The Autism Society Event and Education Recordings Archive

Relaxation is fundamental to self-regulation, flexibility, and adaptive decision-making. Many therapeutic interventions call for relaxation, but few provide guidance as to how to accomplish it. This presentation outlines physiological and psychological factors that contribute to relaxation. Using evidenced-based methods effective for persons with autism, S.T.O.P. and Relax© provides systematic instruction in self-calming skills. These skills promote self-regulation and avert meltdowns. Participants will experience the yoga-based exercises and relaxation practices implemented in this methodology. The presenters will address the objectives through a PowerPoint presentation, other visual displays, and audience participation.

Relaxation is fundamental to self-regulation, flexibility, and adaptive decision-making.  Many therapeutic interventions call for relaxation but provide little guidance as to how to accomplish it.

Persons with autism and related disorders are vulnerable to escalating stress and anxiety. The triggers vary from everyday sensory input to situational events.  The anxious, agitated state is associated with highly challenging behaviors, ranging from complaints, protests, and withdrawal to tantrums, aggression, and “meltdowns.”   Often it is difficult for others to soothe the individual, who might only recover composure after becoming physically exhausted.  These stress episodes interrupt the individual’s learning and social engagement.  For some sufferers, sometimes, these episodes present a danger to self or others.

The problem of stress episodes and the path from escalation to recovery are well detailed in texts and therapeutic resources.  Examples include Understanding the Nature of Autism by Janice Janzen, The Incredible 5-Point Scale by Kari Dunn Buron and Mitzi Curtis, and Outsmarting Explosive Behavior - A Visual System of Support and Intervention for Individuals with Autism Spectrum Disorders by Judy Endow, MSW. 

Methods of helping children recognize the triggers for their stress and their related thoughts, feelings and behaviors are thoroughly addressed. Related interventions include addressing sensory and event triggers by anticipating and preparing for them. There are strategies to increase the individual’s ability to recognize escalating stress and create a plan to counter it. 

The importance of relaxation is cited consistently. However, how do you make the experience of relaxation available to a child who does not know how it feels to be relaxed? Moreover, can this be accomplished without words?

 

• Relaxation involves integration of physiological and psychological factors to shift the (sympathetic/parasympathetic) nervous systems from “fight/flight” to calm.

Dr. Herbert Benson, founder of the Benson-Henry Institute for Mind-Body Medicine (www.massgeneral.org/bhi), has conducted decades of research into the nature of the Relaxation Response.  According to Dr. Benson: "The relaxation response is a physical state of deep rest that changes the physical and emotional responses to stress... and is the opposite of the fight or flight response."  Dr. Benson notes that methods to elicit the relaxation response include meditation, mindfulness, progressive muscle relaxation, tai chi, and yoga. The interplay of the sympathetic and parasympathetic aspects of the autonomic nervous system is illustrated below:

 

Sympathetic	Parasympathetic

 

Rapid, shallow breathing

Slow, deep breathing

Increases blood pressure	Lowers blood pressure
Increases heart rate and force	Slows heart rate and force
Decreases circulation in extremities (cold, clammy hands and feet)	Increases circulation in extremities (warm hands and feet)
Tenses muscles	Relaxes muscles
Speeds reflexes, reactions	Slows reflexes, reactions
Raises anxiety	Lowers anxiety

The mind races or obsesses

The mind is calm

Expends energy, decreases stamina

Saves energy, increases stamina

 

• To teach relaxation it is beneficial to break down the physiological and psychological components of self-calming into a set of attainable skills.  

Practice of specific actions or thoughts conducive to relaxation increases the depth of the relaxation response and the ease of attaining it. This is achieved by creating a system that promotes an individual’s sense of mastery over his/her physical body, including attention to the following:

 

• Muscle control
• Discrimination between tension and relaxation
• Capacity to observe and alter the breath
• Improved balance
• Ability to stand or sit erect
• Increased physical strength
• Increased flexibility
• Capacity to sit or rest quietly

Calming thoughts can be taught as a skill set associated with the physical relaxation response. Strategies relevant to this practice include the following:

 

• Positive self-statements
• Guided imagery
• Social stories

The work of June Groden in teaching relaxation techniques to individuals with special needs is an excellent resource.

 

• The S.T.O.P. and Relax^© program provides instruction, systematic practice, progress monitoring, and generalization of relaxation and self-calming skills, using evidence-based methods cited by the National Standards Report.

S.T.O.P. and Relax^© organizes the practice of relaxation and self-calming into cues and lessons accessible to persons with autism disorders.  This was accomplished by drawing upon research and evidence-based practices.  Benson, Groden, and Janzen, cited above, provided rich information about breathing techniques, yoga, and progressive relaxation, and cognitive-behavioral strategies.  Evidence-based practices in therapy and instruction for persons with autism include the Social Story methods of Carol Gray and the TEACCH center’s use of structured teaching approaches and visual cues.

Developed and piloted in 2001, S.T.O.P. and Relax^© preceded the 2009 National Standards Report produced by the National Autism Center.  It is gratifying to find that the National Standards Report supports the effectiveness of progressive relaxation, modeling, visual prompts, and story-based intervention.

S.T.O.P. and Relax^© integrates  

 

• Sensory cues (music, lighting)
• Progressive relaxation
• Yoga postures
• Visual cues
• Guided imagery
• Structured teaching
• Social stories
• Self-calming routines
• Positive practice

To effectively improve the lives of persons with autism, these methods must be readily available to teachers, counselors, therapists, and parents.  S.T.O.P. and Relax^© includes the following supports:

 

• Instructor’s manual
• Cue cards
• Posters
• Props
• Prompts: oral, written, modeling, pictures
• CD of guided breathing, guided imagery, music
• Social story books
• S.T.O.P. procedure
• Progress monitoring tools
• Generalization techniques

The skills are broken down into simple steps that gradually increase in difficulty and challenge, according to the level of the child. For example, a child begins to identify tension in his body by squeezing the muscles in the arm. Concurrent with the release, he is reminded to relax those muscles. He may tense both arms and then release them, simultaneously with the words “tense” and “relax.”

Practicing one-pointed focus while doing exercise and in postures improves an individual’s capacity to train the mind on a single instruction, position, or thought. Focus of the mind is inherent in the practice of balance.

By teaching an individual to observe his/her breathing, the teacher offers another tool for preventing and averting melt downs. 

A variety of cues integrated throughout the program enhance the student’s responsiveness to prompting with the goal of achieving self regulation after repeated practice.  Ultimately, the individual is able to access the relaxation response through the S.T.O.P. procedure, and this facilitates generalization. This builds on June Groden’s finding (1988) that individuals can learn to self monitor and redirect their activities before an outburst or meltdown occurs.

 

• The skills learned support the individual in pursuing success at school, in the workplace, and in the community.

 As noted earlier, anxiety and emotional agitation causes individuals with autism disorders to engage in fight/flight behaviors that interrupt their learning and social engagement and, for some, present a danger to self or others. 

Mastery of relaxation and self-calming skills makes the individual less vulnerable to sensory stimuli and events that can trigger reactive, fight/flight responses.  An individual free of maladaptive, automatic reactions is able to control his or her thoughts and actions and make productive, constructive choices.  

For example, children in school are required to take high-stakes tests that determine their futures.  The calming and coping skills learned through S.T.O.P. and Relax^© reduce test anxiety and increase cooperation, focus and stamina for test-taking.  For this reason, the pilot project for S.T.O.P. and Relax^© in Broward County Schools (Florida) was initiated during the first academic year that special education students in self-contained classes were required to take the Florida Comprehensive Assessment Test. 

Moreover, well before the test is administered, the skills acquired through S.T.O.P. and Relax^© play a key role in maximizing students’ participation in the instructional setting, so that they remain on-task and benefit from the academic curriculum. 

Children who practiced these techniques in school were able to generalize them into alternative settings.  For example, a child with autism went to the dentist for impressions of her teeth. After two unsuccessful attempts, the child asked for a moment and independently went through the four-step S.T.O.P. mnemonic. After completion, she was able to remain calm throughout the procedure. Parents have reported seeing their children implement relaxation postures learned in school while waiting for a late school bus and in order to self-calm before sleep.

Many teachers have reported that children return to class better able to focus and complete assignments after relaxation sessions. They have observed children adjusting their breathing or posture independently during stressful situations in class.  These independent choices underscore the capacity of a child to learn to implement relaxation techniques and recognize their benefits on an organic level.

Learning Objectives: