Relaxation training for panic-prone patients

Domain XVI · Historical, discredited & harmful

What it is

"Relaxation training for panic-prone patients" is not a separate therapy. It names a risk: that teaching relaxation methods (progressive muscle relaxation, meditation, autogenic training and similar) to people who are prone to panic can, in some of them, provoke anxiety or a panic attack instead of…

Format

• Phase 2. Treatment choice and consent. Goal: agree a treatment the client understands. For panic disorder, NICE names CBT, delivered by suitably trained and supervised practitioners who adhere to empirically grounded protocols, in the optimal range of 7 to 14 hours in total, usually in weekly…

Who practises it, and how they are trained or regulated

• Phase 4. Response to relaxation-induced anxiety. Goal: stop, stabilise, make sense of the reaction with the client, and decide together whether to modify, switch or continue. Wells (1990) reports a single case in which autogenic training increased panic frequency and an external attention-training procedure reduced panic. Move on when a revised plan is agreed.
• Version followed: relaxation training for panic-prone patients as it appears on Lilienfeld's (2007) provisional list of potentially harmful therapies; the relaxation-induced anxiety literature (Heide and Borkovec 1983, 1984; Adler, Craske and Barlow 1987; Wells 1990) as the evidence of harm; applied-relaxation trials (Öst 1988; Öst and Westling 1995; Tarrier and Main 1986; Beck et al. 1994; McCarthy et al. 2018),…
• "Relaxation training for panic-prone patients" is not a separate therapy. It names a risk: that teaching relaxation methods (progressive muscle relaxation, meditation, autogenic training and similar) to people who are prone to panic can, in some of them, provoke anxiety or a panic attack instead of calm. Lilienfeld (2007), in Psychological Treatments That Cause Harm (Perspectives on Psychological Science, 2(1),…

Evidence status, as the guide reports it

• The position is contested. Applied relaxation, a coping-skill method developed by Öst, has been tested against other treatments for panic disorder and is rated by APA Division 12 as having "Modest Research Support" for panic disorder. NICE CG113 recommends applied relaxation as a high-intensity…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• hopelessness after failed treatments. Working: risk is assessed, documented and acted on.
• rising panic scores during the relaxation phase. Working: adverse reactions are caught early.
• escalating panic linked to practice; hiding episodes. Working: the client reports reactions and adjusts.
• steering a client into the method you happen to prefer. Working: the client's choice is informed and recorded.
• the client feeling rejected. Working: the client attends and the receiving clinician has the information needed.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.