Progressive relaxation

Progressive relaxation has been found to increase the clients ability to cope with various stressful situation such as pain, childbirth, difficulty with sleep, and problematic situations that precipitate anger, criticism, fear and anxiety.

Progressive relaxation is a technique developed by Edmund Jacobson in 1929. This technique is based on empirical evidence of the physiologic impossibility being relaxed and emotionally tense at the same time. The aim of this approach is to equip clients with a technique that enables them to feel comfortable and aware of their internal and external environments. The clients is taught to create tension in the muscle group, making thee muscles as tight as possible without causing pain or crams. This tightness is held for about 5 second during which the clients concentrates on how the tension feels. The client then relaxes the muscles, letting them become completely loose. This procedure is repeated twice for each group of muscles. The major group of muscles are:

1. Hands, forearms and biceps: To tighten group, the client is asked to make a first with right hand, followed by bending up tightly the right elbow.

2. Head, neck and shoulders: The client is instructed to squint the eyes, wrinkle and brows, clench the jaw, press the tongue against the roof of the mouth, purse the lips into in O, press the head back as far as possible, roll as slowly and bring it forward by pressing the chine against the chest, shrug the shoulders up and hunch the head down in between them.

3. Chest, stomach and lower back: The client is instructed to breathe in deeply and to breathe in deeply and slowly, and to stomach and arch the back without straining it.

4. Thengs, buttocks, calves and feet: The client is instructed to tighten the buttocks the things by pressing down the heels, and then pointing the toes backward and forward.

Consultation with the attending physician is recommended when considering clients neurologic conditions, since it is possible to cause or worsen rigidity by tensing the muscles.

Common problems in achieving relaxation include:

1. Movement of body parts: The client must assume a comfortable position by sitting or lying dawn, so that every part of the body is supported. If assuming such a position disrupts relaxation, reviewing the effectiveness of the technique becomes essential.

2. Sleep: Falling a sleep decreases the effectiveness of the relaxation especially when this technique is practice at bed time, unless this is the desired outcome. Modulating pitch and volume of the mice may correct this problem. Selecting a time for practicing the technique when the client is not fatigued may also be useful.

3. Sense of losing control; To avoid this potential problem, ensure that the client understands the objectives of the relaxation and that the exercise is introduced gradually.

4. Annoying or distressing words and phrases: Be attentive to the words and phrases that might increase the tension of the client and ensure that these are avoided.

It is impossible to teach the client how to relax when the nurse is tense. Therefore, that you can successfully utilize this technique your self before attempting to teach it to clients. Relaxation is an acquired skill that becomes more highly developed with regular practice. Therefore pushing the client too quickly to relax can have an opposite effect.

STRESS

We all experience stress occasionally. Students may have stress when a relationship with their roommates is not going well, when they must declare a course of studies or when the finals are coming. Today rapidly paced society creates stress for many of us. Air and noise pollution, traffic congestion, crime, and excessive workload are increasing in our daily lives. Finally we are sometimes faced with major stressful events such as the death of a parent or a natural disaster. Exposure to stress can lead to painful emotions, for instance, anxiety or depression. It can also lead to physical illnesses both minor and severe. The people’s reactions to stressful events differ widely, some faced with stress may develop serious psychological or physical problems, whereas other people cope with it without problems and even find it challenging and interesting.

Stress has become a popular topic. The media often attribute unusual behavior or illnesses in people to burn out from stress. For example, when a celebrity attempts suicide it is often said that he or she was burnt out from the pressure from public life. In their daily lives at school students often talk about each other’s levels of stress. “I am so stressed out”. It’s a common claim.

So what is stress? In general terms, stress occurs when people are faced with events they perceived as endangering their physical or psychological well–being. These events are usually referred to as stressors, and people’s reaction to them are stress responses.

Countless events create stress. Some are major changes affecting large number of people such as war, nuclear accidents and earthquakes. Others are changes in the life of an individual, for instance, moving to a new area, changing jobs, getting married, losing a friend or suffering a serious illness. Everyday hassles can also be experienced as stress like getting stuck in traffic, arguing with your professor and so on. Finally, the source of stress can be within the individual in the forms of conflicting motives or desires.

We can say stress is “the rate of wear and tear on the organism”. According to Hans Selye, a stress researcher, “it is the sum of all nonspecific changes caused by function or damage”.

It is important to distinguish stress from a stressor. A stressor is the cause of stress. Stress is the effect. Thus, if one feels mentally and physically exhausted after working in the factory that is filled with loud changing sounds, the loud changing sounds are stressors. The toll taken on the person is stress.

It is now generally recognized that stress is an important factor in both mental and physical illness. A person who wants to remain healthy at both levels needs to pay attention to practical ways to reduce stress.

It is a great pleasure for me to be here today.

As a physician, and later as a Prime Minister, I saw for myself how hard it was to strengthen mental health policies in my own country, Norway. This brought home to me the difficulties faced by those working to improve mental health in both developed and developing countries.

I saw how mental health issues so often were at the periphery of public health practice.

But it is not logical for mental health to be so marginalized. For years there has been enough knowledge about mental illness to reveal similarities with the issues and structure of physical health.

It is also not right that mental health is on the margins, because the separation of mental health from other health concerns has contributed to stigma, discrimination and the slow progress of mental health services.

The World Health Organization has a clear mandate to promote equity in human health throughout the world. During the last three years we have sought ways to move mental health into a more prominent position within global public health efforts.

There is abundant evidence of the need to do this. Let us review the available information about the extent to which mental ill health contributes to the global burden of disease.

Almost 500 million people are suffering from mental disorders today. One in four families have at least one member with a mental disorder at any point in time. And they are on the increase. From 12 per cent of the total burden of disease and projections for 2020 reach 15 per cent. Mental disorders account for 30 per cent of all years lived with disability. Depressive disorders are the fourth leading cause of disease and disability. They are expected to rank second by 2020.

Those are the global figures. But also in Europe, mental disorders figure among the leading causes of disease and disability. In the WHO European Region, and remember that it stretches as far east as Vladivostok and as far south as Tashkent, 33 million people per year have been estimated to suffer from severe depression.

Depression is also a condition increasingly affecting adolescents. In a recent European investigation, 5 per cent of all girls and 1.3 per cent of all boys aged 16, in the country studied, fulfilled the criteria for severe depression. Fourteen per cent of girls and about 5 per cent of boys studied were found to be moderately depressed.

European suicide rates range from 11 to 36 per 100 000 population. The highest rates in the Region are also the highest in the world.

There are three factors contributing to the increasing importance of mental ill health in the global burden of disease.

First of all: We are living in a world of rapid change. This is experienced by people living in the calmest and most prosperous corners of the world. They encounter newness at a breath-taking pace: from new technology to new jobs to new fashions in entertainment and culture. They are being swirled along in the rapidity of global transformation.

In the Eastern European states, the end of central planning and control has led to an even faster pace of change.

Change in itself is not negative. After all, the human quest for progress is motivating much of our behaviour. And, much of the change we see today is for the better.

Yet people exposed to rapid change have to cope with insecurity and unpredictability. And, some of the consequences of change clearly are negative. This is especially the case if change is imposed on people who are powerless to influence how it affects them.

The second determinant of mental ill health is poverty. Over the past decades, the world has seen great progress on many fronts. Great technological breakthroughs. Millions of people better off. Richness, abundance, and lifestyles characterized by more opportunity and more choice.

But, in spite of the spectacular growth since 1970, more than three billion people - that is half of the world's population - still remain poor and live on less than two US dollars per day. Of these, 1.3 billion live on less than one US dollar a day.

A recent study sought information from 60,000 poor people in 60 countries. They were asked to share their realities, their hopes and expectations for the future. When we listen to what they say, we hear the importance that they give to the peace of mind that comes from enjoying good health, from a sense of community, from personal safety and from the predictability of life events. Higher income is necessary, but not sufficient.

The third influence on levels of mental ill health is the ageing of the world's populations. Over the coming decades, we will see a great shift in the demographic structures of both developing and industrialized countries.

There are currently about 600 million people in the world aged 60 and over. This figure is expected to rise to 1020 million within the next 20 years - a 70 per cent increase in the size of this age group. And, by 2020, approximately 70 per cent of this elderly population will be living in developing countries.

The social consequences of this demographic transformation also includes an increased risk of some mental illnesses - the incidence of depression and dementia increases with age.

Although mental health is part of the WHO definition of health since its adoption, for many years there were few interventions to address mental health problems. Patients were kept in separate hospitals, and mental health was not part of public health priorities.

There is today a new understanding of both mental health and mental disorders based on advances in neuroscience and in behavioural medicine. Three of last years' Nobel Prizes were awarded to scientists working on mental health and neurological disorders. This understanding offers a new hope for those suffering from mental disorders. They will benefit if improved and more cost-effective interventions can be made more widely available.

We are more aware of the real burden of mental disorders and their costs in human, social and economic terms. We know of the barriers -particularly stigma, discrimination and inadequate services - preventing millions of people from receiving the treatment they need.

As we analyse this new evidence on mental disorders, we can see the clear links between thought, feelings and physical illnesses. Depression can be a risk factor of heart disease and on the other hand, supportive group therapy for women with breast cancer results in longer life. No longer do we see genetics and environment as two separate and contrasting dimensions to mental ill health: we now recognize that it is the simultaneous effects of human genetics and the environment.

We now have better ways of solving mental health problems. For example, 60 per cent of people with depression can recover with a proper combination of antidepressant drugs and psychotherapy. Nordic studies show a 20-30 per cent decrease in suicide rates after general practitioners were trained to recognize and treat depression.

We are seeing, in many countries, a new trend from institutional care to community based care. From separating mental disorders to integrating them into general health care and prevention services. Several countries in Western Europe have been spearheading this trend - charting out bold new pathways to improve care and prevention.

Families with mental illness are being empowered. Human rights are being recognized as a major concern of mental health services. Key elements of mental health care are being openly debated. The cost-effectiveness of different treatments for depression, schizophrenia, alcohol and drug dependence, epilepsy, and mental retardation is more clearly understood. People with mental disorders are being integrated into the work force through a groundbreaking system of enterprises in many European countries, including co-operatives of persons with mental illness and sheltered employment.

However, there is a long way to go before we can say that solutions and resources for mental health match those invested in physical health. The size and effectiveness of the response to mental ill health do not match the burden on individuals and societies. If we stay in Europe, many countries spend less than 3 per cent of their health budgets on mental health care, although the consequences of mental ill health can easily amount to one third to one half of all health care costs. In addition, the burden is unequally distributed. The poor often have a greater risk of mental disorder and less access to treatment.

Policies that orient mental health action in a systematic and comprehensive way have definite health benefits. Yet, one third of the countries of the WHO European Region still have no explicit policies.

More than half of all patients in some eastern European countries are treated in large mental hospitals housing more than 1000 people. This type of institutional treatment often lead to loss of social skills, excessive restrictions, human rights violations, dependence and reduced opportunities for rehabilitation.

Studies show that mental health problems account for up to 30 per cent of consultations with general practitioners in Europe. Twelve of the countries of the WHO European Region, however, have not integrated the services, keeping mental health and primary care working on parallel tracks. In one out of five European countries, primary care does not include freely available access to at least three of the essential psychotropic drugs.

Why is the situation so unsatisfactory? Mental illness is still a taboo subject. All of us in this hall know the difficulties of structured discussion about mental illness within the context of public health policy outside our own profession. It is hard to break the silence. It is not easy for the neighbour, the community leader, the local politician - even the prime minister - to dare to care for those who are mentally ill. The result is a tragic waste of lives, and of productive livelihoods.

This silence and denial leads to discrimination. In many countries around the world, insurance companies discriminate between physical and mental disorders. Labour policies are less open to welcoming people with a history of mental disorders than those with physical ones. In some countries, the basic human rights of people with mental illnesses are not realized, often in the institutions designed to care for them - the psychiatric hospitals.

Who need help, treatment, care and prevention are often unwilling to seek it out. Societies hide their people who are affected by mental ill health.

We all know how important it is to address the issues of stigma and discrimination - together - and to break the silence about mental ill health. Fortunately, we see some powerful examples of progress -particularly through the actions of groups of people who have themselves been affected by mental illness.

Earlier this month, WHO released this year's World Health Report. Its theme is mental health and its title is "New Understanding New Hope".

This report draws the map over the vast landscape of mental and neurological disorders and what we know about them. It reviews the status of the global response to the burden on mental ill health.

But it also sets out some very concrete directions for what countries need to do to respond effectively to the challenges we are facing.

In drawing together information on the burden of mental ill health, the potential for effective responses and experiences of different countries, WHO offers 10 key recommendations for a strategic response.

Some of them I have already touched upon, such as the need to provide treatment for mental illness in primary health care, to make medicines for psychiatric illness more widely available, and to make mental health care available in the community. But in many countries, it is just as important to establish national policies, programmes and legislation for mental health.

There is a need to match global strategic directions to the reality of individual countries. For these reasons, WHO proposes that national officials and community groups identify a number of minimum actions to be undertaken for mental well-being.

Without focusing on individual countries, WHO has offered guidance that allows every nation to recognize itself in one of three scenarios and consequently, to adopt and implement actions that might be appropriate to its own situation.

We also have available tools and instruments to effect change. A collection of examples of national mental health policies to serve as benchmarks and examples of good practices, models for working with families of the mentally ill, training materials for primary health care personnel and assessment tools for health care workers to document mental disability. We are also initiating research into the cost effectiveness of mental health interventions in primary health care.

We are already beginning to see change. On the World Health Day which was dedicated to mental health this year, a national committee to monitor the state of human rights of mentally ill persons and their families was established in the Ukraine. France announced a policy to phase out psychiatric institutions in favour of community-based mental health services, just to give two examples.

Our engagement does not end with the end of this year which we have dedicated to mental health. We have developed a new "Global Action Programme" or "GAP" The name is no coincidence. This five year programme will focus on helping countries closing the treatment gap. It represents a comprehensive strategy for closing the gap between effective and available mental health services.

The GAP has identified four core strategies: Information, Policy and Service Development, Advocacy, and Research. These four strategies are fundamentally related to one another. Information concerning the magnitude, burden, determinants and treatment of mental disorders leads to enhanced awareness and advocacy against stigma and discrimination. This in turn creates the necessary conditions for the formulation and implementation of integrated policy and services, which in turn serves to generate more advocacy and information for better decisions. Countries' research capacity drives this relationship.

In more ways than one, we make this simple point: we have the means and the scientific knowledge to help people with mental and brain disorders. Governments have been remiss, as has been the public health community. By accident or by design, we are all responsible for this situation. As the world's leading public health agency, WHO has one, and only one option to ensure that ours will be the last generation that allows shame and stigma to rule over science and reason.

Thank you.

Return to Director-General's main page

Return to Top News