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Relaxation is a behavior that is usually incompatible with the experience of anxiety, distress, or pain. Through relaxation, children can regulate their emotional and physical responses to stressful events by learning to reduce physiological changes associated with stress and pain (e.g., increased heart rate, breathing, temperature, and muscle tension). Commonly used relaxation strategies include deep breathing exercises, guided imagery, and progressive muscle relaxation. Although progressive muscle relaxation and deep breathing are intended to directly influence somatic reactions, imagery-based relaxation aims to induce somatic reactions indirectly by influencing cognitions.

In a study aimed at examining the physiological effects of relaxation training in children, Lohaus et al. (2001) found that imagery-based relaxation training led to decreased heart rate and skin conductance levels. Their findings did not indicate a similar physiological pattern for children trained in progressive muscle relaxation. The authors suggested that this may have resulted due to the activation of muscle groups associated with progressive muscle relaxation, which impacted outcome measures. They further suggested that the effects of relaxation training may be more apparent for this type of activity after the training but not during the exercise, when the measurements in this study were taken. It can also be argued that, despite these findings, progressive muscle relaxation may still be a beneficial tool for coping with medical procedures because of its distraction component in which the child is being asked to focus on something other than the noxious stimulus (i.e., the muscle groups). Moreover, many younger children are likely to enjoy progressive muscle relaxation more than imagery-based relaxation because it allows them to stay physically active.

Other studies have indicated an interaction between the effectiveness of the relaxation strategy and the age of the child. For example, in a study utilizing distraction and breathing techniques with a party blower to help children cope with chemother apy venipunctures, 62% of the children refused to use the party blower at some point in the study (Manne et al. 1994). Upon further analysis, the researchers discovered that the majority of children who refused to cooperate were younger children, indicating that coping techniques such as breathing may not be appropriate for this age group.

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