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Relaxation: a self-care healing modality reduces harmful effects of anxiety.

Anxiety, a state of uneasiness or apprehension toward a vague or nonspecific threat, is prevalent in cardiac patients. Estimates are as high as 70% to 80% during the acute phase, and it persists long-term in 20% to 25% of patients. Anxiety inflicts its toll through 3 major pathways. In the physiological pathway, anxiety affects the musculoskeletal system by causing muscular tension; the autonomic nervous system by arousing sympathetic responses; and the psychoneuroendocrine system (hypothalamic-pituitary-adrenal axis) by triggering secretion of catecholamines and glucocorticoids (see Figure). The psychological pathway elevates negative mood states, whereas the social-behavioral pathway promotes disconnection from self and others and stress inhibition with resultant unhealthy lifestyle behaviors. The deleterious effects of this psychophysiological stress response are troublesome because anxiety is an independent predictor of arrhythmic/ischemic complications and increased mortality in cardiac patients. As part of autonomous nursing practice, relaxation is an integrative therapy that calms the mind and body by reducing sympathetic nervous system activity. The resultant relaxation response is characterized by lower respiration, heart rate, blood pressure, myocardial oxygen consumption, and muscle tone. The beauty of relaxation is that it can be used in any setting, and only a basic set of instructions and a quiet, comfortable environment are needed. The relaxation response, consisting of a mental device, passive attitude, and decreased muscle tone, may be evoked through many techniques. A regular feature of the American Journal of Critical Care, Clinical Evidence Review unveils available scientific evidence to answer questions faced in contemporary clinical practice. It is intended to support, refute, or shed light on healthcare practices where little evidence exists. To send an eLetter or to contribute to an online discussion about this article, visit www.ajcconline.org and click “Respond to This Article” on either the full-text or PDF view of the article. We welcome letters regarding this feature and encourage the submission of questions for future review.