TERAPI RELAKSASI

dr. Fadiah Zahrina

dr. Siti Nurul Badriyah

Pembimbing : Dr. dr. Tirza Z. Tamin, Sp.K.F.R, M.S. (K)

Content

What is stress?

What is relaxation?

Relaxation techniques

Effectiveness of relaxation therapy

 Stress

LAZARUS AND FOLKMAN (1984)

“psychological stress is a particular relationship between the
person and the environment that is appraised by the person as
taxing or exceeding his or her resources and endangering his
or her wellbeing”

COX AND MACKAY (1976)

“a perceptual phenomenon arising from a comparison between
the demand on the person and his ability to cope. An imbalance
gives rise to the experience of stress and to the stress
response”

Berjot S, Gillet N. Stress and coping with discrimination and stigmatization. Front Psychol. 2011 Mar 1;2:33
Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
 Body Response
to Stress

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical

guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
 Chronic Pain and Stress

Chen, Teng & Wang, Jing & Wang, Yan-Qing & Chu, Yu-Xia. (2022). Current Understanding of the Neural Circuitry in the Comorbidity of Chronic Pain and Anxiety. Neural Plasticity. 2022. 10.1155/2022/4217593.
Symptoms of stress

Physiological Subjective Physiological

Symptoms Symptoms Symptoms

↑ heart rate Headache Excessive eating or loss of

↑ blood pressure Palpitation appetite
↑ blood coagulation rate Tiredness and/or difficulty to Restlessness
↑ ventilation sleep Increased alcohol, tobacco,
↑ blood glucose level Muscle tension (particularly in and food consumption
Sweating neck & shoulder muscles) Loss of sexual interest
Irritable, impatience Tendency to experience
Indigestion, constipation, accident
diarrhea
Difficulty in concentrating and a
tendency to worry

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
 Relaxation

RYMAN (1995)
“a state of consciousness characterized by feelings of peace and release from..
anxiety and fear, as well as tension”

Relaxation has a mental and physical dimension

In reference to muscle : release tension and lengthening of muscle fibers

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
Relaxation training

AIM MECHANISM OF ACTION

Relieve muscle tension Activating parasympathetic nervous system

Relieve or reduce pain Reduce muscle tension
Reduce anxiety or stress Distracting effects
Relieve or reduce associated physical
impairment or medical conditions (high blood
pressure, tension headache, respiratory APPROACHES
distress)
Somatic
Cognitive behavioral

Kisner C, Colby LA. Therapeutic Exercise Foundation and Techniques. F.A. Davis Company: Philadelphia. Pg. 100. Relaxation Techniques for Health. 2016.
Safety

Generally considered safe for healthy people, no negative side

effects in most studies

Occasionally, some people report negative experience (anxiety, fear

of losing control, intrusive thought)

Relaxation Techniques for Health. United States. National Center for Complementary and Integrative Health. 2016 may [cited Sept 16 2020]. Available from
https://www.nccih.nih.gov/health/relaxation-techniques-for-health
Importance of practice

Relaxation training = learning new skills → practice is essential

Relaxation training in trained individual resulting in lower anxiety level compared

to untrained ones

Kisner C, Colby LA. Therapeutic Exercise Foundation and Techniques. F.A. Davis Company: Philadelphia. Pg. 100. Relaxation Techniques for Health. 2016.
RELAXATION TECHNIQUES
 Somatic
1. Breathing Exercise

Slow breathing, deep breathing, breathing meditation, abdominal breathing

Directly influence autonomic nervous system
Easy to learn, readily available, accepted approach
Slow breathing → has stress-relieving properties (connected to parasympathetic
dominance)
Breathing awareness : focusing attention to breathing pattern
Mechanism is unclear : Lum (1981) : slow breathing → corrective effect of abnormal
breathing pattern Garssen et al (1992) : slow breathing → distraction → reduce stress

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
 Somatic
General points

Breathing should occur at patient’s natural pace

Encourage patient to ‘letting the air in” rather than ‘taking a breath’
Smooth transfer between inhalation and exhalation
Prefer breathing through the nose rather than breathing through the mouth
Respiration should always be gentle
Do not repeat artificially deep breath in close succession → may lead to hyperventilation

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
 Somatic
2. Progressive Relaxation (Jacobson’s)

Systematic progression of voluntary muscle contraction and relaxation from distal

to proximal

Based on the concept of integrated activity of mind and muscles, thus relaxed
musculature will induced reduction of sympathetic activities

Kisner C, Colby LA. Therapeutic Exercise Foundation and Techniques. 2016. Philadelphia: F.A. Davis Company Payne RA, Donaghy M.
Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 ed. 2010. Edinburg: Elsevier.
 Somatic
Sequence of Progressive Relaxation

Place the patient in quite area with comfortable position and loosened clothing
Ask the patient to have deep and relaxed breath
Instruct the patient to voluntarily contract distal musculature of hands or feet for several
seconds (5-7 seconds), then relax those muscles for 20-30 seconds
Ask the patient to feel the sense of heaviness in the hands or feet and sense of warmth in
the muscles that just relaxed
Continue the same steps for more proximal musculature.
Finally, have the patient isometrically contract and relax the entire extremity
Suggest the patient to feel the sense of warmth and relaxation in the entire limb and
throughout the whole body

Kisner C, Colby LA. Therapeutic Exercise Foundation and Techniques. 2016. Philadelphia: F.A. Davis Company Payne RA, Donaghy M.
 Somatic
3. Stretching

During stretching, more length sensitive receptor activated rather than during tensing
→ stronger contrast between stretching and releasing compared to tensing and
releasing → easier to release body tension
Stretching :→ lower motor neuron pool excitability → decrease level of muscle tension,
pain, and ischemia
5-10 seconds of stretch → released quickly → 30 seconds interval before the next
stretch

Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 ed. 2010. Edinburg: Elsevier.
 Somatic
3. Stretching

BODY ROTATION

BODY TURNING SHOULDER CIRCLING

CURLING INTO A BALL HIP STRETCHES

Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 ed. 2010. Edinburg: Elsevier.
 Somatic
3. Stretching

ARM STRETCHING HEAD PRESSING TRUNK BENDING ARM & TRUNK ARMS STRETCHING
ABOVE THE HEAD BACKWARDS SIDEWAYS BENDING SIDEWAYS BACK

Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 ed. 2010. Edinburg: Elsevier.
 Somatic
3. Stretching

ARMS REACHING TRUNK TWISTING BACK ARCHING CROUCHING INNER THIGH

UPWARDS STRETCHING

ARMS STRETCHING SIDEWAYS

Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 ed. 2010. Edinburg: Elsevier.
 Somatic
4. Behavioral Relaxation Training

Prinsip: Postur tubuh yang rileks berbeda dengan yang stres. Pasien diminta
untuk terlihat serileks mungkin.
Prosedur: Fokus pada tiap kelompok otot, lihat apakah bagian-bagian tersebut
tampak rileks. Pasien diminta untuk mengingatrasanya saat rileks.
Dapat dilakukan sebagian saat sedang melakukan aktivitas, disebut “Mini-
relaxation”.
Dapat digabung dengan latihan kognitif seperti meditasi/autogenics.
Latihan ini mudah dan dapat dilakukan oleh siapa saja, bahkan pada orang yang
memiliki gangguan belajar.

Kisner C, Colby LA. Therapeutic Exercise Foundation and Techniques. 2016. Philadelphia: F.A. Davis Company Payne RA, Donaghy M.
 Somatic
Relaxed vs Unrelaxed

Pasien tidur, tutup mata.

Terapis menginstruksikan
postur yang harus dicapai.
Minta untuk tahan 30-60
detik.
Sesi latihan: 15-20 menit.
Latihan di rumah 20 menit per
hari.

Kisner C, Colby LA. Therapeutic Exercise Foundation and Techniques. 2016. Philadelphia: F.A. Davis Company Payne RA, Donaghy M.
 Somatic
Behavioral Relaxation Training

Item Relaxed Unrelaxed

Both feet flat on the floor with right

Crossed legs, extended,
Legs angle at the knees; Knees fall
tucked under the chair
outwards

Bending forwards,
Shoulder blades and hips touch the
Back arching backwards, or
chair symmetrically
leaning to one side

Hanging down, crossed,

Arms Wrists are resting on the thighs
leant on.

Tilted or turned in any

Head Held upright and looking forwards.
direction.

Kisner C, Colby LA. Therapeutic Exercise Foundation and Techniques. 2016. Philadelphia: F.A. Davis Company Payne RA, Donaghy M.
 Somatic
Behavioral Relaxation Training
PENILAIAN
Dinilai tiap 1 menit sekali. Lingkari +
jika postur rileks, - jika tidak rileks.
30 detik pertama → Rate pernapasan,
hitung jumlahnya lalu kalikan 2.
15 detik selanjutnya : scanning key
posture
15 detik terakhir: rate each items •
Repeat until 5 intervals
Rumus:
(Jumlah (+))/(Total observasi (50))×100= …
%
Kisner C, Colby LA. Therapeutic Exercise Foundation and Techniques. 2016. Philadelphia: F.A. Davis Company Payne RA, Donaghy M.
 Kognitif
1. Autogenic Training
Autogenic = Sesuatu yang datang dari dalam diri sendiri.
Pendekatan yang diturunkan dari self-hypnosis.
Melibatkan relaksasi secara sadar, melalui autosugesti atau diri
sendiri, melalui latihan yang progresif, juga meditasi sehingga
kita bisa berkonsentrasi akan sensasi fisik akan rasa hangat,
berat, pada berbagai bagian tubuh.
Menggunakan imajinasi visual dan body awareness untuk
mengurangi stres..
Prosedur: Mengulang kata-kata atau sugesti di dalam pikiran
sehingga dapat rileks dan mengurangi ketegangan otot.
Goal: Mencapai trance (gangguan kesadaran; drowsiness)
Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 ed. 2010. Edinburg: Elsevier.
 Kognitif
1. Autogenic Training
Persyaratan
1.Kondisi eksternal dibuat tenang (sunyi, lampu diredupkan).
2.Konsentrasi pasif; hilangkan pikiran yang muncul.
3.Repetisi frase berdasarkan 6 tema utama ini:
a)Rasa berat pada lengan dan kaki
b)Rasa hangat pada lengan dan kaki
c)Denyut jantung tenang dan teratur
d)Napas tenang
e)Perut terasa hangat
f)Dahi terasa dingin.
4.Lakukan kontak mental pada bagian tubuh yang ditujukan oleh frase.
30 detik untuk instruksi; 35-40 detik untuk observasi gerakan pasien.
Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 ed. 2010. Edinburg: Elsevier.
 Kognitif
1. Autogenic Training
I II
Lengan kanan saya berat. Lengan kanan saya hangat.
Lengan kiri saya berat. Lengan kiri saya hangat.
Kaki kanan saya berat. Kaki kanan saya hangat.
Kaki kiri saya hangat.
Kaki kiri saya berat.
Semua lengan dan kaki saya hangat.
Semua lengan dan kaki saya berat.
(Ulang 6 kali)
Posisi berbaring atau bersandar. (Ulang 6 kali) Saya merasa damai (1 kali)
Bayangkan Anda ada di lokasi
yang menurut Anda
menenangkan (misal di padang
III IV
rumput, di pantai, dll). Rasakan Lengan kanan saya berat dan hangat. Napas saya tenang dan teratur (6 kali)
tubuh Anda. Seluruh tungkai saya berat dan hangat. Saya sangat tenang (1 kali)
Denyut jantung saya tenang dan teratur. Perut saya terasa hangat (6 kali)
Saya merasa damai. Saya sangat tenang (1 kali)
(Ulang 6 kali) Dahi saya terasa dingin (6 kali)
Saya sangat tenang (1 kali)

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 ed. 2010. Edinburg: Elsevier.
 Kognitif
1. Autogenic Training
 Kognitif
2. Self Hypnosis
Gelombang Beta (14-50 Hz)
Sadar, waspada, terjaga; Pikiran kritis aktif
Self hypnosis : “self
induction into the Gelombang Alpha (7.5-14 Hz)
Sistem RAS mulai mati; Masih dapat
hypnotic process mendengar dan memahami; Pikiran sangat
produced by self- dapatmenerima sugesti dan mengikuti
visualisasi
generated suggestions”
Gelombang Theta (4-7.5 Hz)
Pikiran mulai mengembara; Mulai tidak dapat
mendengar sebagian omongan terapis;
Alambawah sadar yang akan melakukan
tindakan & mendengarkan.

Gelombang Delta (0.5-4 Hz)

Eason AD, Parris BA. Clinical applications of self-hypnosis: a systematic review
and meta-analysis of randomized controlled trials. [Online]. Available from:
https://core.ac.uk/download/pdf/161510965.pdf
https://melbournehypnotherapyclinic.com/stages-of-hypnosis/
Sudah tidak dapat menyadari ucapan terapis
namun sugestinya diterima; Fase restoratif
terdalam.
 Kognitif
3. Guided Imagery

Seseorang diminta untuk fokus pada gambar menyenangkan untuk

menggantikan perasaan negatif atau perasaan stres.
Partisipan diajarkan untuk memvisualisasikan gambar-gambar yang
menyenangkan seperti pantai yang cerah, padang rumput di pedesaan,
atau taman yang wangi
Dapat dipandu oleh diri sendiri maupun dipandu orang lain/rekaman.
Agar bisa relax saat melakukannya, biasanya dapat digabungkan dengan
indera lainnya seperti suara, penciuman, & perabaan.
Dapat dilakukan selama 10-15 menit per sesi.

Krau SD. The multiple uses of guided imagery [Online]. 2020[cited 2023 Sept 11]. Available from: chrome extension
://efaidnbmnnnibpcajpcglclefindmkaj/https://www.mghpcs.org/munncenter/Documents/weekly/july-22/Guided-Imagery-2021.pdf Payne RA, Donaghy M. Payne’s handbook of relaxation
techniques: a practical guide for the health care professional. 4 ed. 2010. Edinburg: Elsevier.
 Kognitif
3. Guided Imagery
TIPE-TIPE
1. Guided walking imagery
Teknik ini ditemukan oleh psikoleuner. Pada teknik ini pasien dianjurkan untuk
mengimajinasikan pemandangan standar seperti padang rumput, pegunungan, pantai.
2. Autogenic abstraction
Teknik ini pasien diminta untuk memilih sebuah perilaku negatif yang ada dalam pikirannya
kemudian pasien mengungkapkan secara verbal tanpa batasan. Bilaberhasil akan tampak
perubahan dalam hal emosional dan raut muka pasien
3. Covert sensitization
Teknik ini berdasar pada paradigma reinforcement yang menyimpulkan bahwa proses
imajinasi dapat dimodifikasi berdasarkan pada prinsip yang sama dalam modifikasi perilaku.
4. Covert behaviour rehearsal
Teknik ini mengajak seseorang untuk mengimajinasikan perilaku koping yang dia inginkan.
Teknik ini lebih banyak digunakan.
Grocke, D. & Moe, (2015). Guided imagery & Music (GIM) and Music Imagery Methods for Individual and Group Therapy. London: Jessica KingsleyPublisher
 Kognitif
3. Guided Imagery
 Kognitif
4. Biofeedback-Assisted Relaxation

Mengukur fungsi tubuh dan memberi informasi untuk belajar

mengendalikannya
Menggunakan perangkat elektronik yang menghitung fungsi tubuh (HR, TD,
ketegangan otot) agar dapat mengetahui dan mengatur respon tubuh
untuk stress dan relaksasi

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
 Kognitif
4. Biofeedback-Assisted Relaxation
 Kognitif
5. Meditasi

Meditasi adalah konsep mengosongkan pikiran; melepaskan pikiran yang

mengganggu.
Tujuan umum: Non-attachment; Untuk menghancurkan tujuan-tujuan rasional.
Meditasi dapat membantu untuk meredakan pikiran/akal/mind kita guna mengurangi
pikiran yang membuat stress
Meditator tidak jatuh ke dalam trance (drowsiness, surrender control); Namun
dirinya mencapai kesadaran penuh, sadar sekeliling, dan terfokus pada momen
sekarang.
Durasi per sesi 5 menit untuk pemula; 15-20 menit untuk yang sudah
berpengalaman..

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
 Kognitif
5. Meditasi

V : Return to everyday activity

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
 Kognitif
5. Meditasi

Payne RA, Donaghy M. Payne’s handbook of relaxation techniques: a practical guide for the health care professional. 4 edn. Edinburg: Elsevier. 2010
Effectiveness of Relaxation Techniques

FIBROMYALGIA
ANXIETY EMG-biofeedback significantly reduce pain
Reduce anxiety in people with heart intensity in fibromyalgia patients for short
disease, medical procedures, older adults time period, lack of studies on long term
effect

RHEUMATOID ARTHRITIS CHRONIC INSOMNIA

limited evidence that biofeedback or other Relaxation techniques can be combined
relaxation techniques might be valuable with other strategies for getting a good
additions to treatment programs for RA night's sleep

PAIN
Guided imagery for musculoskeletal pain :
promising but inconclusive
 THANKS FOR
YOUR ATTENTION!