Cue-controlled relaxation is a powerful tool for calling up the relaxation response and is especially useful after joint replacement surgery. With this approach, you learn to use a specific cue as a signal to elicit relaxation.

"It's one of the very best relaxation techniques for people preparing for joint replacement surgery," says clinical health psychologist William Deardorff, Ph.D. Among other things, cue-controlled relaxation can be used to cope with nausea after anesthesia and pain after a total joint replacement. It can also be used to prepare for an uncomfortable procedure such as manipulation of a new hip joint in the unlikely event it becomes dislocated right after surgery. This relaxation technique can also help you relax during stressful situations such as discussing your concerns about having joint replacement surgery.

Remember the famous experiments in which Pavlov rang a bell while feeding dogs? The dogs learned to associate the bell with food. Eventually, just hearing the bell made the dogs salivate, even when no food was present. This form of learning, called classical conditioning, is the foundation underlying cue-controlled relaxation.

To try this technique, follow these basic steps:

1. Pick a cue. It can be a word or phrase you say quietly to yourself, such as "relax" or "stay calm." Or it can be a simple movement, such as gently touching the thumb and index finger of one hand together. "I encourage use of the finger cue, because it's convenient in situations when you're interacting with others or thinking about something else that makes the use of a verbal cue difficult, says Deardorff."

2. Associate the cue with the relaxation response. Let's say you learn to call up this response by taking several deep, slow, regular breaths. For the last 20 breaths or so of each practice session, pair the cue with the breathing. If you chose the finger cue, for example, press your thumb and index finger together on each breath in. Then relax the squeeze on each exhalation.

3. Use the cue alone to bring on the relaxation response. Once the cue and relaxation are firmly associated in your mind, you should be able to use the cue to relax even without the deep breathing. Says Deardorff, "This is especially useful in situations when deep breathing might not be possible, such as when you're talking to your doctor."

To use this technique to manage nausea and pain after joint replacement surgery, cue yourself at the first twinge of unpleasantness to help blunt the sensation. It also helps you prepare for any uncomfortable post-operative examinations. You can cue yourself a few minutes before the exam starts and repeat the cue during the examination, if necessary.

Typically, using the cue alone won't lead to as profound a level of relaxation as the breathing exercise does. However, it's still extremely useful in situations where you need to be discrete or focus on something other than your breathing. This relaxation technique may come in handy if you're in public when your new joint starts causing discomfort. In many situations, light relaxation may be all you need to stop stress, anxiety, and joint pain from escalating.

A final way to employ cue-controlled relaxation is using it to help stop unproductive, negative thoughts. After your total joint replacement, if you find yourself thinking, I can't handle this pain, use the cue to halt the thought. Then retarget your thinking in a more positive direction such as, "This pain is bad, but I can manage it. I can relax and cope with my pain. It won't last forever."