Progressive muscle relaxation
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Progressive muscle relaxation (or PMR) is a technique for reducing anxiety by alternately tensing and relaxing the muscles. It was developed by American physician Edmund Jacobson in the early 1920s.[1] Jacobson argued that since muscular tension accompanies anxiety, one can reduce anxiety by learning how to relax the muscular tension. PMR entails a physical and mental component.
The physical component involves the tensing and relaxing of muscle groups over the arms, legs, face, abdomen and chest. With the eyes closed and in a sequential pattern, a tension in a given muscle group is purposefully done for approximately 10 seconds and then released for 20 seconds before continuing with the next muscle group.
The mental component focuses on the difference between the feelings of the tension and relaxation. Because the eyes are closed, one is forced to concentrate on the sensation of tension and relaxation. In patients with anxiety, the mind often wonders with thoughts such as "I don't know if this will work" or "Am I feeling it yet." If such is the case, the patient is told to simply focus on the feelings of the tensed muscle. Because of the feelings of warmth and heaviness are felt in the relaxed muscle after it is tensed, a mental relaxation is felt as a result. With practice, the patient learns how to effectively relax and deter anxiety when it becomes at an unhealthy level where an anxiety attack would otherwise occur.[2]
Jacobson trained his patients to voluntarily relax certain muscles in their body in order to reduce anxiety symptoms. He also found that the relaxation procedure is effective against ulcers, insomnia, and hypertension. There are many parallels with autogenic training, which was developed independently. The technique has also proven effective in reducing acute anxiety in people with Schizophrenia.[3]
Jacobson's Progressive Relaxation has remained popular with modern physical therapists.
[edit] Relaxation method
Progressive relaxation involves alternately tensing and relaxing the muscles.[4] A person using PMR may start by sitting or lying down in a comfortable position. With the eyes closed, the muscles are tensed (10 seconds) and relaxed (20 seconds) in sequence as per the following progressive pattern:
The tension of the lower arms. The hands are made into fists with the hand pushed back to make a right angle with the lower arm. The sensation is felt throughout the wrists, hands, fingers, and knuckles. During the tension process of the muscles, the mind is to be focusing only on the sensation of the muscles. After an uncomfortable 10 second tension, the hands are relaxed. The muscles should then feel warm and heavy.
The tension of the upper arms. The triceps and deltoids are utilized to make the upper arm squeezed back and in towards the side of the body. The tension is felt into the shoulders, upper back and triceps areas. When relaxed, the arms should collectively feel a sensation of relaxation as the inflow of blood rushes to the relaxed muscles.
The tension of the lower legs. The feet are tensed by pointing the feet up high, with the toes tensed up. The tension is felt in the shins, feet, toes, ankles, and calf muscles.
The tension of the upper legs. The knees are tensed closely together, off the ground or bed. The tightness is felt around the hip and quadriceps muscles. After the release of this tension, the legs should collectively feel relaxed with the arms.
The tension of the stomach. The stomach is pulled in towards the spine very tightly. When relaxed, the abs should feel at ease.
Tension of the chest. The patient now does the opposite by breathing in until the chest is fully expanded will also create a tension. As one holds the breath for 10 seconds, the chest feels a tension. When released, one should wait 20 seconds as the whole abdomen is relaxed before proceeding.
The tension of the shoulders. The shoulders are tensed tightly and are raised as close to the ears as possible.
The tension of the neck. With the chin pointed down and the back of the head pointed up, this tension will be very uncomfortable. When released, the neck should be supported only by the back of a chair or bed.
The tension of the mouth. An uncomfortable tight, wide smile is made. The jaw and lips should be tight. As this is felt, one should describe the sensation in their head.
The tension of the eyes. The eyes should be squeezed shut for a few seconds and then released. Note the difference in feeling.
The tension of the lower forehead. The eyebrows are to be squeezed down as low as he or she can toward the center of the face and held. Hold for 10 seconds then release, describing the difference to yourself.
The tension of the upper forehead. The opposite is done here as the eyebrows are raised as high as he or she can. After holding for 10 seconds, the sensation of relaxation is felt. The face should collectively be relaxed.
After doing each of these muscle groups, the patient should feel collectively relaxed and warm.
The whole PMR session takes approximately 30 minutes. As this is a technique, practice with PMR does make perfect and will usually not work effectively as it should the first couple of times. The goal of PMR is to teach a patient with anxiety disorder how to calm themselves eventually in one single step. Patients with generalized anxiety disorder who first try PMR with anxiety may become frustrated, feel rushed, or feel an increase in anxiety for various reasons such as being afraid to "let your guard down." As with doing anything new, this is to be expected and simply practiced again or twice a day.[5]
[edit] References
^ Jacobson, E. (1938). Progressive relaxation. Chicago: University of Chicago Press
^ Craske & Barlow (2006), Worry, Oxford University Press, Inc., p. 53, ISBN 0-19-530001-7
^ Chen WC; Chu H; Lu RB; Chou YH; Chen CH; Chang YC; O'Brien AP; Chou KR. (Aug 2009). "Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia.". Journal Of Clinical Nursing (15): 2187–96.
^ Wolpe, J. & Lazarus, A.A. (1966) Behavior therapy technique. New York. Pergamon Press.
^ Craske & Barlow (2006), Worry, Oxford University Press, Inc., p. 53, ISBN 0-19-530001
