توسعه یک برنامه بیمار محور بر اساس واکنش آرم سازی،: برنامه تاب آوری واکنش آرام سازی (3RP)

Background Chronic daily stress has significant physical, emotional, and financial implications; levels of stress are increasing in the US. Dr. Benson highlighted how the mind and body function together in one's experience of the stress response and proposed the existence of the relaxation response (RR). Objective The current paper describes the foundation and development of an 8-session multimodal treatment program for coping with chronic stress: the Relaxation Response Resiliency Program (3RP). Methods We review the past decades of RR research, outline the development of the 3RP treatment, and provide an overview of the program's theory and content. Results Extensive research and clinical work have examined how eliciting the RR may combat stress through down-regulation of the sympathetic nervous system. Related to this work are the multidimensional constructs of resiliency and allostatic load. The 3RP is based on principles from the fields of stress management, cognitive-behavioral therapy, and positive psychology, and has three core target areas: (1) elicitation of the RR; (2) stress appraisal and coping; and (3) growth enhancement. An 8-week patient-centered treatment program has been developed, with the purpose of assisting patients with a variety of psychological and medical issues to better cope with chronic stress. Conclusions Mastery of the RR is theorized to maximize one's ability to benefit from multimodal mind body strategies. The goal of the 3RP is to enhance individuals' adaptive responses to chronic stress through increasing awareness and decreasing the physiological, emotional, cognitive, and behavioral effects of the stress response, while simultaneously promoting the effects of being in the RR.

Chronic daily stress has significant physical, emotional, and financial implications, and levels of stress are increasing in the US. The 2012 American Psychological Association report, Stress in America, documented that approximately one-fourth of Americans surveyed experience extremely high stress, and almost half of Americans reported that their stress levels have increased over the past 5 years. 1 There is significant need for interventions that combat the negative effects of stress. The Relaxation Response Resiliency Program (3RP) is a comprehensive, multimodal treatment that was designed to promote adaptation to stress and enhance resiliency. This program is rooted in the elicitation of the relaxation response (RR). Four decades of empirical studies by Herbert Benson and other researchers have characterized the effects of eliciting the RR on genomic, structural, physiological, psychological, and functional outcomes. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 and 18 Together with advances in our understanding of stress, coping, and post-traumatic growth, this work has contributed to an integrative intervention model for promoting resiliency. The Stress Response and the Relaxation Response Stress is the process through which environmental demands tax or exceed the adaptive capacity of an organism, resulting in distress. Distress may manifest as psychological and/or biological changes that place individuals at risk for disease. Hans Selye defined stress as “the nonspecific response of the body to any demand,”19 and stated that distress occurs when stress is overwhelming or persistent and not dealt with in a positive manner. Related to stress is the stress response, described by Walter B. Cannon as the “fight-or-flight” response,20 which is a cascade of coordinated physiological changes that occur when animals, including humans, perceive threat. These changes involve several structures within the brain and a redirection of neural activity from the “self-regulating center” to lower regions within the limbic system, which causes an increase in stress hormones and a resulting increase in metabolism, blood pressure, and heart rate. Researchers studying the long-term effects of a prolonged or severe stress response have concluded that it may lead to harmful physiological changes such as increasing the risk for heart disease or diabetes.21 A converse to the stress response, the RR is a physiological state characterized by decreased arousal of the sympathetic nervous system22 (Figure 1). The term “relaxation response” was first described in humans as a “wakeful hypometabolic state.”23 This state, the foundation of the 3RP model, is used to combat maladaptive responses to stress and guide an individual's attainment of an optimal stress level. The rationale for eliciting the RR among individuals facing a chronic stressor in particular is that the changes associated with this response (e.g., decreases in oxygen consumption and carbon dioxide elimination and in heart rate, respiratory rate, and blood pressure)2 and 6 are the opposite of changes that occur during the stress response. Full-size image (47 K) FIGURE 1. Stress Response and Relaxation Response. Dusek and Benson (2009) Minnesota Medicine. Figure options As described above, a central tenet of Benson's work is that the RR is a state rather than a specific technique. It has been demonstrated that many different techniques can elicit the RR24 (see Table 1). In an early review of studies conducted before 1974, Benson concluded that several techniques led to similar physiological changes. For instance, the techniques of transcendental meditation, autogenic hypnosis, Zen and yoga, contention, sentic cycles, and progressive muscle relaxation were all found to decrease sympathetic arousal as evidenced by decreased oxygen consumption, respiratory rate, and heart rate as well as increased alpha waves and skin resistance.3 This response was also found to be elicited by a simple technique—the repetition of a word, sound, or phrase—developed by Beary, Benson, and Klemchuck in 1974.2 In later studies of the RR, investigators found that it could also be elicited during exercise,25 leading to decreased oxygen consumption for a given heart-rate. Taken together, the literature highlights that the RR may be elicited when an individual engages in a repetitive or sustained mental or physical action while passively disregarding other distracting thoughts.26 The essential component of RR-inducing techniques is to break the chain of everyday thinking, creating a sense of “quieting” of the mind and body. TABLE 1. Example Techniques for Eliciting the Relaxation Response Technique Concept Mechanism Breath awareness Shift from shallow breathing to abdominal breathing. Draw air deep into lungs using even breath. Improve ability of respiratory system to produce energy from oxygen and remove waste. Self-hypnosis Narrow consciousness without completely losing awareness, to allow suspension of disbelief and experience of thoughts and images as real. Facilitates both focused, intense mental activity and state of relaxation simultaneously. Guided imagery Use imagination to refocus mind on positive, healing images. Negative thoughts influence feelings and behavior, and exacerbate physical symptoms. Thoughts become reality (i.e., you are what you think you are). Therefore, use imagination to reduce subjective stress and to treat physical symptoms. Autogenic training Use verbal commands that suggest bodily warmth and heaviness in limbs. Word phrases suggest relaxation to the unconscious mind, which manifests the desired responses in the body. Aims to reverse “flight or flight” response during physical or emotional stress by promoting relaxation of the voluntary arm and leg muscles, inducing peripheral vasodilation, and normalizing cardiac activity. Progressive muscle relaxation Alternately tense and relax different muscle groups, to better distinguish between these two states. Based on premise that the body responds to anxiety-provoking phenomena with muscle tension that increases subjective anxiety. Muscle relaxation reduces physiologic tension and, therefore, blocks the subjective anxious response. Transcendental meditation Engage in attempting to anchor attention nonjudgmentally on a silent mantra. Negative emotion cannot persist when focusing on something other than the target of the emotion. Habitual thought patterns lose influence when brought to conscious awareness. Present focus reduces emotional extremes. Meditation also slows sympathetic nervous system activity. Mindful awareness Observation or attention to phenomena in the moment nonjudgmentally as they enter awareness Strong emotions become manageable by focusing on sensations rather than the content of emotional thoughts. Yoga Movement meditation correlated with the breath. Yoga is a comprehensive system of practices for physical and psychological health and well-being, and incorporates multiple techniques including physical postures/exercises, breathing exercises, and meditation/concentration techniques. As an integrative discipline, yoga takes advantage of the simultaneous application of its component techniques, all of which contribute to eliciting the relaxation response.