniques have been associated with reduced pulse rate, systolic blood pressure, diastolic blood pressure, lower perception of stress and enhanced perception of health. Further research is needed to confirm these results.

Premenstrual syndrome
There is early evidence that progressive muscle relaxation may improve physical and emotional symptoms associated with premenstrual syndrome. Better-quality research is necessary before a recommendation can be made.

Menopausal symptoms
There is promising early evidence from trials in humans supporting the use of relaxation therapy to temporarily reduce menopausal symptoms. Better-quality research is necessary before a firm conclusion can be drawn.

Headache
Preliminary evidence suggests that relaxation therapy may help reduce the severity of headaches in children and migraine symptoms in adults. Positive changes in self-perceived pain frequency, pain intensity and duration, quality of life, health status, pain related disability and depression have been reported. Additional research is necessary before a firm conclusion can be drawn.

Chemotherapy-induced nausea and vomiting
Early trials in humans report that relaxation therapy may be helpful in reducing nausea related to cancer chemotherapy. Better-quality research is necessary before a firm conclusion can be drawn.

Rheumatoid arthritis
Limited early research reports that muscle relaxation may improve function and quality of life in people with rheumatoid arthritis. More studies are needed to reach a firm conclusion.

Smoking cessation
Early research reports that relaxation with imagery may reduce relapse rates in people who successfully completed stop-smoking programs. Further research is needed before a recommendation can be made.

Facial paralysis
In a randomized clinical trial, mime therapy — including automassage, relaxation exercises, inhibition of synkinesis, coordination exercises and emotional expression exercises — was shown to be a good treatment choice for patients with sequelae of facial paralysis.

Fibromyalgia
Relaxation has been reported to reduce fibromyalgia pain in one randomized controlled study. However, results from other studies are conflicting, and therefore further research is needed before a clear recommendation can be made.

Osteoarthritis pain
In a randomized study of patients with osteoarthritis pain, Jacobson relaxation was reported to lower the level of subjective pain over time. The study concluded that relaxation may be effective in reducing the amount of analgesic medication taken by participants. Further well-designed research is needed to confirm these results.

Obsessive-compulsive disorder
Results of randomized controlled studies of relaxation techniques for obsessive-compulsive disorder show conflicting results. Further research is needed before conclusions can be drawn.

Asthma
Preliminary studies of relaxation techniques in individuals with asthma report a significant decrease in asthma symptoms, anxiety and depression, along with improvements in quality of life and measures of lung function. Further large trials in humans are needed to confirm these results.

Well-being
Studies assessing relaxation to improve psychological well-being and "calm" in multiple types of patients have reported positive results, although the results of most trials have not been statistically significant. Although this research is suggestive, additional work is merited before a firm conclusion can be drawn.

Irritable bowel disease
Early research in humans suggests that relaxation may aid in the prevention and relief of irritable bowel disease symptoms. Large, well-designed trials are needed to confirm these results.

HIV/AIDS
Mental health and quality-of-life improvements have been seen in preliminary studies of HIV/AIDS patients. These findings suggest the need for further, well-controlled research.

Tinnitus (ringing in the ears)
Relaxation therapy has been associated with benefits in preliminary studies of tinnitus patients. Further research is needed to confirm these results.

Huntington's disease
Preliminary research in patients with Huntington's disease has evaluated the effects of either multisensory stimulation or relaxation activities (control) for four weeks, with unclear results. Further research is necessary before a conclusion can be drawn.

Angina
Preliminary research in patients with angina reports that relaxation may reduce anxiety, depression, frequency of angina episodes, medication need and physical limitations. Large well-designed studies are needed to confirm these results.

Myocardial infarction (heart attack)
Initial research in which patients were given an advice and relaxation audiotape within 24 hours of hospital admission for a heart attack found a reduction in the number of misconceptions about heart disease, but no benefits on measured health-related outcomes.

Post-traumatic stress disorder
Relaxation has been studied for post-traumatic stress disorder with no benefit seen in these patients.

Neurocardiogenic syncope
A small study showed that biofeedback-assisted relaxation benefits patients with neurocardiogenic syncope. Further study is necessary to confirm these results.

Unproven Uses

Relaxation therapy has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using relaxation therapy for any use.

Potential Dangers

Most forms of relaxation therapy are considered safe in healthy adults, and severe adverse effects have not been reported. It has been theorized that relaxation therapy may increase anxiety in some individuals or that it may cause autogenic discharges (sudden, unexpected emotional experiences characterized by pain, heart palpitations, muscle twitching, crying spells or increased blood pressure). People with psychiatric disorders such as schizophrenia or psychosis should avoid relaxation therapy unless recommended by a qualified health care provider. Relaxation techniques that involve inward focusing may intensify a depressed mood, although this has not been clearly shown in scientific studies.

Jacobson relaxation techniques (flexing specific muscles, holding the tension, then relaxing the muscles) and similar approaches should be used cautiously by people with heart disease, high blood pressure or musculoskeletal injuries.

Relaxation therapy is not recommended as the sole treatment for potentially severe medical conditions. It should not delay diagnosis by a qualified health care provider and treatment with more proven techniques.

Summary

Relaxation therapy has been suggested for many conditions. Early scientific evidence suggests that relaxation may play a role in treating anxiety, although better studies are needed that identify which approaches are most effective. Research also reports possible effectiveness for anxiety, depression, pain, insomnia, premenstrual syndrome and headache, although this evidence is early and better studies are needed to form clear conclusions. Relaxation is generally believed to be safe when practiced appropriately, but it should not be used as the sole treatment for severe illnesses.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

Resources

1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Relaxation Therapy

Natural Standard reviewed more than 320 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Arntz A. Cognitive therapy versus applied relaxation as treatment of generalized anxiety disorder. Behav Res Ther 2003;Jun, 41(6):633-646.
2. Astin JA. Mind-body therapies for the management of pain. Clin J Pain 2004;20(1):27-32.
3. Beck JG, Stanley MA, Baldwin LE, et al. Comparison of cognitive therapy and relaxation training for panic disorder. J Consult Clin Psychol 1994;62(4):818-826.
4. Berger AM, VonEssen S, Kuhn BR, et al. Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: results of a feasibility intervention study. Oncol Nurs Forum 2003;May-Jun, 30(3):513-522.
5. Biggs QM, Kelly KS, Toney JD. The effects of deep diaphragmatic breathing and focused attention on dental anxiety in a private practice setting. J Dent Hyg 2003;Spring, 77(2):105-113.
6. Blanchard EB, Appelbaum KA, Guarnieri P, et al. Five year prospective follow-up on the treatment of chronic headache with biofeedback and/or relaxation. Headache 1987;27(10):580-583.
7. Borkovec TD, Newman MG, Pincus AL, Lytle R. A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. J Consult Clin Psychol 2002;Apr, 70(2):288-298.

1. Boyce PM, Talley NJ, Balaam B. A randomized controlled trial of cognitive behavior therapy, relaxation training, and routine clinical care for the irritable bowel syndrome. Am J Gastroenterol 2003;98(10):2209-2218.
2. Broota A, Dhir R. Efficacy of two relaxation techniques in depression. J Pers Clin Stud 1990;6:83-90.
3. Bugbee ME, Wellisch DK, Arnott IM, et al. Breast core-needle biopsy: clinical trial of relaxation technique versus medication versus no intervention for anxiety reduction. Radiology 2005;234(1):73-78.
4. Carroll D, Seers K. Relaxation for the relief of chronic pain: a systematic review. J Adv Nurs 1998;27(3):476-487.
5. Cheung YL, Molassiotis A, Chang AM. The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psychooncology 2003;Apr-May, 12(3):254-266.
6. Cimprich B, Ronis DL. An environmental intervention to restore attention in women with newly diagnosed breast cancer. Cancer Nurs 2003;Aug, 26(4):284-292. Quiz, 293-294.
7. Deckro GR, Ballinger KM, Hoyt M, et al. The evaluation of a mind/body intervention to reduce psychological distress and perceived stress in college students. J Am Coll Health 2002;May, 50(6):281-287.
8. Delaney JP, Leong KS, Watkins A, Brodie D. The short-term effects of myofascial trigger point massage therapy on cardiac autonomic tone in healthy subjects. J Adv Nurs 2002;Feb, 37(4):364-371.
9. Diette GB, Lechtzin N, Haponik E, et al. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia. Chest 2003;Mar, 123(3):941-948.
10. Edelen C, Perlow M. A comparison of the effectiveness of an opioid analgesic and a nonpharmacologic intervention to improve incentive spirometry volumes. Pain Manag Nurs 2002;Mar, 3(1):36-42. +
11. Egner T, Strawson E, Gruzelier JH. EEG signature and phenomenology of alpha/theta neurofeedback training versus mock feedback. Appl Psychophysiol Biofeedback 2002;Dec, 27(4):261-270.
12. Engel JM, Rapoff MA, Pressman AR. Long-term follow-up of relaxation training for pediatric headache disorders. Headache 1992;32(3):152-156.
13. Eppley KR, Abrams AI, Shear J. Differential effects of relaxation techniques on trait anxiety: a meta-analysis. J Clin Psychol 1989;45(6):957-974.
14. Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial. J Psychiatr Res 2002;May-Jun, 36(3):179-187.
15. Foster RL, Yucha CB, Zuk J, Vojir CP. Physiologic correlates of comfort in healthy children. Pain Manag Nurs 2003;Mar, 4(1):23-30.
16. Gay MC, Philippot P, Luminet O. Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson [correction of Erickson] hypnosis and Jacobson relaxation. Eur J Pain 2002;6(1):1-16.
17. Ginsburg GS, Drake KL. School-based treatment for anxious african-american adolescents: a controlled pilot study. J Am Acad Child Adolesc Psychiatry 2002;Jul, 41(7):768-775.
18. Good M, Anderson GC, Stanton-Hicks M, et al. Relaxation and music reduce pain after gynecologic surgery. Pain Manag Nurs 2002;Jun, 3(2):61-70.
19. Good M, Stanton-Hicks M, Grass JA, et al. Relaxation and music to reduce postsurgical pain. J Adv Nurs 2001;33(2):208-215.
20. Goodale IL, Domar AD, Benson H. Alleviation of premenstrual syndrome symptoms with the relaxation response. Obstet Gynecol 1990;75(4):649-655.
21. Grazzi L, Andrasik F, Usai S, et al. Pharmcological behavioural treatment for children and adolescents with tension-type headache: preliminary data. Neurol Sci 2004;25(Suppl 3):270-271.
22. Greist JH, Marks IM, Baer L, et al. Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. J Clin Psychiatry 2002;Feb, 63(2):138-145.
23. Grover N, Kumaraiah V, Prasadrao PS, D'Souza G. Cognitive behavioural intervention in bronchial asthma. J Assoc Physicians India 2002;Jul, 50:896-900.
24. Halpin LS, Speir AM, CapoBianco P, Barnett SD. Guided imagery in cardiac surgery. Outcomes Manag 2002;Jul-Sep, 6(3):132-137.
25. Hanley J, Stirling P, Brown C. Randomised controlled trial of therapeutic massage in the management of stress. Br J Gen Pract 2003;Jan, 53(486):20-25.
26. Harvey L, Inglis SJ, Espie CA. Insomniacs' reported use of CBT components and relationship to long-term clinical outcome. Behav Res Ther 2002;Jan, 40(1):75-83.
27. Hattan J, King L, Griffiths P. The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial. J Adv Nurs 2002;Jan, 37(2):199-207.
28. Hockemeyer J, Smyth J. Evaluating the feasibility and efficacy of a self-administered manual-based stress management intervention for individuals with asthma: results from a controlled study. Behav Med 2002;Winter, 27(4):161-172.
29. Hoebeke P, Van Laecke E, Renson C, et al. Pelvic floor spasms in children: an unknown condition responding well to pelvic floor therapy. Eur Urol 2004;46(5):651-654; discussion, 654.
30. Houghton LA, Calvert EL, Jackson NA, et al. Visceral sensation and emotion: a study using hypnosis. Gut 2002;Nov, 51(5):701-704.
31. Irvin JH, Domar AD, Clark C, et al. The effects of relaxation response training on menopausal symptoms. J Psychosom Obstet Gynaecol 1996;17(4):202-207.
32. Jacob RG, Chesney MA, Williams DM, et al. Relaxation therapy for hypertension: design effects and treatment effects. Ann Behav Med 1991;13(1):5-17.
33. Jacobs GD, Rosenberg PA, Friedman R, et al. Multifactor behavioral treatment of chronic sleep-onset insomnia using stimulus control and the relaxation response: a preliminary study. Behav Modif 1993;17(4):498-509.
34. Kircher T, Teutsch E, Wormstall H, et al. Effects of autogenic training in elderly patients [Article in German]. Z Gerontol Geriatr 2002;Apr, 35(2):157-165.
35. Kober A, Scheck T, Schubert B, et al. Auricular acupressure as a treatment for anxiety in prehospital transport settings. Anesthesiology 2003;Jun, 98(6):1328-1332.
36. Kohen DP. Relaxation/mental imagery (self-hypnosis) for childhood asthma: behavioral outcomes in a prospective, controlled study. Hypnos 1995;22:132-144.
37. Kroener-Herwig B, Denecke H. Cognitive-behavioral therapy of pediatric headache: are there differences in efficacy between a therapist-administered group training and a self-help format? J Psychosom Res 2002;Dec, 53(6):1107-1114.
38. Kroner-Herwig B, Frenzel A, Fritsche G, et al. The management of chronic tinnitus: comparison of an outpatient cognitive-behavioral group training to minimal-contact interventions. J Psychosom Res 2003;Apr, 54(4):381-389.
39. Lechner SC, Antoni MH, Lydston D, et al. Cognitive-behavioral interventions improve quality of life in women with AIDS. J Psychosom Res 2003;Mar, 54(3):253-261.
40. Lee DW, Chan KW, Poon CM, et al. Relaxation music decreases the dose of patient-controlled sedation during colonoscopy: a prospective randomized controlled trial. Gastrointest Endosc 2002;Jan, 55(1):33-36.
41. Lemstra M, Stewart B, Olszynski WP. Effectiveness of multidisciplinary intervention in the treatment of migraine: a randomized clinical trial. Headache 2002;Oct, 42(9):845-854.
42. Leng TR, Woodward MJ, Stokes MJ, et al. Effects of multisensory stimulation in people with Huntington's disease: a randomized controlled pilot study. Clin Rehabil 2003;Feb, 17(1):30-41.
43. Lewin RJ, Furze G, Robinson J, et al. A randomised controlled trial of a self-management plan for patients with newly diagnosed angina. Br J Gen Pract 2002;Mar, 52(476):194-196, 199-201.
44. Lewin RJ, Thompson DR, Elton RA. Trial of the effects of an advice and relaxation tape given within the first 24 h of admission to hospital with acute myocardial infarction. Int J Cardiol 2002;Feb, 82(2):107-114. Discussion, 115-116.
45. Lichstein KL, Peterson BA, Riedel BW, et al. Relaxation to assist sleep medication withdrawal. Behav Modif 1999;23(3):379-402.
46. Livanou M, Basoglu M, Marks IM, et al. Beliefs, sense of control and treatment outcome in post-traumatic stress disorder. Psychol Med 2002;Jan, 32(1):157-165.
47. Machiko T, Katsutaro N, Chika O. A study of psychoneuroendocrinological effects of music therapy [Article in Japanese]. Seishin Shinkeigaku Zasshi 2003;105(4):468-472.
48. Mandle CL, Jacobs SC, Arcari PM, et al. The efficacy of relaxation response interventions with adult patients: a review of the literature. J Cardiovasc Nurs 1996;10(3):4-26.
49. Mastenbroek I, McGovern L. The effectiveness of relaxation techniques in controlling chemotherapy induced nausea: a literature review. Austral Occupat Ther J 1991;38(3):137-142.
50. Mataix-Cols D, Marks IM, Greist JH, et al. Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: results from a controlled trial. Psychother Psychosom 2002;Sep-Oct, 71(5):255-262.
51. McCain NL, Munjas BA, Munro CL, et al. Effects of stress management on PNI-based outcomes in persons with HIV disease. Res Nurs Health 2003;Apr, 26(2):102-117.
52. McGrady AV, Kern-Buell C, Bush E, et al. Biofeedback-assisted relaxation therapy in neurocardiogenic syncope: a pilot study. Appl Psychophysio Biofeedback 2003;28(3):183-192.
53. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain 1999;80(1-2):1-13.
54. Murray LL, Kim HY. A review of select alternative treatment approaches for acquired neurogenic disorders: relaxation therapy and acupuncture. Semin Speech Lang 2004;25(2):133-149.
55. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. JAMA 1996;276(4):313-318.
56. Okvat HA, Oz MC, Ting W, Namerow PB. Massage therapy for patients undergoing cardiac catheterization. Altern Ther Health Med 2002;May-Jun, 8(3):68-70, 72, 74-75.
57. Ost LG, Breitholtz E. Applied relaxation vs. cognitive therapy in the treatment of generalized anxiety disorder. Behav Res Ther 2000;38(8):777-790.
58. Ostelo RW, van Tulder MW, Vlaeyen JW, et al. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev 2005;Jan 25(1):CD002014.
59. Pallesen S, Nordhus IH, Kvale G, et al. Behavioral treatment of insomnia in older adults: an open clinical trial comparing two interventions. Behav Res Ther 2003;Jan, 41(1):31-48.
60. Passchier J, van den Bree MB, Emmen HH, et al. Relaxation training in school classes does not reduce headache complaints. Headache 1990;30(10):660-664.
61. Pawlow LA, O'Neil PM, Malcolm RJ. Night eating syndrome: effects of brief relaxation training on stress, mood, hunger, and eating patterns. Int J Obes Relat Metab Disord 2003;Aug, 27(8):970-978.
62. Petersen RW, Quinlivan JA. Preventing anxiety and depression in gynaecological cancer: a randomised controlled trial. BJOG 2002;Apr, 109(4):386-394.
63. Piazza-Waggoner CA, Cohen LL, Kohli K, Taylor BK. Stress management for dental students performing their first pediatric restorative procedure. J Dent Educ 2003;May, 67(5):542-548.
64. Popova EI, Ivonin AA, Shuvaev VT, Mikheev VF. Neurophysiological mechanisms of acquisition of fear-resistance habit controlled by biological feedback displayed by skin galvanic response [Article in Russian]. Zh Vyssh Nerv Deiat Im I P Pavlova 2002;Sep-Oct, 52(5):563-569.
65. Rankin EJ, Gilner FH, Gfeller JD, et al. Efficacy of progressive muscle relaxation for reducing state anxiety among elderly adults on memory tasks. Percept Mot Skills 1993;77(3 Pt 2):1395-1402.
66. Renzi C, Peticca L, Pescatori M. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results. Int J Colorectal Dis 2000;15(5-6):313-316.
67. Richards SC, Scott DL. Prescribed exercise in people with fibromyalgia: parallel group randomised controlled trial. BMJ 2002;Jul 27, 325(7357):185.
68. Rybarczyk B, Lopez M, Benson R, et al. Efficacy of two behavioral treatment programs for comorbid geriatric insomnia. Psychol Aging 2002;Jun, 17(2):288-298.
69. Sander Wint S, Eshelman D, Steele J, Guzzetta CE. Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer. Oncol Nurs Forum 2002;Jan-Feb, 29(1):E8-E15.
70. Schofield P. Evaluating Snoezelen for relaxation within chronic pain management. Br J Nurs 2002;Jun 27-Jul 10, 11(12):812-821.
71. Schofield P, Payne S. A pilot study into the use of a multisensory environment (Snoezelen) within a palliative day-care setting. Int J Palliat Nurs 2003;Mar, 9(3):124-130. Erratum in: Int J Palliat Nurs 2003;Apr, 9(4):178.
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Overview of exercise as an alternative treatment for depression and whether exercise works in treating depression.

What is Exercise Therapy?

There are two main types of exercise: exercise which builds up the heart and lungs (such as running) and exercise which strengthens arms and legs (such as weight training).

How does Exercise Therapy work?

There are many views as to how exercise works to reduce depression symptoms. Exercise may block negative thoughts or distract depressed people from daily worries. If a person exercises with others, exercise may increase social contact. Increased fitness may lift mood. Exercise may increase levels of neurotransmitters (chemical messengers) that have been found to be in short supply in depression. Exercise may increase endorphins, which are chemicals in the brain that have 'mood-lifting' qualities.

Is Exercise Therapy effective?

A number of studies have found that exercise helps depression. Jogging, weightlifting, walking, stationary bicycling and resistance training (pushing or pulling weights with arms and legs) have all been found to be helpful. Exercise has been found to be more helpful than relaxation therapy, health education and light therapy. In older people, exercise has been found to be as helpful as antidepressant medication or social contact. Unfortunately, the number of good studies in this area is small, and further work needs to be done.

Are there any disadvantages to Exercise Therapy?

People can injure themselves doing exercise. People over 35 years of age should seek a medical check up before starting strenuous exercise. People with bone or heart problems may not be able to do all forms of exercise.

Where do you get Exercise Therapy?

Strenuous exercise such as jogging, running and walking can be done outside in parks or bicycle tracks. Stationary bicycles can be purchased or hired from sports or bicycle stores. Resistance training is available at gyms and health clubs.

Recommendation

There is evidence that physical exercise helps depression. Further research is required to confirm its effectiveness in younger people.

Key references

Singh NA, Clements KM, Fiatarone MA. A randomised controlled trial of progressive resistance training in depressed elders. Journal of Gerontology 1997; 52A: M27-M35.

Blumenthal JA, Babyak MA, Moore KA et al. Effects of exercise training on older patients with major depression. Archives of Internal Medicine, 1999; 159: 2349-2356.

McNeil JK, LeBlanc EM, Joyner M. The effect of exercise on depressive symptoms in the moderately depressed elderly. Psychology and Aging 1991; 6: 487-488.

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