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Paradoxical Relaxation and the Treatment of Chronic Pelvic Pain Syndrome

Paradoxical Relaxation and the Treatment of Chronic Pelvic Pain Syndrome

In a recent New York Times article (see excerpt below), the usefulness of concentration as an integral part of a discussion of mindfulness is discussed. The ability to concentrate is not a subject that is often discussed in the psychological literature on pain reduction; thus, this article is a welcome addition to the narrative of what we consider a critical issue in dealing successfully with chronic pelvic pain.

It has become clear over the last decade that nervous system arousal is a central issue to treat in those suffering from chronic pelvic pain syndromes. Gevirtz and Hubbard have convincingly shown emotional arousal raises the level of electrical activity in pain referring trigger points in those with myofascial-related pain. There have been recent studies evaluating the usefulness of hypnosis and cognitive therapy to deal with nervous system arousal, but it has been our observation that psychotherapy by itself has little effect on modulating or reducing chronic pelvic pain. Traditional methods of cognitive therapy help patients recognize their dysfunctional thinking and analyze distorted thoughts in order to discard them. In our work using the Wise-Anderson Protocol over the last 18 years, we have observed that these methods are not greatly helpful when patients’ pain goes on unabated and they remain helpless to do anything about it.

The method of Paradoxical Relaxation used in the Wise-Anderson Protocol is one of the main ingredients we use to help those with pelvic pain lower their autonomic nervous system arousal. Many of our patients who become competent in this methodology commonly report that they can significantly reduce their pain using this relaxation method.

Paradoxical Relaxation is the practice of focusing attention on sensation rather than mental thought. The aim is to take attention away from all thought—not analyze any of it. While it is sometimes useful to analyze dysfunctional thinking, that is not the aim of Paradoxical Relaxation. If someone is helpless to stop their chronic pain, it doesn’t matter how much analysis of dysfunctional thinking is done because the inability to affect the pain is the main driver of the sense of helplessness and disempowerment.

In the Paradoxical Relaxation session, the nervous system is deliberately deprived of the symbolic stimuli that cause it to become aroused. This break in arousal can help break a flare up of symptoms and moves in the direction of downwardly resetting the nervous system ‘idle speed.’

The most profound relaxation occurs when attention is controlled and kept focused in sensation. Just as the deepest sleep is dreamless (non-REM) sleep, relaxation that is void of thinking produces the deepest level of relaxation. This type of deep relaxation allows for an up-regulated nervous system to quiet down. The idea of relaxation depending on the control of attention rather than the releasing of such control is counter-intuitive, yet over the years patients using Paradoxical Relaxation in the Wise-Anderson Protocol have experienced the ability to control attention, to reduce pain, and ‘down regulate’ the nervous system.

Training attention to stay focused is a discipline that, as the New York Times article we quote below understands, has many benefits. In our work with pelvic pain, calming down nervous arousal to reduce pain is the most important of these benefits.

Excerpt from “The Power of Concentration” by Maria Konnikova in the New York Times on December 16, 2012.

The Power of Concentration


December 16, 2012

“MEDITATION and mindfulness: the words conjure images of yoga retreats and Buddhist monks. But perhaps they should evoke a very different picture: a man in a deerstalker, puffing away at a curved pipe, Mr. Sherlock Holmes himself. The world’s greatest fictional detective is someone who knows the value of concentration, of “throwing his brain out of action,” as Dr. Watson puts it. He is the quintessential unitasker in a multitasking world…

In 2011, researchers from the University of Wisconsin demonstrated that daily meditation-like thought could shift frontal brain activity toward a pattern that is associated with what cognitive scientists call positive, approach-oriented emotional states — states that make us more likely to engage the world rather than to withdraw from it.

Participants were instructed to relax with their eyes closed, focus on their breathing, and acknowledge and release any random thoughts that might arise. Then they had the option of receiving nine 30-minute meditation training sessions over the next five weeks. When they were tested a second time, their neural activation patterns had undergone a striking leftward shift in frontal asymmetry — even when their practice and training averaged only 5 to 16 minutes a day.

…But mindfulness goes beyond improving emotion regulation.”

Read the rest of the article here.