A Practical Handbook for the Health Care Professional.
Rosemary A. Payne

Churchill Livingstone, 1995.
ISBN 0-443-04933-5

It has been well documented that stress plays an important part in the causation and aggravation of both physical and mental illness. From as early as 1956 researchers such as Hans Selye have illustrated the influence of stress on our health with graphs, diagrams and poignant and acclaimed articles. Lists have even been produced ranking various life events in the amount of stress they produce.

In addition certain illnesses such as peptic ulcer, irritable bowel syndrome, asthma and many others have for many years been known by the medical profession to be severely aggravated, if not caused, by stress in many people. As the author points out, studies have shown that 80% of modern diseases are initiated by stress and over 75% of GP consultations are about stress-related illnesses. The widespread prescription of tranquillisers to deal with stress over the past few decades is well known and recently the side effects and addictive qualities of these medications has caused concern among doctors and patients alike.

A plethora of books and audiotapes on various ‘How to relax’ methods has been available for many years. The great majority of these are directed at the layman and to be found in the ‘Self Help’ section at book shops. Most of the literature claims with some justification that it is demonstrably possible to off-load stress by simple techniques that are quite easy to learn. The positive effects of the regular practice of such techniques on many illnesses have been well established. From this it would seem obvious that there is a good case for making the teaching of some of these methods a major part of any health service. It would seem logical that if stress is at the root of three quarters of consultations in general practice, that teaching patients stress-releasing and stress-proofing techniques would be at the core of modern Western medical practice. Sadly this is not the case.

The author takes us through a thorough theoretical background and then presents the history, practical application, potential benefits and pitfalls of the different relaxation methods which she has divided into two categories; physical and mental.This is a little surprising as all relaxation techniques are holistic in that they claim to have therapeutic effects on the body, mind and even spirit.

The physical methods discussed comprise: Jacobson’s progressive relaxation, Bernstein & Borkovec’s modified version, Madder’s release-only, Ost’s applied relaxation, Poppen’s behavioural relaxation training, the Mitchell method, the Alexander technique (a controversial inclusion as most Alexander teachers would not regard themselves as teachers of a relaxation techniques), differential relaxation, stretching, exercise, and breathing methods.

The psychological methods discussed consist of: self-awareness, imagery, goal-directed visualisation, Autogenic Training, meditation and Benson’s relaxation response.

The history and theory of each method are well presented but the practical description of the technique varies. In ‘Goal-directed visualisation’ an impressive technique for giving up smoking is described in detail. In the section on Autogenic Training, whilst the theory and history of this important method are excellent, the practical description of how it is done is confusing and not an accurate description of how Autogenic Training is taught in the UK.

The author addresses the book to health care professionals and suggests that ‘GPs and psychologists may find it useful’. I think that its formal layout and immaculate referencing make it ideal reading for medical students and GP trainees. Previous works covering the same territory are either not as comprehensive or not written in a style suitable to be a textbook. She also addresses it to the lay person but I feel it will be an unsatisfying and not very relaxing read for the average reader who would do better to buy a self-help book on a specific relaxation technique.

This is a unique addition to the literature in that it gives detailed descriptions of a great variety of relaxation techniques in one volume. It is ideal for the doctor or health professional wanting to learn more about these techniques in order to be able to make appropriate referrals of patients who might benefit from a relaxation technique. It would also be invaluable for the doctor or health practitioner wanting to teach a relaxation technique to his or her patients but not knowing where to start. Thus it is a pity that a list of institutions teaching or providing teacher training in the various techniques is not included as an appendix.

The prevention and treatment of physical and mental illness by reducing stress with relaxation is the very essence of the holistic paradigm in medicine. The regular practice of a relaxation technique empowers patients to be responsible for their health and is capable of transforming their lives as well as their illnesses. This book, written in the style of a professional textbook, is capable of making health professionals aware of this possibility for themselves and their patients.

Review by Dr Brian Kaplan MBBCh MFHom.
December 1995