Psychology

Question 1A
Progressive muscle relaxation (PMR) is a technique used for stress and anxiety management. This technique exploits two steps Deliberate tensing up of the muscles and releasing the induced tension to create relaxation. This technique was developed by Dr.Edmund Jacobson fifty years ago when he discovered that muscles can be relaxed by first tensing it and then releasing it. Tensing and releasing the various muscle groups in the body produces a deep relaxation state which can relieve many conditions like high blood pressure. This technique is especially effective in people with anxiety that is associated with muscle tension. Lehrer et al (2007) suggests that before starting the progressive muscle relaxation procedure, one should take several deep diaphragmatic breaths after which the following procedures are carried out

A quiet dimly lit room with a comfortable temperature should be chosen and then the patient should be allowed to lie down or sit comfortably with the eyes closed. The patient should then breathe in deeply through the nose, hold the breath for a few seconds and then completely release it through the slightly parted lips. This process should be repeated several times and the affected person should be encouraged to imagine the body becoming warm and heavy and letting go any tension that may build up. As the breathing continues slowly, both fists should be clenched along with a continuous process of squeezing them as hard as possible. Both biceps should then be tightened and the tension held for several seconds. The tension should then be released and focus laid on the change in sensations. In addition, all the tension in the fingers, hands and arms should also be released at this point. The patient should then extend the fingers slightly while letting the arms drop to hisher side and at the same time try to keep the hands open to feel the last remnants of tension floating away. Thereafter, the initial in and out breathing should be resumed very slowly with the feel of heaviness and warmth being experienced at the same time.

Progressive muscle relaxation should be continued in this manner until all the major body muscle groups have are sequentially tensed for several seconds and then relaxed (Lehrer et al, 2007).

Question 1B
 Muscle tension refers to the condition in which muscles remain in a semi-contracted state for an extended period and its typically caused by the physiological effects of stress. This happens when the bodys nervous system constricts blood vessels and reduces blood flow to the muscles. On the other hand, relaxation is the elongation of muscle fibers which eliminates the tension sensation. After a period of tension exertion, a muscle does not only quickly relax back to its pre-tensed state but it becomes even more relaxed than it was before tension was created. When this procedure of creating tension and releasing it is applied to every major muscle in the body, a feeling of relaxation is experienced .To achieve the benefit of both physical and mental relaxation, the body must always stay as relaxed as possible. This is possible if there is a positive transfer of the muscle relaxation technique into daily activities (Lehrer et al, 2007).

Question1C
According to the principle of muscle physiology, muscles have to relax whenever tension is exerted on them and this normally happens naturally because muscles must react in that manner to tension. Little oxygen is required for a relaxed muscle hence the breathing rate is slow and since the heart does not need to be beating so fast to supply oxygen to tense muscles, the heart rate and blood pressure fall. Normal blood flow takes place making the hands and feet to become warm and as a result, the voluntary muscles become directed into a state of relaxation leaving the body with a calm and refreshing feeling. Progressive muscle relaxation is based on the fact that the covert functions of the body can be controlled through slight muscle tensions. As such, the tension sensation is commonly referred to as the control signal because it basically controls the bodys activities. Muscles achieve this function of control when they interact with the brain through neuromuscular circuits. This happens when the neural impulses generated by contracting muscles send messages to the brain resulting into complex events and then the neural impulses return to the muscles through neural pathways. Numerous neuromuscular circuits in the body reverberate in the same way to carry out various body functions. Relaxation of the muscle controls usually produce a state of rest throughout the neuromuscular circuits with reduced activity of the brain (Lehrer et al, 2007).

Question 1D
The theory behind progressive muscle relaxation is based on Jacobsons rationale which assumes that anxiety and other emotional states usually involve subjective, behavioral and physiological components that interact to create an ongoing emotional experience. Jacobson goes ahead to give an example that when physiological activation which may bring about panic, cognitive flooding and a variety of other behavioral and physiological consequences. Therefore progressive muscle relaxation comes in handy to provide a way of reducing autonomic activation. It is also believed that over activation of the sympathetic nervous system is mainly responsible for the excessive skeletal muscle activity and when this activity is reduced, the result is progressive relaxation. (Lehrer et al, 2007).

Question 2A
Hypnosis is a condition in which someone is usually induced by another person and the subject stays in a state of subconsciousness and responds with certain limitations to the suggestions of the hypnotist. The hypnosis technique is based on a theoretical foundation that recognizes that a human being has a system of nerve cells, nerve fibers and a central brain. Together, all these determine the actions and behavior of a person. This system triggers movement and functions in the human body. The causes of these actions are vivid visualizations and dynamic ideas which can come from a persons own self and can penetrate through the senses from the outside. In hypnosis, a persons self is deactivated and the senses are activated hence the visualizations and dynamic ideas that come from the exterior can directly enter into the body system unhindered and trigger some actions. The activation of the self center that makes the actual self to become passive are known to allow a purposeful redirection of blood flow patterns (Lehrer et al, 2007).

Autogenic training refers to the psychologic method of psychotherapy which uses passive concentration together with some combinations of psychophysiologically adapted stimuli. Its a clinically recognized technique for improving stress management and it helps to bring about changes which are generated from within the body system. The main aim of this technique is to allow the bodys self regulating, homeostatic mechanism to become activated in order to initiate the needed repair. Autogenic training is based on the following theoretical foundation Johannes Heinrich, the creator of Autogenic training, believed that the body can carry out self regulatory roles and self healing powers of the body if its left to do its programmed work. Although the most common application of this technique is to reduce excessive autonomic arousal, its rationale mainly lies in a bidirectional homeostatic model. This model suggests that Autogenic training should be equally useful in raising dysfunctional low levels of an autonomic function like low heart rate variability. The objective of this technique is to allow self regulation through passive concentration otherwise known as self hypnosis. Autogenic training is designed to strengthen independence and to give back control to the patient hence eliminating the need for physiological feedback devices (Lehrer et al, 2007).

Autogenic biofeedback is a technique of stress management which represents an integration of two distinct and self regulatory techniques autogenic training and biofeedback. The following theoretical foundation underlies the autogenic biofeedback technique. This method was developed in the context of existentialism and was derived from the basic concept that human beings have an innate regulatory mechanism that can restore the brain and body processes to optimum homeostatic conditions. Studies done in Japan show that this technique has been applied in treatment of chronic lumbar pain, childhood migraine and chronic leg pain in Arteriosclerosis obliterans (Lehrer et al, 2007).

Question 2B
Hypnosis works by inducing a state of subconciousness in the patient whereby the subjects subconscious mind becomes active and the conscious mind becomes less active. As such, once the patient has been guided into a trance state, effective communication can be made to the subconscious mind which helps to change any habit or fear in a person (Lehrer et al, 2007).

Autogenic training works by use of a series of exercises that are progressively learned and carried out for a formulated period of time. These exercises normally refer to specific body sensations and are subvocally repeated by the patient who is encouraged to develop vivid meaningful images to enhance the exercises.  Some exercises are directed towards gaining control over the heart beat, breathing system, inner organs and the mind. In this training program, the basic idea is that the body should follow the dictates of the mind (Lehrer et al, 2007).

 Autogenic biofeedback training works by combining the principles of both autogenic training and the biofeedback technique to bring a much more effective way of stress management. Autogenic training, being a system of psychosomatic self regulation, allows the gradual acquisition of autonomic control through passive concentration on standard repetitive verbal phrases that imply subjective sensations like heaviness and warmth in the extremities. On the other hand, biofeedback is essential in accelerating voluntary psychosomatic self regulation. It also controls a wide variety of physiological parameters like temperature, blood pressure and muscle tension by monitoring the level of function in a physiological system and providing a continuous feedback (Lehrer et al, 2007).

Question 2C
Hypnosis is associated with few risks but its contraindicated for individuals with certain medical problems like pain or those who are actively involved in drug or alcohol abuse. Similarly, Autogenic training is contraindicated in people with mental retardation, central nervous system disorders and uncontrolled psychoses. There are no known contraindications in the application of Autogenic biofeedback technique although training may fail to work when there is lack of motivation in the patient (Lehrer et al, 2007).

Question 3A
The method of stress management that I will use to provide relaxation to Sally is progressive muscle relaxation. To provide relaxation to this client, I will carry out the following set of activities. First of all, a clinical assessment of the patient will be carried out on Sally to affirm her suitability to this relaxation technique and the clinical efficacy of the technique in management of stress and anxiety. The following will be put in consideration in the assessment process (Lehrer et al, 2007).

(i)Evidence that the clients complaints are related to stress and anxiety and stress will be sought by looking at the behavioral and physiological signs that coincide with Sallys experience.

(ii) Assessment as to whether anxiety or stress is the primary focus of treatment will be reviewed.

This is because anxiety plays a significant role in the clients problems and before choosing progressive muscle relaxation as an appropriate technique of treatment, there should be satisfaction its the best option for use.

(iii)Establishment of any organic components in the anxiety related problem. This is essential because it involves examining whether Sally has any organic causal factors or if she presents any psycho physiological disorders like pain in the head, neck or any cardiac symptoms.

After the assessment process is through, the method of relaxation that will be used shall be explained to Sally. This is an important step whereby the specific procedures must be explained to the client in details to promote cooperation and understanding. This will include an explanation of the role that anxiety seems to play in the clients problem and the ways in which this technique will be of help (Lehrer et al, 2007).

Question 3B
The following is a step by step description of the progressive muscle relaxation technique that will be used in treating Sally. Before beginning, the client will be asked to take deep breaths by slowly and deeply inhaling through the nose and exhaling through the mouth. This will be repeated for several times. Tensing and relaxing of the group muscles will then follow. Sally will bend her feet upward from the ankle towards her face flexing as much as she can and then hold onto this position for about 5 to 10 seconds before quickly releasing the tension. After release, she will remain still for about 20 to 30 seconds. Focus should be made to the sensation and relaxation that is experienced. Next, the muscles in the thighs and buttocks will be tensed and these positions held for 5 to 10 seconds and then quickly release the tension. Relaxation will be done for 20 to 30 seconds. The stomach muscles will be tightened and the tension will be released after 10 seconds while noting the difference in the feeling before and after the procedure (Lehrer et al, 2007).

The same process of tension and relaxation will be carried out for the muscles of the hand and arms, abdomen, elbow, shoulders, neck, chest, upper back down to the ears, the forehead and the eyes. Sally will then be asked to open her mouth wide open, feel the tension in the jaw and then relax it with the lips slightly parted. Deep breathing will then be continued for a few minutes while focusing on how relaxed the muscles feel.

After completing the session, the patient will roll over on her side for a few moments before sitting up and once she does so, she should sit with the legs crossed comfortably. The hands should be on the knees for some time to give herself time to make transition from the deeply relaxed state to a more active one before continuing with normal activities. With regular practice of this technique, Sally will find it easy to perform and she will be able to achieve a greater depth of relaxation .In addition, special considerations will be carried out to know whether Sally will have experienced feelings of emotional distress while using progressive muscle relaxation and whether and if her muscles became sore. This will be important in advising her to see a doctor before she continues with the technique any further to avoid causing injury to the body (Lehrer et al, 2007).

There are many potential problems that could come up in the course of the training period although most of them are common problems that have workable solutions. Some of them include muscle cramps, muscle twitches, movements, talking, anxiety producing thoughts, sleep and sexual arousal among others.  Sally will be informed about these possible problems so that she can also help in overcoming them for the exercise to succeed. This is because most of these problems cause interruptions in relaxation process which is the final desired effect of progressive muscle relaxation (Lehrer et al, 2007).

In conclusion, the two techniques of stress management that have been discussed in this essay are equally effective in treatment of stress patients but its upon the clinician to decide which of them best suits the client depending on the condition that is presented. Before any technique is applied to the patient, its always good to ensure that heshe understands what will be done during the procedure to enhance cooperation. The clinician should also know the contraindications of both techniques so that the necessary precautions are put into consideration.