THE TECHNIQUES OF THE WISE-ANDERSON PROTOCOL
purpose of Paradoxical Relaxation in the Wise-Anderson Protocol is to teach a patient to profoundly relax the tensed and shortened
muscles within the pelvic floor basin associated with certain
kinds of pelvic pain. It involves a daily practice of the cultivation
of effortlessness in the presence of pain, anxiety, and tension in order to abate them.
Paradoxical Relaxation has two components: (i) a breathing
technique used at the beginning of relaxation. This coordination
of heart rate and respiration supports the patient’s respiratory
sinus arrhythmia which reduces respiration to approximately
6 breaths per minute and (ii) instruction given for the remainder
of the relaxation session directing patient to focus attention
on the effortless letting go of tension in a specified area
of the body and accepting residual tension that does not easily
Patients are asked to listen to approximately 1 hour of recorded
relaxation instruction daily focusing on individual of predetermined
anatomical sites including frontalis, jaw, neck, shoulders,
arms, hands, upper back, chest, stomach pelvis, legs, and feet.
Each site is the focus of practice for approximately 2 weeks
and the entire course lasts for approximately a year and two
months. Home practice is done daily and includes the use of
46-recorded lessons varying in length from 7 minutes to 45 minutes.
The focus on relaxation of the pelvic floor is generally
avoided for the first several months of relaxation training
because such a focus can exacerbates symptoms until competence
in relaxation is gained in neutral, non-painful areas.
Relaxation instruction guides the patient to rest attention
in sensation and to redirect attention away from discursive
thinking and daydreaming. The target range of brain wave activity
is low frequency alpha.
Catastrophic thoughts that increase sympathetic arousal arising
during relaxation are identified and a cognitive therapy protocol
is used to help the patient reduce the impact of such thinking.
process of Paradoxical Relaxation is very slow. Respect
for and cooperation with this very slow process is essential to
the success of the method. When the desire of the treating physician
or the patient aims to hurry up the body’s slow letting
go of deeply ingrained tension, the patient usually fails to relax
the pelvic floor. In Paradoxical Relaxation, the instruction
is given to the patient to let go of tension that easily and effortlessly
lets go. This effortless relaxation usually occurs in small and
unremarkable steps and recognizing and working with these small
gradations of relaxation is essential.
Jacobson described residual tension in detail in his long career
in the development of relaxation therapy begun in 1908. The patient
is instructed to keep attention focused on residual tension without
efforting toward it or trying to change it. When attention is
distracted by visual or conceptual thinking, throughout the protocol,
the patient is instructed to refocus attention on the sensation
of the remaining residual tension without efforting toward this
tension or aiming to achieve any result. It is essential that
the patient and physician understand that deep relaxation occurs
when attention rests in sensation and not in thinking.
alternate between letting go of tension that easily lets go and
effortlessly feeling the remaining tension. The tension that is
being focused upon without effort on the patient’s part
usually abates during this process and the patient is instructed
to permit this abatement to occur. Sometimes the tension does
not abate or even increases and the patient is instructed to remain
softly focused on the remaining sensation without an intention
to change it. The concept underlying this protocol is that one
does not relax stubborn, residual tension directly but instead
is effortless in remaining continually aware of the sensation
of tension. Relaxation occurs without any effort on the part of
the patient. Exerting any effort increases tension. This is because
relaxation is identical to effortlessness.
specifically discourage patients from focusing on the relaxation
of the pelvic floor for the first 4 months of treatment, as the
patient’s attachment to the relief of symptoms tends to
interfere with the conscious and simultaneous effortless attention
on tension. The focus on relaxation of the upper body is most
easily accomplished by the patient and usually results in a reduction
of pelvic tone. The focus on the relaxation of the pelvic musculature
requires that the patient make the distinction between pain and
tension and the aim of the protocol then becomes directed to the
tension and not the pain in the area of a painful pelvis.
Relaxation is a method specifically designed to teach the
patient to profoundly relax autonomic arousal and pelvic tension
in the presence of pain and anxiety. Pain and anxiety stimulate
additional tension and aversion. Without instruction most patients
who are not properly instructed are loathe to sit still in the
presence of unresolved pain. The instructions of Paradoxical Relaxation train patients to stop the tension-anxiety-pain cycle by focusing
on tiny residual tensions that they can easily relax at the same
time accepting the tension and pain that remains. Attention is
redirected from negative cognitions and focuses on letting go
of tiny and often ignored tensions in the body unconsciously aimed
stopping the pain and tension – efforts that only exacerbate
symptoms. In the paradoxical acceptance of pain and tension that
does not easily relax, the patient learns how to ride the tension
down in the pelvic floor in particular and autonomic arousal in
general in small steps that require acceptance of what formerly
has been unacceptable and frightening.
Chronic pelvic pain syndromes tend to be self-perpetuating
disorders in which a patient’s pain causes a reflexive tightening
of the pelvic floor, which in most patients, often prompting a
flurry of negative and catastrophic thinking. The reflex to contract
against pain actually increases the pain. Negative and catastrophic
thinking that is common to pelvic pain patients fan the fire of
the pain by igniting the electrical activity in the trigger points
referring pain in the pelvis. The tension-anxiety-pain cycle is
the major obstacle to reduction or abatement of pelvic pain as
it feeds itself and is present in the moment that a patient is
asked to relax the pelvic tension. The disruption of the self-feeding
cycle of tension, anxiety, and pain can be accomplished by a select
group of patients who become competent in Paradoxical Relaxation.
we utilize an extensive set of recorded tapes in the Wise-Anderson Protocol relaxation method, competent instruction is necessary
to train patients in the method. Below we discuss the issue of
stand-alone relaxation tapes.
Paradoxical Relaxation cannot be learned from recorded
tapes in the absence of competent instruction
is part of a response sent to the webmaster of the chronicprostatitis.com
website on the issue of stand-alone relaxation tapes)
As we have discussed, I do not sell the audio Paradoxical Relaxation course on a stand-alone basis. There are numerous relaxation tapes
that can be bought from many different sources and people are
free to buy them. I could sell the recorded lessons I use on a
stand-alone basis… I have certainly had enough requests….but
choosing not to do this is neither a casual nor a self -serving
decision on my part. I have a short answer and a long answer to
is the short answer.
have no confidence that someone can learn to relax a painful pelvic
floor from a relaxation tape without both instruction from someone
who is competent in the method him or herself and without intrapelvic
Trigger Point Release. I do not want to associate myself with
making available a half measure that appears to offer something
substantial but does not.
I was symptomatic, I tried many remedies that all seemed reasonable
but ultimately failed to help me. They left me hopeful at first,
then disappointed, and disheartened. A stand-alone relaxation
tape, in my opinion, is a half measure. Half measures give little
chance of offering real recovery from chronic pelvic pain syndromes.
I have decided that if I am to err, I will err in the direction
of not offering anything instead of offering a half measure in
which I have no confidence.
is the long answer.
to deeply relax the pelvic muscles in order to facilitate the
healing of a sore and contracted pelvic floor from a relaxation
tape that you buy is like learning to play a violin by listening
to recorded instructions. In my experience, such an endeavor usually
fails; the person gets discouraged and usually gives up. To learn
the violin, you need instruction from someone who plays the violin
and the more accomplished the player the better. You want to learn
the violin from someone who plays it everyday, who is excited
about it, and whose expertise is obvious. Imagine learning the
violin from someone who does not play it. The obstacles to learning
to play the violin and learning to relax deeply are very similar
--- except learning to deeply relax a painful pelvic floor is
harder than playing the violin.
instinct is to tighten against pain and not to relax with it and
yet I found that relaxing with the tension of certain kinds of
pelvic pain can dissolve it. Learning to do this is a major event
in someone’s life because it is from this place that it
can become possible to break the cycle of pain, anxiety, and tension
and allow the sore and irritated tissue in the pelvic floor to
may be some unusual individuals who can deeply relax on a consistent
basis by simply using recorded instructions and I applaud them
and wish them well. The reason I do not have any faith in this
is that to relax a painful pelvic floor and maintain a relaxed
pelvic floor over time, (and not everybody can learn how to do
this) requires guidance and instruction with regard to many issues.
Examples of the issues that must be addressed are: what to do
with the pain during relaxation; how to not add tension the tension
of ‘trying’ to relax tension; when to use breathing
to focus distracted mind and when to cease the breathing technique:
what to do when emotions arise that the tension in the pelvic
floor is suppressing; how to accept the resistance to accepting
the tension; what it means to rest while there is discomfort;
what to do when a plateau is reached and tension doesn’t
reduce; what to do when symptoms abate during relaxation and then
resume quickly afterward; how to relax in the office or on the
bus --- as well as other issues. I have seen many patients distort
what to me are clear instructions and become frustrated in their
practice of relaxation. A relaxation tape usually addresses none
of this and the successful resolution of these issues makes the
difference between success and failure.
learn to relax the pelvic floor, especially in the presence of
pain, is an enigma and the method to do this is anti-intuitive.
Furthermore, it is often frightening for someone with pelvic pain
to sit still with their pain and their thoughts without someone
guiding and supporting them in doing so. In my experience, people
avoid the kind of relaxation required to relax a tight and painful
pelvis if there is no guidance and support and the recorded tapes
wind up on the shelf.
professionals whom I have offered to train in teaching this method
have been interested. I think that the reason is that they were
not motivated, like my pain motivated me, to spend the time learning
to do the relaxation themselves. The best teachers of this method
are turning out to be the patients I have trained who are doing
well and use it on a daily basis.