Relaxation-Induced Anxiety

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Christina Luberto is a doctoral candidate in psychology at the University of Cincinnati. She is in D.C. today to present research on a concept called relaxation-induced anxiety (RIA). It is precisely what it sounds like: being relaxed, itself, actually triggers anxiety.

RIA has been mentioned sporadically in medical literature since the 1980s, but never as a diagnosis in itself. Luberto looks at it as a disposition; a maladaptive process. She says about 15 percent of people have experienced it, and it's not outside the realm of benefiting from treatment. So she developed an index to identify exactly what part of relaxation is causing a person's anxiety, which should help inform targeted therapy.

RIA is different from just being the sort of person who doesn't find traditionally relaxing things to be relaxing. If those things (doing yoga, playing harp, brunching with Yanni, etc.) actually make you feel anxious -- but you then feel at ease, say, organizing socks -- that's not RIA. Because you are able to relax, albeit by atypical means. In this model, anything that elicits relaxed physiology (slow heart rate, decreased muscle tone, deep breathing) counts as relaxing.

It's also different from being straight-up unable to ever relax, as in severe chronic anxiety.

In RIA, you are able to relax (by whatever does it for you -- cooking, chilling, vacuuming), but it's not long before the relaxation triggers anxiety. You briefly enter a parasympathetic (chill) state, but then your heart rate spikes, and your respiratory rate increases, and you feel anxious.

So why does this happen? It varies, widely, but that's where Luberto's work comes in. She developed a 21-item self-examination that is supposed to help people with RIA identify exactly what part of relaxation triggers their anxiety. She calls it the Relaxation Sensitivity Index.

Luberto tested it on a group of undergrads, and it seemed to work. I asker her if we could publish the full version of the test, but she prefers to wait until her academic article is published, which will also include the dense rubric for interpreting and managing the results. She did release a few examples, though.

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The prompts are broken down into three subsections, and each would be rated by the patient on a five point scale.

Social:

• "I worry that when I let my body relax, I look unattractive."
• "I worry that if I relax, other people will think I'm lazy."

Cognitive: 

• "I don't like to relax because I don't like it when my thoughts slow down."
• "I don't like to relax because it makes me feel out of control." 

Physical:

• "It scares me when my breathing becomes deeper." 
• "I hate getting massages because of the feeling it creates when my muscles relax." 

Treatment could then be tailored based on the responses. 

And then, what do you mean by treatment? Luberto made the point that relaxation is often the prescription for anxiety. In this case, it can't be. At least not in the traditional sense. 

She believes people with RIA will benefit from exposure procedures ("facing their fears," in a therapeutic context), which, yes, will involve controlled, supervised relaxation sessions. It's like when you take people who are afraid of commitment and force them to get married. Just kidding, that's not a thing. But there is a real TV show called Fear Factor where we make other humans do scary things. A relaxation-themed episode would be mildly interesting.