In this article, I develop the different points that make up the methods of stress management, their physiological and psychological characteristics.

Pedro de Vincente de Monjo in 1987, quotes: "the essential elements that any technique must contain in order to be called relaxation are breathing and muscle tone".

Breathing

Breathing is generally an integral part of all methods of relaxation, hypnosis, meditation, yoga and others. It is also a vital function in the homeostasis of our body: it transports oxygen to our lungs and excretes carbon dioxide from them. It is the only neuro-vegetative function on which we can act voluntarily. At birth, this breathing is diaphragmatic due to the immaturity of the other respiratory muscles. Most people develop thoracic respiration during growth. This thoracic respiration limits the filling of the lungs and therefore the good oxygenation of the blood (Chauvel. D; Noret. C, 2003).

The diaphragm, which is the main muscle of inspiration, is initially dome-shaped at rest and separates the thoracic cage from the abdominal organs (Marieb. E p.355-356, 6th edition). On inspiration, it flattens and sets all the organs and the fluids present in the abdominal cavity in motion, which favours the stimulation of the parasympathetic system and thus the general slowing down of the metabolism (Raoul. F, 2015).

Slow and deep abdominal breathing helps to create an increase in ventilation. It is necessary to understand that this hyperventilation is different from the hyperventilation syndrome produced in a state of stress, anxiety or excitement. In fact, the latter consists of rapid respiratory movements, mainly thoracic, whereas the breathing aimed at relaxation is of the abdominal and slow type. Moreover, the context is also different: "hyperventilation" with a relaxing aim is to be practised in a reassuring context and atmosphere. This has the effect of modifying the electroencephalogram waves and thus lowering the levels of vigilance, modifying the state of consciousness by relaxing analytical thinking and defences. Emotional lability and increased suggestibility also occur (Guiose.M, 2003).

Diaphragmatic breathing is carried out by breathing in slowly and deeply through the nose, inflating the abdomen and then holding one's breath for a few seconds (maximum 10 seconds). Exhalation is done slowly through the mouth, allowing the abdomen to relax. This cycle must be carried out several times. The practitioner can help himself by positioning his hand on his abdomen in order to better feel it inflate when inhaling and retract when exhaling (Raoul. F, 2015).

Relaxation

Definition of relaxation according to the Larousse dictionary: "Physical and mental relaxation resulting from a decrease in muscle tone and nervous tension. A method aimed at achieving this relaxation through conscious control of physical and mental tone in order to soothe internal tensions and consolidate the person's mental equilibrium".

"Relaxation represents a set of methods, techniques and therapies that voluntarily seek physical and mental relaxation, as well as the adaptation of alertness to the current situation". Psychosomatic medicine is at the origin of most modern western methods of relaxation. The first modern relaxation technique created on the basis of psychological and physiological research is Professor Schultz's autogenic training. Many other techniques have since emerged. (Parodi Riera. L, 2012).

The relaxation techniques are divided into two classes:

1. Relaxation with a mental starting point or with a descending path, such as autogenic training. These methods use autosuggestion or mental imagery to relax the body.

2. Relaxation with a physical or bodily starting point, also known as upward path relaxation. Mental relaxation is brought about by muscle relaxation (Tai chi, Gi gong, massage, stretching, breathing).

Caycedo sophrology, related to hypnosis, mixes several existing techniques. It is "the science of consciousness, its modifications and the physical, chemical or psychological means that can modify it for prophylactic, pedagogical or therapeutic purposes" (Caycedo. A, s.d).

Another technique is the Yoga Nidra which consists of 5 points:

1. Focussing of the consciousness on each part of the body

2. Breathing

3. Feelings of warmth, heaviness, feelings...

4. Visualisations

5. Resolution

Relaxation has an effect on alertness and state of consciousness. Vigilance can be measured by means of the electroencephalogram (EEG), eye movements and electrodermal resistance. This makes it possible to classify different levels of alertness (Guiose. M, 2003) :

Diffuse vigilance, with the mesencephalic cross-linked substance.

Focused or attentive vigilance, with the intrathalamic reticulated substance, which is very cholinergic.

Affective" vigilance with the rhinencephalon and the whole limbic system.

Consciousness, on the other hand, is more subjective and to date no technique can provide information on its content. However, parallels are drawn with the level of vigilance and physiological measurements such as heart and respiratory rhythm. At the central level, wave modification at the EEG is the most widely used.  

Relaxation acts on stress via the secretion of stress hormones (see physiology of stress, p.8). This decrease in catecholamines is correlated only with a decrease in alertness (Guiose. M, 2003).

Diffuse vigilance, with the mesencephalic cross-linked substance.

Focused or attentive vigilance, with the intrathalamic cross-linked substance, very cholinergic.

Affective" vigilance with the rhinencephalon and the whole limbic system.

Consciousness, on the other hand, is more subjective and to date no technique can provide information on its content. However, parallels are drawn with the level of vigilance and physiological measurements such as heart and respiratory rhythm. At the central level, wave modification at the EEG is the most widely used.  

Relaxation acts on stress via the secretion of stress hormones (see physiology of stress, p.8). This decrease in catecholamines is correlated only with a decrease in alertness (Guiose. M, 2003).

Any relaxation also has an effect on muscle tone, which is controlled in the brain by the following areas :

Reticulated training (activating or inhibiting muscle tone) is related to the level of vigilance of each individual. Also responsible for the sleep-wake mode.

The hypothalamus, the seat of emotional reactions, manages the level of hormones secreted. It is responsible for the links between emotions and muscle tone.

The cortex, which analyses the data it receives, triggers the action.

"Tone is the permanent and moderate contraction of the muscles, maintained by nerve impulses. It is highlighted clinically by the slight tension that constantly affects any muscle at rest and becomes exaggerated during effort. (...) The passive stretching of a muscle causes active resistance. The muscle develops a resistance greater than that which is provoked. If, on the other hand, the muscle tended to shorten through contraction, the loop would work in the opposite direction and would tend to bring the muscle back to its length. This reaction is called the myotatic reflex" (J-D. Vincent, 1987; Guiose. M, 2003). The information on muscle tension is transmitted at the spinal level via the fibres of the Neuro Muscular Spindle (NMT) to the gamma regulatory system which has the function of regulating the stretching and relaxation of the muscle. This regulation takes place in the reticular training.

At the subcortical level, the reticular zone where the hypothalamus and the upper thalamus and the reticular substance are located is the point of convergence of the sensory afferents, but also the starting point of the effector and facilitator systems. This area is responsible for the overall regulation of tone. At the cortical level, it is the cortex which influences the tone according to voluntary messages (Guiose. M, 2003).

The responses of the nervous system are different from one relaxation method to another.

In an upward direction, muscular tensions will decrease, which consequently will decrease the proprioceptive information sent to the reticulated training. This will reduce the stress on the cortex, which will lead to calmness. The descending route regulates the intensity of hypothalamic control, selectively filtering the related information to reduce the stimulation of the reticular formation and therefore lowering muscle tone via the gamma regulatory system (Parodi Riera. L, 2012).

Work based on encephalograms has shown a modification of brain waves in a state of relaxation. This has the effect of increasing the state of alertness around the body and generates a better tolerance to stress (J-F. Espinas, 1987).

On a physical level, the respiratory frequency is lowered because the oxygen needs are less. Heart rate and blood pressure decrease. Splanchnic relaxation occurs, increasing the quality of intestinal transit. Muscle tone is reduced, as is energy consumption (Parodi Riera. L, 2012).

"The central nervous system is the interpreter of everything that happens in the world in order to adapt muscle tone to this physical presence in the world, in accordance with the world in which the body is situated. Isn't it possible to speak of emotional tone under these conditions? Indeed, emotion in the broadest sense, or passion, is quite simply the way of being from the individual to the world [...] to be in the world is to be moved" (J-D. Vincent, 1987, p24). This quotation links psycho-emotional factors and muscle tone. The latter influence muscle tone by responding to feedback loops. It is therefore possible to act on emotional tensions by acting on tone. The work of S. Bloch (1986, 1989) demonstrates this by the fact that voluntary changes in breathing rhythm and posture generate various emotional feelings. Whether the basis is cognitive interpretation or bodily modifications, there is a close relationship between body and mind.

Meditation

Definition:

According to the Larousse dictionary (n.d.), meditation is defined as the action of thinking, of thinking deeply about a subject, about the realisation of something. A mental prayer, an application of the mind to religious truths.

It can be the attitude of becoming absorbed in deep reflection; in other words, the act of immersing oneself in meditation.

Historically, meditation is said to be more than 3000 years old in the East (Walsh, 1992). In the West, empirical research began only 75 years ago. Many meditation techniques have been developed over time, some of which are sometimes religious in nature.

Golemann (1977) proposes a classification of these techniques according to several types:

A type called "concentration", where the individual concentrates all his thoughts on a theme such as breathing, visualisations, etc., and where the individual is able to concentrate on the theme.

Another "introspective" type where the individual places himself as a witness to the different phenomena of his mind.

Finally, a third type is a mixture of the two previous types, called "integrated" meditation.

Golemann also proposes a classification according to whether the individual belongs to a religious concept or not (theistic or not). Meditations of theistic type are accompanied by religious notions and strict rules of life. The non-theistic types focus on self-observation (Rioux. À, 2009).

Taken from: What is meditation? Definitions and variety of techniques by Alain Rioux Ph.D. psychologist

Meditation refers to a group of techniques that are known to enhance certain skills such as concentration, regulation of conscious states and self-awareness. Meditation techniques are traditionally embedded in the psychology of consciousness in disciplines such as Buddhism and Yoga and are used to promote personal development and spiritual growth. Thus, meditation has been more intimately associated with the religious and philosophical belief systems of India and East Asia (Craven, 1989, p.648).

According to Shapiro, "meditation is a set of techniques that have in common the conscious attempt to fix attention in a non-analytical way and to avoid becoming attached to discursive or ruminative thoughts. "(Rioux.A). This explanation corresponds to a secular and scientific definition. However, it is necessary to understand that nowadays the numerous scientific researches still do not have answers that fulfil their empirical criteria on the explanation of the different phenomena of meditation. In 1980 Wilson classifies meditation as psychotherapy because, according to him, it is part of an inner exploration in search of our truth.

Studies:

Numerous studies have shown that learning meditation has a positive effect on stress. An impressive number of scientific articles are concerned. Here is a small sample on the subject.

A randomised study involved 58 first-year medical students. The students followed a Mindfullness meditation programme for 8 weeks with a weekly 75-minute session as well as meditation exercises at home and a rest day at the weekend. In order to measure their stress level, they completed the Percevie Stress Scale (PSS) pre- and post-intervention. The scores decreased from 18.11 to 15.49 for the mindfulness group and from 19.58 to 19.04 for the control group. It can therefore be concluded that learning this method is favourable to stress reduction (Erogul.M and al, 2014).

An Indian randomised controlled study involved 100 dental students. These students practiced 60 minutes of yoga breathing exercises before their first surgery. The students who practiced the exercises also showed a reduction in their stress and anxiety levels on the Visual Analogue Anxiety Scale from 0 to 100, from a score of 78 pre-exercises to 59 post-exercises, compared to 81 to 82 for the pre- and post-exercise control group respectively (Shankarapillai R and al, 2012).

A randomised controlled study dating from 2015 shows that a five-week implementation of a stress management programme based on mindfulness is an effective means in the more or less short term. This research involved 75 medical students from Malaysia who were randomly assigned to a control (N=37) or comparison (N=38) group. Vigilance, perceived stress, psychological distress and self-efficacy were measured before and after the intervention in all students. There was a significant improvement in each variable one week after the intervention in the control group. However, no difference between the two groups was observed six months after the intervention. Only the self-efficacy variable remained higher in the control group compared to the comparison group. For 90% of the participants, the programme was appreciated and recommended to others (Phang. C et al, 2015).

A meta-analysis in February 2017 included 19 studies with a total of 1,815 students from different health professions (medicine [n=10], nursing [n=4], (e.g. social worker [n=1], psychology [n=1], other medical professions including dieticians, physiotherapists and occupational therapists [n=3]). During periods ranging from four to ten weeks, students participated in a variety of stress management methods such as mindfulness, sitting meditation, qi gong, body scan and yoga.

In the pooled studies, the level of anxiety, depression, stress, mood and risk of burnout were measured before and after the intervention. In the studies on the stress level (n=11), favourable results for mindfulness emerged. However, of the 954 participants, 198 showed no reduction in their post-intervention stress level. With regard to anxiety, 679 participants are included in this evaluation and for 114 of them there is no difference in their anxiety state (Mc Conville.J and al, 2017).

Guided meditation

The aim of guided meditation is to teach the individual to mobilise his or her capacities in autonomous ways, verbalising the path to be followed, and making him or her feel sensations or emotions or images that can be freely interpreted by each person (Delune.A, Sarro.A, s.d).

Guided meditation is based on three principles:

1. The feeling which consists in letting go of our psyche, being in the present moment as a witness of reality without the filters of thoughts and emotions specific to each one, by focusing on all our internal and external sensory faculties. This manifests itself in states of mind and body sensations and under creative ideas, dreams...

2. Relaxation is the letting go of our physical body, through muscular relaxation. The body and the psyche are connected and certain mental tensions contract certain muscles without necessity.

3. Posture is similar to relaxation, but concerns the state of mind in which we find ourselves. It is a kind of non-verbal reflection of it. By adopting a comfortable and adequate posture, we will therefore positively influence our state of mind.

For optimal stress management, regular practice of a meditation or relationship technique is essential.

But more than that, understanding the origin of this emotional state is vital.

Bibliography:

1. Guiose Marc, Fondements théoriques et techniques de la relaxation, Psychomotricité première année 2003 - 2004, Faculté de médecine Pierre et Marie Curie. Updated: 7 November 2003. [Accessed December 2016]. Available at: http://www.chups.jussieu.fr/polysPSM/psychomot/relaxation1/index.html

2. Joëls M, Baram TZ. The neuro-symphony of stress. Nat Rev Neurosci. June 2009; 10 (6):45966.

3. Jonville Eva and Fradin Jacques, Cerveau et psycho, [Online], n34 July-August 2009, Bien utiliser son cerveau pour vivre sans stress. [Viewed April 2016]. Available at: http://www.cerveauetpsycho.fr/ewb_pages/a/article-bien-utiliser-son-cerveau-pour-vivre-sans-stress-22720.php [Access by subscription]

4. Krohne H. W., 2002, Stress and Coping Theories, [Online] 2002. Available at: http://userpage.fu-berlin.de/schuez/folien/Krohne_Stress.pdf

5. Kuhlmann S, Piel M, Wolf OT. Impaired Memory Retrieval after Psychosocial Stress in Healthy Young Men. J Neurosci. 16 March 2005; 25 (11):2977-82.

6. McConville J, McAleer R, Hahne A. Mindfulness Training for Health Profession Students-The Effect of Mindfulness Training on Psychological Well-Being, Learning and Clinical Performance of Health Professional Students: A Systematic Review of Randomized and Non-randomized Controlled Trials. Explore: The Journal of Science and Healing. Jan 1, 2017; 13(1):26-45.

7. McEwen BS. Stress, adaptation, and disease. Allostasis and allostatic load. Ann N Y Acad Sci. 1 May 1998; 840:33-44.

8. Parodi-Riera Lisette, La relaxation ou regulation psychotonique, 20/01/2012. [Accessed September 2016]. Available at: http://www.f2smhstaps.ups-tlse.fr/tp/fichier/UE6.2/CM_relaxation.pdf

9. Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study. Adv in Health Sci Educ (2015) 20: 1115. doi:10.1007/s10459-015-9591-3

10. Rioux Alain, 2009. What is meditation? Definitions and variety of techniques. The psychology library of Psycho-Ressources [Online], 2009. [Accessed December 2016]. Available at: http://www.psycho-ressources.com/bibli/meditation.html

11. Rutter, M. (1987), PSYCHOSOCIAL RESILIENCE AND PROTECTIVE MECHANISMS. American Journal of Orthopsychiatry, 57: 316-331. doi:10.1111/j.1939-0025.1987.tb03541.x

12. Sarro Elan. Untitled. [Accessed November 2016]. Available at: http://www.meditationsguidees.com/

13. Shankarapillai R, Nair MA, George R. 2012. The effect of yoga in stress reduction for dental students performing their first periodontal surgery: A randomized controlled study. Int J Yoga [Online], 2012. [Accessed November 2016]. Available at: http://www.ijoy.org.in/text.asp?2012/5/1/48/91714

14. Warnecke Emma, Quinn Stephen, Ogden Kathryn, Towle Nick, Nelson Mark R. 2011. A randomised controlled trial of the effects of mindfulness practice on medical student stress levels.

15. Yacob MA, Daud A, Noor NM, Mohammad WMZW. 2010. Prevalence and associated factors of stress among assistant medical officers in ministry of health (MOH) hospitals in Kelantan and Terengganu, Malaysia. International Medical Journal, 17(1), 9-16.