Progressive Muscle Relaxation

Description

Progressive relaxation training has been demonstrated to be a clinically important intervention. Selected results include:

• Applied relaxation (incorporating progressive muscle relaxation) in the treatment of general- ized anxiety disorder (GAD) resulted in treatment effects that were comparable to CBT (Dugas et al, 2010).
• A meta-analysis comparing ‘less complex’ interventions (including progressive muscle relaxa- tion) with ‘more complex’ interventions (such as CBT, EMDR, and behavioural therapies) for a wide range of conditions found that ‘less complex’ treatments yielded medium effect sizes. ‘More complex’ interventions added only modest additional benefits (Stevens et al, 2007).
• Progressive muscle relaxation is effective in reducing acute feelings of stress and anxiety in pa- tients with schizophrenia (Vancampfort et al, 2011)
• Progressive muscle relaxation is of debatable utility in the treatment of panic attacks and panic disorder. Some research has indicated that relaxation can be beneficial in the treatment of panic (e.g. Ost, 1988) although dismantling studies indicate that muscle relaxation is one of the less important techniques for the treatment of panic (e.g. Pompoli et al, 2018). Contemporary treatment approaches for panic tend to emphasise the importance of exposure to physical sensations of anxiety (e.g. Craske et al, 2014).

This Psychology Tools exercise is a one-page resource to help clients learn the technique of progressive muscle relaxation. Clinicians may find it helpful to practice the techniques in session and then to encourage regular self-practice.

Instructions

Clients should be given a rationale for the utility of learning progressive muscle relaxation. Bernstein & Borkovec (1973) used the following:

“Progressive relaxation training consists of learning to sequentially tense and then relax various groups of muscles, all through the body, while at the same time paying very close and careful attention to the feelings associated with both tension and relaxation.”

Clients should be instructed to:

• Focus their attention on each muscle group in turn
• Tense the muscle group
• Maintain the tension for 5-7 seconds
• Release the tension
• Maintain the focus of attention on the muscle group for about 20-30 seconds and notice feelings of relaxation before moving on to the next muscle group

A recommended full sequence of muscle groups is given below:

1. Right hand and lower arm (clench your fist and tense the lower arm)
2. Left hand and lower arm
3. Right upper arm (bring your hand to your shoulder and tense your biceps)
4. Left upper arm
5. Right lower leg and foot (point your toe and gently tense the calf muscle)
6. Left lower leg and foot
7. Both thighs (press your knees and thighs tightly together)
8. Abdomen (pull your abdominal muscles in tightly)
9. Chest (take a deep breath and hold it in)
10. Shoulders and back (hunch your shoulders or pull them towards your ears)
11. Neck and throat (push your head backwards against the surface you are resting on)
12. Lips (press them tightly together without clenching your teeth)
13. Eyes (closing them tightly)
14. Lower forehead (frown and pull your eyebrows together)
15. Upper forehead (wrinkle your forehead)

Alternative muscle sequences are given below. Bernstein & Borkovec (1973) describe three muscle relaxation sequences varying in length. They recommend that clients become familiar with the full sequence before practicing with the shorter sequences. We find that some clients prefer to practice relaxation in ‘upwards’ or ‘downwards’ sequences.

16 muscle group sequence

• Dominant hand and forearm (make a fist and simultaneously tense the lower arm)
• Dominant biceps (bring your hand to your shoulder and tense the biceps)
• Nondominant hand and forearm
• Nondominant biceps
• Forehead
• Upper cheeks and nose
• Lower cheeks and jaw
• Neck & throat
• Chest, shoulders, upper back
• Abdominal or stomach region
• Dominant thigh
• Dominant calf
• Dominant foot
• Nondominant thigh
• Nondominant calf
• Nondominant foot

7 muscle group sequence

• Dominant hand, lower arm, and bicep
• Nondominant hand, lower arm, and bicep
• Facial muscles (com- bination of frowning, squinting the eyes, wrinkling the nose, and pulling the corners of the mouth back
• Neck and throat
• Chest, shoulders, upper back, and abdomen
• Dominant thigh, calf, and foot
• Nondominant thigh, calf, and foot

4 muscle group sequence

• Left & right hands, arms, and biceps
• Muscles of the face and neck
• Chest, shoulders, back, and abdomen
• Left and right thighs, calves, and feet

Upwards sequence

• Left and right feet
• Left & right calves
• Left & right thighs
• Abdomen
• Left and right hands and forearms
• Left and right biceps
• Shoulders and upper back
• Neck and throat
• Lower cheeks and jaw
• Upper cheeks and nose
• Forehead

Downwards sequence

• Forehead
• Upper cheeks and nose
• Lower cheeks and jaw
• Neck and throat
• Shoulders and upper back
• Left and right biceps
• Left and right hands and forearms
• Abdomen
• Left and right thighs
• Left and right calves
• Left and right feet

References