Anxiety, Tension, and Muscular Relaxation
In elementary physiological terms, the nervous system is made up of two main parts, the peripheral or voluntary and the central or autonomous. The peripheral nervous system is charged with the posture, locomotion, and peripheral sensibility of the person, and fundamentally obeys the human being’s will, thus deriving its name.
The central nervous system, conversely, is charged with the vital functions or which sustain life, and is fundamentally autonomous, and composed of two major subsystems, the sympathetic and the parasympathetic, charged with the emergency functions the former and of the routine functions the latter.
The sympathetic and parasympathetic subsystems inhibit each other reciprocally, but while maintaining a relative and reciprocating equilibrium, that is, when the one activates, the other works to a complementary lesser degree, and vice versa. In its handling of the emergencies, the sympathetic system inhibits the routine processes of digestion, reproduction, and relaxation, among others, substituting them for, by the effect of the hormone adrenalin, an increase in the cardiac rhythm and of the rate of breathing, which produces a greater oxygenation of the blood, which concentrates in the muscles of the extremities rather than in the trunk, because these will be required in the fight or flight response to the perceived aggression.
This blood, rich in oxygen, tends to irrigate mainly in the deepest parts of the superior and inferior extremities, more so than in the periphery of these extremities or in the trunk, in prevision of a possible wound and excessive bleeding. This is why people tend to look pale when they are scared or in panic.
The muscular tension experienced by the human being is one of the consequences of the activation of the sympathetic central nervous system. In other words, the activation of the fight or flight response makes the muscles become tense in the presence of the perceived menace and produce the unpleasant sensation which we know with the term “anxiety”.
What makes the human being more complex is not the function of the sympathetic, which is adaptive and necessary for survival. It is, however, that because of the natural selection and the adaptation of the organism to the environment, the activation of the sympathetic central nervous system frequently occurs when facing situations or instigating variables which are not usually physically menacing, but conceptually judged as harmful or dangerous. In other words, the menace may be real or perceived and is, on occasions, even imagined. Sometimes the perception of proprioceptive (produced and perceived within an organism) stimuli also generates this response of activation of the sympathetic.
The reality above described is made evident in the case of a person who thinks he or she is going to have a heart attack after thinking that this occurred to someone close to them and that this can happen to himself or herself, appearing this event on occasions associated to the perception in his or her body of a slight heart arrhythmia or of an extra-systole.
The occurrence of these events may be so menacing that his or her sympathetic will activate and when the increase in the cardiac rate and chest oppression by effect of the generalized muscular tension is felt, he or she will think that he or she is really having a myocardial infarction, which in turn will make him or her more tense and anxious, confirming these “symptoms” the imminence of the attack and the urgent need to require emergency medical services.
Frequently the emergency medical services limit themselves to place the person at rest and/or to use a mild tranquilizer and wait until the parasympathetic nervous system inhibits the sympathetic. Nevertheless, when to protect himself or herself legally, the emergency doctor makes a referral to the specialist in cardiology without making the necessary referral to the clinical psychologist, confirms with this action the menace perceived by the person, reinforcing positively his or her pattern of behavior, which will make this pattern of behavior to increase its probability of occurrence and to tend to repeat itself more often in the future.
The medical model traditionally controls tension by using psychoactive medications. These substances are administered under the hypothetical assumption of controlling or blocking the organic reaction until the reestablishment of the normal and usual environmental parameters which do not generate anxiety, with the hope that by homeostasis the organism will return to its base level of functioning after the instigating external causes of the event or “stress” cease.
Drugs, however, do not act on the learned patterns of behavior, but are fundamentally palliative of the reaction in the human being which takes place when faced by a perceived menace and at no time do they act on the environmental instigating stimuli, because these are external to the human being.
In other words, when the human being has learned to systematically produce the fight or flight response when faced with situations which are frequent in his or her life, that is, with the behavior of tension and anxiety, the drug can only be beneficial while it is being used and, when this occurs during a prolonged period of time, complex and debilitating mental or physical processes of addiction to these substances tend to occur.
It is convenient to remember that the role of medicinal drugs in mental health consists fundamentally in (a) the facilitation of the realization of an effective psychotherapeutic program only when the conditions of the individual thus require it, because the use of medicinal substances should not be the primary modality of intervention because of its iatrogenic effects, and because of the basic principle that all interventions with therapeutic purposes should be started with procedures considered of the least level of invasiveness or restrictiveness which is effective for the problem in question and, (b) the repair of sick or damaged tissue, that is, when in the presence of somatic changes, when the foreseeable benefits surpass the risks inherent to the use of these medicines.
Muscular relaxation can be effectively used in the treatment of muscular tension and the resulting anxiety and, in contrast to medicinal drugs, it has the advantage of not presenting iatrogenic effects. However, it is convenient to emphasize that drugs nor muscular relaxation are substitutes of other specific therapies in the modification of the learned patterns of behavior learned as a response to stimuli both external and internal which affect the individual and which activate the sympathetic response.
Based in that it is an effective procedure and that it does not produce additional risks, the training in relaxation should be considered as the technique of choice in the reduction of the response of muscular tension and anxiety, along with and as a facilitator of the specific psychotherapeutic processes which may be required, depending on the case.
The majority of people can benefit from training in muscular relaxation, even though they may not have specific problems in mental health. It is evident that the era in which we live is marked by a great emphasis on production and achievement, as well as in the efficiency with which we attain them. The effort we devote to these activities produces a great demand on the human being which frequently translates into the activation of the sympathetic nervous system and, therefore, in the defense response to which the muscular tension and anxiety are associated. This is very common in economic environments, where yield and making ever more predominate.
An organism that is subjected to a program of functioning in which it has to maintain a high rate of production during a long time, will be subjecting itself to physical wearing out due to excess utilization of the sympathetic or emergency system. This is the case of the so-called “type A personality”, as it is associated to working under conditions of continued “stress” for long periods of time, which produces problems of relevance at the level of risk of coronary disease of the heart, whereas individuals with the “type B personality” do not present this risk.
© 2009 Angel Enrique Pacheco, Ph.D., C.Psych. All Rights Reserved.
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