Progressive muscle relaxation

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Progressive muscle relaxation

• C. Jeffrey Terrell, Ph.D., M.Div.
• Psychological Studies Institute

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Progressive muscle relaxation

• Edmund Jacobson was studying the effects of an
  unexpected loud noise on startle reflex. He found
  that there was no obvious startle to sudden noise
  in more relaxed subjects, and this was the birth
  of progressive muscle relaxation.
• Jacobsons research continued to involve tension
  and reflex activity.
• Knee-jerk reflex had decreased amplitude when
  patient was relaxed. Realized that reflexes
  require muscle tone or tension. Without it, no
  response occurs.
• Began to wonder what kind of effects this muscle
  tension had on the system.
• In relaxed subject, the thought of moving a limb
  was accompanied by a covert burst of muscular
  activity in that limb.
• If subject were told to imagine hitting a nail 3x
  with a hammer, 3 bursts of EMG activity in
  dominant arm.
• Further, he found that eye and speech muscles
  were especially important in visual and auditory
  imagery, and that mental activity decreased
  substantially when skeletal musculature relaxed
  toward zero microvolts of activity.

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Progressive muscle relaxation

• What Jacobson actually demonstrated was that to
  relax the mind and the body, you must relax all
  of the skeletal musculature. And, conversely that
  relaxed skeletal muscles produced a general state
  of relaxation.

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Theoretical Foundationsof PMR

• Progressive muscle relaxation begins with the
  ancient concept of rest.
• Tension" is the contraction of skeletal muscle
  fibers that generates the tension sensation.
  "Relaxation" is the elongation (lengthening) of
  those fibers, which then eliminates the tension
  sensation. After learning to identify the
  tension sensation, you learns to relax it away.
  For this, you learn to allow the muscle fibers
  that generated the tension to elongate. In the
  learning process, you contrast the previous
  tension sensation with the later elimination of
  tension.
• This general procedure is then applied to all of
  the major muscle groups. In PR you learn to
  control all of the skeletal musculature, so that
  any portion thereof may be systematically relaxed
  or tensed as you choose.

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Differences of PMR with other methods

• In learning classical PR, patients are never told
  that they are doing well, that they are getting
  better, that they are relaxing, that their hands
  feel heavy, that they are getting sleepy, or the
  like. No attempt is made to convince the
  patients that they will be "cured" in any sense
  of the word, nor are any such promises made.
  Instead, the patients are aided by instructions
  just as in any other learning procedure. Thus a
  teacher may interrupt a patient's practice with
  criticism whenever the patient is failing to
  relax. Jacobson (1938) listed a number of reasons
  for avoiding suggestion.
• As with the placebo effect, any method will
  accomplish something (though usually only
  temporarily) if it instills into the patient the
  belief that he or she will benefit from its
  application.
• Jacobson relaxation is a physiological
  occurrence that consists of learning to elongate
  muscle fibers systematically.
• Definitive physiological changes in the body that
  differ from those occurring during suggestion.
  The patient may be skeptical in regard to the
  procedure, but still can learn very well when
  presented with objective evidence of progress.
• Also, patient learns independence from therapist
  in "suggestion" therapies, dependence on
  therapists is engendered.
• Jacobson held that the danger of suggestion ...
  is that it may make the individual feel that
  relaxation is taking place even when it is not.
  The perception of relaxation is not so important
  as actual physical relaxation.

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Differences of PMR with other methods

• Relaxation is not exercise.
• Many suggestions for how to relax use a lay
  meaning of the term, which is inappropriate in a
  scientific/clinical context. For instance,
  advice to exercise is not advice to relax,
  because exercise is work. Exercise is good.
• For the same reason, terms such as "relaxation
  exercises" or "relaxation response" are self
  contradictory, because "exercise" and "response"
  are "work words." The essence of relaxing is to
  allow the muscle fibers to elongate, which is
  physiologically impossible when you try (through
  exercising or responding) to accomplish it. You
  simply cannot make an effort to relax, because an
  effort to relax is a failure to relax.

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The Method- PMR

• You explain the basic physiology of neuromuscular
  circuits and the nature of tension and
  relaxation. Muscles, the learner is told, contain
  muscle fibers that are about the diameter of the
  human hair and are aligned in parallel. Their
  action is very simple, in that they can do only
  two things By sliding alongside each other, they
  can contract (tense) or lengthen (relax). When
  muscles contract, they generate the control
  signal that is used within neuromuscular circuits
  to control the functions of the body. Relaxation
  of the body is achieved when a person learns how
  to allow the muscle fibers to elongate.

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The Method- PMR

• You provide a realistic estimate of how far an
  overly tense individual has to go. It is
  explained that there are some 1030 striated
  muscles in the human body, which comprise almost
  half of the body weight. A lifetime of
  injudicious use of such a mass of muscle simply
  cannot respond to "quick and easy cures" for
  tension maladies. just as the learner has spent a
  lifetime learning how to misuse the muscles, it
  is reasonable to expect that prolonged practice
  is required to re-educate them. It simply takes
  time and practice to learn to reverse
  long-standing maladaptive muscular habits.
  Fortunately, this cultivation of a state of
  bodily rest can be achieved in much less time
  than it took to learn deleterious muscle habits
  in the first place.

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The Method- PMR

• A frequently asked question is this "How long
  will it take me to learn to relax?" Depends on
  where you start and on how proficient you wish to
  become. An answer more acceptable to the
  prospective learner is that the basic course
  specified by Jacobson is about 13 weeks in
  length. For those who have an anxiety disorder
  such as a phobic reaction, or generalized
  anxiety, a bit more time may be required.
• A disadvantage of PR is that some people
  complain that "it takes too much time."
  Jacobson's at one time wrote that learning PR
  sufficiently early can add 20 years to a person's
  life.

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Abbreviated Progressive Muscle Relaxation

• Instruct the client to focus attention on one
  muscle group at a time. Have them pay attention
  only to what you are saying and to the sensations
  that they are experiencing in that muscle group,
  allowing the rest of their body to remain
  relaxed.

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Abbreviated Progressive Muscle Relaxation

• When you ask them to tense a group, say, for
  example, "Tense the muscles in your forehead by
  raising your eyebrows, now...... Now will be
  the cue word for you to tense the muscles. Do
  not tense the muscles until I say now.
• When you want them to relax a muscle group, say
  OK, relax the muscles in your forehead. When I
  say that, let all the tension go all at once, not
  gradually.
• Ask them to tense and relax each muscle group
  twice. After the second time, I will ask them to
  signal if the muscle group is completely relaxed.
  Please signal by raising the index finger on the
  right hand whichever hand is visible to the
  therapist, but do not signal unless the muscles
  really feel completely relaxed.

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Abbreviated Progressive Muscle Relaxation

• During the session, try not to move any more than
  is necessary to remain comfortable. In order to
  gain the most benefit from relaxation, it is
  preferable not to move any muscles that have
  already been relaxed. This prevents tension from
  reappearing in those muscles.
• In order to maintain as much relaxation as
  possible, ask that they do not to talk to you
  during the session unless it is absolutely
  necessary. Try to mainly use the finger signal
  as a means of communication, and talk about how
  the session went after finishing. Questions they
  may have can be discussed after completion of the
  relaxation.
• The session will take about 45, so if they would
  like to use the restroom before starting, please
  have them do so.
• Ask them to remove or loosen any items (e.g.,
  glasses or tight belts).
• Have them get in a comfortable position in the
  chair. Have them close their eyes and keep them
  closed.

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Muscle Groups

• Muscle group- Method of tensing
• 1. Dominant hand and forearm- Make a tight fist
  while allowing upper arm to remain relaxed
• 2. Dominant upper arm- Press elbow downward
  against chair without involving lower arm
• 3. Nondominant hand and forearm- Same as dominant
• 4. Nondominant upper arm- Same as dominant
• 5. Forehead- Raise eyebrows as high as possible
• 6. Upper checks and nose- Squint eyes and wrinkle
  nose
• 7. Lower face- Clench teeth and pull back corners
  of the mouth

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Muscle Groups

• 8. Neck- Counterpose muscles by trying to raise
  and lower chin simultaneously
• 9. Chest, shoulders, and upper- Take a deep
  breath hold it and pull back shoulder blades
  together
• 10. Abdomen- Counterpose muscles by trying to
  push stomach out and pull in simultaneously
• 11. Dominant upper leg- Counterpose large muscle
  on top of leg against two smaller ones underneath
  (specific strategy will vary considerably)
• 12. Dominant calf- Point toes toward head
• 13. Dominant foot Point toes downward, turn foot
  in, and curl toes gently
• 14. Nondominant upper leg- Same as dominant
• 15. Nondominant calf - Same as dominant
• 16. Nondominant foot- Same as dominant

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Beginning the exercise

• Instruct the client to focus attention on the
  group.
• Using the predetermined "now" cue, instruct the
  client to produce tension in that group,
  repeating the instructions for tensing that
  group. For example, say, "By making a tight
  fist, tense the muscles in your right hand and
  lower arm, now." Allow the client to maintain the
  tension for 5 to 7 seconds while describing the
  sensations of tension to the client. Use a
  shorter tension duration for the feet or other
  muscles where the client may experience cramping.

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Beginning the exercise

• Using the predetermined "relax" cue, instruct the
  client to relax the muscle group all at once (not
  gradually) and to attend to the sensations of
  relaxation. Allow the client to focus on the
  relaxation for 30 to 40 seconds while giving him
  or her some relaxation "patter" to highlight the
  sensations (see example below).
• Repeat steps 2 and 3. After the second
  tension-release cycle, allow the client to
  maintain the relaxation and to focus on the
  sensations for 45 to 60 seconds.

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Beginning the exercise

• Before moving on to the next muscle group, ask
  the client to signal if the current muscle group
  is completely relaxed. If not, repeat the
  tension and relaxation steps a third time. If
  the client still does not signal that the group
  is relaxed, the procedure may be repeated again.
  However, if relaxation is not achieved in four or
  five attempts, alternative means for achieving
  relaxation may be required. One alternative
  would be to instruct the client to allow those
  muscles to relax as much as possible while moving
  on to other groups, and to return to them at a
  later point.

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Beginning the exercise

• When the focus is on the chest, shoulders, and
  upper back, emphasis on breathing should be
  introduced as part of the procedure. Instruct
  the client to take a deep breath and hold it
  while the muscles are tensed and to exhale when
  instructed to relax. From this point on,
  breathing cues should be included as a part of
  the tension release procedure for all muscle
  groups. Furthermore, mention of slow, regular
  breathing can be incorporated into the relaxation
  patter.

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Beginning the exercise

• When these steps are combined, they go something
  like this
• OK, John, I would like you to focus all of your
  attention on the muscles of your chest,
  shoulders, and upper back. And by taking a deep
  breath and holding it and by pulling your
  shoulder blades back and together, I'd like you
  to tense the muscles of the chest, shoulders, and
  upper back, now. Good, notice the tension and
  the tightness, notice what the tension feels
  like, hold it ... and relax.
• Fine, just let all that tension go. Notice the
  difference between the tension you felt before
  and the pleasant feelings of relaxationjust
  focus all your attention on those feelings of
  relaxation as they flow into your chest,
  shoulders, and back...just focus on your slow and
  regular breathing and go right on enjoying the
  relaxation.

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Beginning the exercise

• Tension-release cycle is repeated after 30-45
  seconds.
• OK, John, I would like you to signal if the
  muscles in the chest, shoulders, and upper back
  are as deeply relaxed as those of the neck (i.e.,
  the previous group). OK, fine, just go on
  relaxing.
• When all 16 muscle groups have been relaxed, the
  therapist should review each group, reminding the
  client that these muscles have been relaxed and
  asking him or her to continue to allow them to
  relax while attending to the accompanying
  sensations. The client should then be asked to
  signal if all the groups are indeed completely
  relaxed. If the client does not signal, the
  muscle groups should be named, one at a time, and
  the client should be instructed to signal when
  the group or groups that are not totally relaxed
  are mentioned. Repeat tense-release cycle.