Cue-Controlled Relaxation

Description of the Strategy

Cue-controlled relaxation is a procedure designed to enable an individual to achieve relaxation rapidly through self-produced cues, usually a deep breath that is exhaled and a specific word.

Typically, training in deep diaphragmatic breathing and muscle relaxation (e.g., progressive muscle relaxation) precedes the introduction of cue-controlled relaxation. Once clients master deep muscle relaxation, cue-controlled relaxation is introduced. The specific training in cue-controlled relaxation would begin the session with the same procedures for attaining deep muscle relaxation as in previous sessions. After clients become relaxed during this session, they will be instructed to focus their attention on their breathing. They are instructed to slowly inhale and exhale, with attention to the use of the diaphragm. Upon exhalation, clients are asked to silently repeat to themselves a word such as “relax” or “calm” while the clinician audibly repeats the designated cue word in synchrony with five consecutive exhalations. Clients then repeat the procedure of pairing the exhalation with the cue word about 15 more times. Following [Page 242]this, there is a 60-second period during which the clients are asked to focus on general feelings that accompany their relaxation. Such pairing is then repeated about 20 more times. This is important, as training in cue-controlled relaxation requires repeated pairings of a relaxed state with a designated cue. This training is repeated in session for four to five more sessions.

Clients are also encouraged to practice the cuecontrolled relaxation procedure (e.g., 20 pairings) on a daily basis on their own outside of the treatment setting. While it is emphasized initially that these exercises are to be practiced in nonanxietyor arousal-eliciting settings, clinicians later may also ask clients to practice the pairings in situations where anxiety is elicited, including those that may be of interest for treatment success (e.g., public speaking, test taking, etc.). Related to this, during treatment sessions, clients may be asked to imagine a threatening situation related to their presenting problem until some level of anxiety is experienced, and then to practice the pairings. If relaxation is attained, the clients are asked to use the cue training any time they experience elevations in anxiety outside of the clinical setting.

An innovative variation on cue-controlled relaxation training relates to its optional use with nonverbal externally produced cues that occur on a regular basis. For instance, behaviors such as making the bed, turning on a coffeepot, using keys, and stopping for traffic lights could be paired with relaxation by having the clients perform the deep-breathing exercises and subvocal cuing during their performance of these behaviors. This training can be particularly useful when clinicians are interested in having clients experience the cue-controlled relaxation as part of their daily lives following the conclusion of treatment. While this unique use of cue-controlled relaxation can be useful to clients, it is not necessarily a requirement with cuecontrolled relaxation. It is simply an optional, innovative use of the mechanism (i.e., classical conditioning via pairing a cue with relaxation) by which cuecontrolled relaxation achieves its goal (eliciting a relaxation response when desired).

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