The Techniques of the Wise-Anderson Protocol Paradoxical Relaxation

The purpose of Paradoxical Relaxation in the Wise-Anderson Protocol is to teach a patient to profoundly relax the tensed and shortened muscles within the pelvic floor basin associated with certain kinds of pelvic pain. It involves a daily practice of the cultivation of effortlessness in the presence of pain, anxiety, and tension in order to abate them.

a. Paradoxical Relaxation has two components: (i) a breathing technique used at the beginning of relaxation. This coordination of heart rate and respiration supports the patient’s respiratory sinus arrhythmia which reduces respiration to approximately 6 breaths per minute and (ii) instruction given for the remainder of the relaxation session directing patient to focus attention on the effortless letting go of tension in a specified area of the body and accepting residual tension that does not easily release

b. Patients are asked to listen to approximately 1 hour of recorded relaxation instruction daily focusing on individual of predetermined anatomical sites including frontalis, jaw, neck, shoulders, arms, hands, upper back, chest, stomach pelvis, legs, and feet. Each site is the focus of practice for approximately 2 weeks and the entire course lasts for approximately a year and two months. Home practice is done daily and includes the use of 46-recorded lessons varying in length from 7 minutes to 45 minutes. The focus on relaxation of the pelvic floor is generally avoided for the first several months of relaxation training because such a focus can exacerbate symptoms until competence in relaxation is gained in neutral, non-painful areas.

c. Relaxation instruction guides the patient to rest attention in sensation and to redirect attention away from discursive thinking and daydreaming. The target range of brain wave activity is low frequency alpha.

d. Catastrophic thoughts that increase sympathetic arousal arising during relaxation are identified and a cognitive therapy protocol is used to help the patient reduce the impact of such thinking.

The process of Paradoxical Relaxation is very slow. Respect for and cooperation with this very slow process is essential to the success of the method. When the desire of the treating physician or the patient aims to hurry up the body’s slow letting go of deeply ingrained tension, the patient usually fails to relax the pelvic floor. In Paradoxical Relaxation, the instruction is given to the patient to let go of tension that easily and effortlessly lets go. This effortless relaxation usually occurs in small and unremarkable steps and recognizing and working with these small gradations of relaxation is essential.

Edmund Jacobson described residual tension in detail in his long career in the development of relaxation therapy begun in 1908. The patient is instructed to keep attention focused on residual tension without efforting toward it or trying to change it. When attention is distracted by visual or conceptual thinking, throughout the protocol, the patient is instructed to refocus attention on the sensation of the remaining residual tension without efforting toward this tension or aiming to achieve any result. It is essential that the patient and physician understand that deep relaxation occurs when attention rests in sensation and not in thinking.

Instructions alternate between letting go of tension that easily lets go and effortlessly feeling the remaining tension. The tension that is being focused upon without effort on the patient’s part usually abates during this process and the patient is instructed to permit this abatement to occur. Sometimes the tension does not abate or even increases and the patient is instructed to remain softly focused on the remaining sensation without an intention to change it. The concept underlying this protocol is that one does not relax stubborn, residual tension directly but instead is effortless in remaining continually aware of the sensation of tension. Relaxation occurs without any effort on the part of the patient. Exerting any effort increases tension. This is because relaxation is identical to effortlessness.

We specifically discourage patients from focusing on the relaxation of the pelvic floor for the first 4 months of treatment, as the patient’s attachment to the relief of symptoms tends to interfere with the conscious and simultaneous effortless attention on tension. The focus on relaxation of the upper body is most easily accomplished by the patient and usually results in a reduction of pelvic tone. The focus on the relaxation of the pelvic musculature requires that the patient make the distinction between pain and tension and the aim of the protocol then becomes directed to the tension and not the pain in the area of a painful pelvis.

Paradoxical Relaxation is a method specifically designed to teach the patient to profoundly relax autonomic arousal and pelvic tension in the presence of pain and anxiety. Pain and anxiety stimulate additional tension and aversion. Without instruction most patients who are not properly instructed are loathe to sit still in the presence of unresolved pain. The instructions of Paradoxical Relaxation train patients to stop the tension-anxiety-pain cycle by focusing on tiny residual tensions that they can easily relax at the same time accepting the tension and pain that remains. Attention is redirected from negative cognitions and focuses on letting go of tiny and often ignored tensions in the body unconsciously aimed stopping the pain and tension – efforts that only exacerbate symptoms. In the paradoxical acceptance of pain and tension that does not easily relax, the patient learns how to ride the tension down in the pelvic floor in particular and autonomic arousal in general in small steps that require acceptance of what formerly has been unacceptable and frightening.

Chronic pelvic pain syndromes tend to be self-perpetuating disorders in which a patient’s pain causes a reflexive tightening of the pelvic floor, which in most patients, often prompting a flurry of negative and catastrophic thinking. The reflex to contract against pain actually increases the pain. Negative and catastrophic thinking that is common to pelvic pain patients fan the fire of the pain by igniting the electrical activity in the trigger points referring pain in the pelvis. The tension-anxiety-pain cycle is the major obstacle to reduction or abatement of pelvic pain as it feeds itself and is present in the moment that a patient is asked to relax the pelvic tension. The disruption of the self-feeding cycle of tension, anxiety, and pain can be accomplished by a select group of patients who become competent in Paradoxical Relaxation.

While we utilize an extensive set of recorded tapes in the Wise-Anderson Protocol relaxation method, competent instruction is necessary to train patients in the method. Below we discuss the issue of stand-alone relaxation tapes.

Why Paradoxical Relaxation cannot be learned from recorded tapes in the absence of competent instruction

(This is part of a response sent to the webmaster of the chronicprostatitis.com website on the issue of stand-alone relaxation tapes)

As we have discussed, I do not sell the audio Paradoxical Relaxationcourse on a stand-alone basis. There are numerous relaxation tapes that can be bought from many different sources and people are free to buy them. I could sell the recorded lessons I use on a stand-alone basis… I have certainly had enough requests….but choosing not to do this is neither a casual nor a self -serving decision on my part. I have a short answer and a long answer to explain why.

Here is the short answer.

I have no confidence that someone can learn to relax a painful pelvic floor from a relaxation tape without both instruction from someone who is competent in the method him or herself and without intrapelvic Trigger Point Release. I do not want to associate myself with making available a half measure that appears to offer something substantial but does not.

When I was symptomatic, I tried many remedies that all seemed reasonable but ultimately failed to help me. They left me hopeful at first, then disappointed, and disheartened. A stand-alone relaxation tape, in my opinion, is a half measure. Half measures give little chance of offering real recovery from chronic pelvic pain syndromes. I have decided that if I am to err, I will err in the direction of not offering anything instead of offering a half measure in which I have no confidence.

Here is the long answer.

Learning to deeply relax the pelvic muscles in order to facilitate the healing of a sore and contracted pelvic floor from a relaxation tape that you buy is like learning to play a violin by listening to recorded instructions. In my experience, such an endeavor usually fails; the person gets discouraged and usually gives up. To learn the violin, you need instruction from someone who plays the violin and the more accomplished the player the better. You want to learn the violin from someone who plays it everyday, who is excited about it, and whose expertise is obvious. Imagine learning the violin from someone who does not play it. The obstacles to learning to play the violin and learning to relax deeply are very similar — except learning to deeply relax a painful pelvic floor is harder than playing the violin.

Our instinct is to tighten against pain and not to relax with it and yet I found that relaxing with the tension of certain kinds of pelvic pain can dissolve it. Learning to do this is a major event in someone’s life because it is from this place that it can become possible to break the cycle of pain, anxiety, and tension and allow the sore and irritated tissue in the pelvic floor to heal.

There may be some unusual individuals who can deeply relax on a consistent basis by simply using recorded instructions and I applaud them and wish them well. The reason I do not have any faith in this is that to relax a painful pelvic floor and maintain a relaxed pelvic floor over time, (and not everybody can learn how to do this) requires guidance and instruction with regard to many issues. Examples of the issues that must be addressed are: what to do with the pain during relaxation; how to not add tension the tension of ‘trying’ to relax tension; when to use breathing to focus distracted mind and when to cease the breathing technique: what to do when emotions arise that the tension in the pelvic floor is suppressing; how to accept the resistance to accepting the tension; what it means to rest while there is discomfort; what to do when a plateau is reached and tension doesn’t reduce; what to do when symptoms abate during relaxation and then resume quickly afterward; how to relax in the office or on the bus — as well as other issues. I have seen many patients distort what to me are clear instructions and become frustrated in their practice of relaxation. A relaxation tape usually addresses none of this and the successful resolution of these issues makes the difference between success and failure.

To learn to relax the pelvic floor, especially in the presence of pain, is an enigma and the method to do this is anti-intuitive. Furthermore, it is often frightening for someone with pelvic pain to sit still with their pain and their thoughts without someone guiding and supporting them in doing so. In my experience, people avoid the kind of relaxation required to relax a tight and painful pelvis if there is no guidance and support and the recorded tapes wind up on the shelf.

Few professionals whom I have offered to train in teaching this method have been interested. I think that the reason is that they were not motivated, like my pain motivated me, to spend the time learning to do the relaxation themselves. The best teachers of this method are turning out to be the patients I have trained who are doing well and use it on a daily basis.