Relaxation Induced Anxiety

In some people, attempting to purposely calm down leads instead to something called “relaxation induced anxiety”. Loganholme Psychologist Dr Amanda White explains …

The natural response for many people when overwhelmed by the experience of stress, anxiety, or trauma is to purposely calm down or practice relaxation.

Through stress reduction exercises, such as breathing or cognitive reappraisal strategies, we aim to initiate the relaxation response. Here physiological changes to metabolism, heart rate, respiration, blood pressure and brain chemistry lead us to cope more effectively.

However, sometimes trying to relax can seemingly go awry, escalating symptom distress beyond what was experienced prior to attempting intentional relaxation.

This paradoxical or ironic effect is termed “Relaxation Induced Anxiety” (RIA).

RIA happens repeatedly to a small subset of the population. Intentional relaxation has been shown to increase anxious arousal and panic symptoms in some individuals predisposed to high state anxiety, eg those diagnosed with generalized anxiety disorder or panic disorder. A paired association may arise over time linking intentional relaxation to an anticipated stress response, rather than the relaxation response.

But RIA is not defined only as an atypical process tied purely to individuals who experience high state anxiety. RIA can affect anybody given the right conditions.

Ironic Processes of Mental Control

Underlying the cognitive explanation of RIA is Wegner’s theory detailing ironic processes of mental control.

Mental control is described as a function of two subprocesses:

1. A conscious and intentional seeking out of content consistent with the intended state, and
2. An ironic, unconscious (and thus uninterruptible) monitoring process seeking out information inconsistent with the goal state.

For relaxation, the intentional process might include attending to breathing and other physiologically relaxing exercises, cognitive challenging, and visualisation. The second, ironic process might be a subloop of distressing feelings, thoughts, and images that indicate a failure to relax. These two subprocesses are generally cooperative. Experience of stress motivates the healthful, conscious, and intentional process, with the ongoing subloop fulfilling its monitoring role to alert the system to re-evaluate and adapt should stress escalate.

But every system can fail. Wegner suggests that intentional control of any mental process can prompt or induce an opposing process, eg  intentional efforts to sleep produce wakefulness (Ansfield, Wegner & Bowser, 1996).

Elements that undermine the intentional subprocess include distraction, stress, and mental load (how many items are held in short term memory). Intentional relaxation can then be overwhelmed by the otherwise avoided content monitored by the ironic subloop. Triggered by the least desired thoughts, feelings or actions, a stress reaction can essentially engulf purposeful relaxation. In this way, RIA occurs.

Overcoming the Fear of Relaxation

By adjusting relaxation practice to accommodate RIA, it is still possible to purposefully calm down.

Learning and then implementing new approaches for stress management may require effort, especially if there has been a paired association of relaxation to the stress response, but beneficial outcomes with skills development are commonly reported.

Remember, mental control is a generally effective practice. The solution to RIA focuses partly on minimising factors that undermine intentional relaxation: distraction, stress, and mental load (how many items are held in short term memory).

The other part of the solution is practicing physical management of stress to ensure hyperventilation does not occur.

Help for Relaxation Induced Anxiety

Here are some simple steps to cultivate relaxation in the face of ironic processes:

1. When stressors are present, activation of the fight or flight system changes the rate at which we breathe. Learn and implement deep breathing techniques where the out-breath is longer than the in-breath. Exhale the natural build-up of carbon dioxide. If you think you already know how to this, then challenge yourself with new techniques. Practice regularly.
2. Progressive muscle relaxation, where you tense and relax muscle groups systematically, allows stress management on a physical level without any overall instruction to relax. It takes no mental control beyond muscular tensing, thus avoiding ironic processes. Practice regularly.
3. When stress levels are escalating, if possible find a space with minimal distractions. Think about all possible forms of sensory distraction (noise and light levels, smells, tight clothing, etc) as well as the social or workplace setting. Focus on breathing.
4. Develop a mindfulness meditation practice. Directing attention purely to the present moment, allowing an emphasis on sensory awareness paired with non-judgemental appraisal of what is occurring (thoughts, feelings, sensations or breath), can lead to improved coping and responding within the present moment. Traditionally Vipassana is a seated practice, but mindfulness can be practiced effectively in parallel with daily activities.
5. Write your thoughts down. This has a twofold benefit. Firstly, it reduces mental load. Secondly, it allows you to objectively view distressing content and challenge it. Write the challenges down, see whether more information arises. Keep writing.
6. Cultivate wellbeing. This covers our approach to social, economic, psychological, spiritual and medical states of being, and emphasises the experience of affirmative engagement with our life and life goals. Think big, act small. Start problem solving areas of your life that do not reflect core values, eg time management.

If you would like to know more about Relaxation Induced Anxiety, or engage a supportive and structured learning model to address anxiety and stress management, psychological services can be of great benefit. Call M1 Psychology for more information, or to book an appointment with a qualified treating therapist.

Author: Dr Amanda White, PhD, B Psych (Hons), B Beh Sc, DipH, MAPS.

Amanda is not currently taking bookings, however, we have a number of clinicians available for bookings.

To make an appointment please visit our webpage here to learn about our highly qualified clinicians, or call M1 Psychology Loganholme on (07) 3067 9129.

REFERENCES

• Ansfield, M.E., Wegner, D.M., & Bowser, R. (1996). Ironic effects of sleep urgency. Behaviour Research and Therapy, 34 (7), 523-531.
• Borkovec, T. D. et al (1987). The effects of relaxation training with cognitive or nondirective therapy and the role of relaxation-induced anxiety in the treatment of generalized anxiety. Journal of Consulting and Clinical Psychology, 55(6), 883-888.
• Goldfried, M. R., & Davison, G. C. (1994). Clinical behaviour Therapy (Expanded ed.). New York: Wiley-Interscience.
• Heide, F. J. & Borkovec, T. D. (1983). Relaxation-induced anxiety: Paradoxical anxiety enhancement due to relaxation training. Journal of Consulting and Clinical Psychology, 51(2), 171-182.
• Levitt, J. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35(4), 747-766.
• Wegner, D.M. (1994). Ironic processes of mental control. Psychological Review, 101(1), 34-52.
• Wegner, D.M., Broome, A., & Blumberg, S.J. (1997). Ironic effects of trying to relax under stress. Behaviour Research and Therapy, 35(1), 11–21.
• Wells, A. (1990) Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21 (3), 273-280.
• Wilson, C.J., Barnes-Holmes Y, & Barnes-Holmes, D. (2014).  How Exactly Do I “Let Go”? The Potential of Using ACT to Overcome the Relaxation Paradox. Sage Open, 4(1).