Progressive Muscle Relaxation

One of the most simple and easily learned techniques for relaxation is Progressive Muscle Relaxation (PMR), a widely-used procedure today that was originally developed in 1939.

The PMR procedure teaches you to relax your muscles through a two-step process. First you deliberately apply tension to certain muscle groups, and then you stop the tension and turn your attention to noticing how the muscles relax as the tension flows away.

Through repetitive practice you quickly learn to recognize—and distinguish—the associated feelings of a tensed muscle and a completely relaxed muscle. With this simple knowledge, you can then induce physical muscular relaxation at the first signs of the tension that accompanies anxiety. And with physical relaxation comes mental calmness—in any situation.

Before practicing PMR, you should consult with your physician if you have a history of serious injuries, muscle spasms, or back problems, because the deliberate muscle tensing of the PMR procedure could exacerbate any of these pre-existing conditions. If you continue with this procedure against a doctor’s advice, you do so at your own risk.

There are two steps in the self-administered Progressive Muscle Relaxation procedure: (a) deliberately tensing muscle groups, and (b) releasing the induced tension. This two-step process will be described after you are introduced to the muscle groups.

After learning the full PMR procedure as follows, you will spend about 10 minutes a day maintaining your proficiency by practicing a shortened form of the procedure. As you practice the short procedure, you will be simultaneously learning cue-controlled relaxation.

Ultimately, you will acquire something that will probably become an indispensable part of your daily life, and the initial drudgery of practice will be long-forgotten. It is recommended that you practice full PMR twice a day for about a week before moving on to the shortened form (below). Of course, the time needed to master the full PMR procedure varies from person to person. Here are some suggestions for practice:

  • Always practice full PMR in a quiet place, along, with no distractions like television or phones. We don’t suggest even using background music.
  • Remove your shoes and wear loose clothing
  • Don’t eat, smoke or drink right before practicing PMR. It’s best to practice before meals rather than after to avoid problems with digestion.
  • Never practice this while under the influence of any intoxicants.
  • Sit in a comfortable chair or lying down in bed. · Plan on falling asleep before the cycle is complete if you do this in bed
  • If you are doing PMR just to relax instead of falling asleep, after you are done, relax with your eyes closed for a few seconds and then get up slowly. If you stand up too quickly, you could experience a sudden drop in blood pressure which could cause you to feel faint. Some people like to count backwards from 5 to 1 timed to slow, deep breathing and then say “Eyes open, supremely calm, fully alert.”

You will be working with most all the major muscle groups in your body, but for convenience you will make a systematic progression from your feet upwards. Here is the most popular recommended sequence:

  • Right foot
  • Right lower leg and foot
  • Entire right leg
  • Left foot
  • Left lower leg and foot
  • Entire left leg
  • Right hand
  • Right forearm and hand
  • Entire right arm
  • Left hand
  • Left forearm and hand
  • Entire left arm
  • Abdomen
  • Chest
  • Neck and shoulders
  • Face

If you’re left handed, begin with your left side. Here is how to perform the tension-relaxation procedure.

Step One: Tension. The process of applying tension to a muscle is essentially the same regardless of which muscle group you re using. First, focus your mind on the muscle group; for example, your right hand. Then inhale and simply squeeze the muscles as hard as you can for about 8 seconds; in the example, this would involve making a tight fist with your hand.

Beginners usually make the mistake of allowing muscles other than the intended group to tense as well; in the example, this would be tensing muscles in your right arm and shoulder, not just in your right hand. With practice you will learn to make very fine discriminations among muscles; for the moment just do the best you can. It can be very frustrating for a beginner to try to experience a fine degree of muscle separation.

Because neglect of the body is an almost universal cultural attitude, it is usually very difficult to begin learning how to take responsibility for your body’s mechanics. Take heart and realize that learning fine muscle distinction is in and of itself a major part of the overall PMR learning process. PMR isn’t just about tension and relaxation – it’s also about muscle discernment.

Relax and realize that no part of the body is an isolated unit. The muscles of the hand, for example, do have connections in the forearm, so when you tense your hand, there will still be some small tension occurring in the forearm. When PMR asks that the hand be tensed without tensing the arm, it is really speaking to the beginner who, out of unfamiliarity with the body’s muscles will unthinkingly tense everything in the whole arm.

If you accept the fact that you are in the beginner phase and not inept at practicing the procedure, then you will begin to patiently discover the fine muscles with practice. It’s important to really feel the tension. Done properly, the tension procedure will cause the muscles to start to shake, and you will feel some pain.

Be careful not to hurt yourself, as compared to feeling mild pain. Contracting the muscles in your feet and your back, especially, can cause serious problems if not done carefully; i.e., gently but deliberately.

Step Two: Releasing the Tension. This is the best part because it is actually pleasurable. After the 8 seconds, just quickly and suddenly let go. Let all the tightness and pain flow out of the muscles as you simultaneously exhale. This would be imagining tightness and pain flowing out of your hand through your fingertips as you exhale.

Feel the muscles relax and become loose and limp, tension flowing away like water out of a faucet. Focus on and notice the difference between tension and relaxation. The point here is to really focus on the change that occurs as the tension is let go. Do this very deliberately, because you are trying to learn to make some very subtle distinctions between muscular tension and muscular relaxation.

Stay relaxed for about 15 seconds and then repeat the tensionrelaxation cycle. You’ll probably notice more sensations the second time. Once you understand the muscle groups and the tensionrelaxation procedure, then you are ready to begin the full PMR training.

Simply follow the list of muscle groups in the sequence given and work through your entire body. Practice twice a day for a week. Spend extra time, if necessary, until you can achieve a deep sense of physical relaxation; then you can move on to the Shortened PMR schedule.

In the shortened form of PMR, you will work with summary groups of muscles rather than individual muscle groups, and begin to use cue-controlled relaxation. The four summary muscle groups are:

  • Lower limbs
  • Abdomen and chest
  • Arms, shoulders, and neck
  • Face

Instead of working with just one specific part of your body at a time, simply focus on the complete group. In Group 1, for example, focus on both legs and feet all at once.

Cue-controlled relaxation: Use the same tension-relaxation procedure as full PMR, but work with the summary groups of muscles. In addition, focus on your breathing during both tension and relaxation. Inhale slowly as you apply and hold the tension.

Then, when you let the tension go and exhale, say a cue word to yourself (below). This will help you to associate the cue word with a state of relaxation, so that eventually the cue word alone will produce a relaxed state. Many people find that cue-controlled relaxation does not have to depend on only one word; it may actually be more helpful in some situations to use a particular phrase. Some suggestions for cue words/phrases include:

  • Relax
  • Let it go
  • It’s OK
  • Stay calm
  • All things are passing
  • Trust in God

Initially, you should practice the shortened form of PMR under the same conditions as you practiced full PMR. After about a week of twice-daily practice you will then have enough proficiency to practice it under other conditions and with distractions. Or you might want to move on to the final process of Deep Muscle Relaxation.

Once you have learned PMR and are familiar with the feeling of muscle relaxation, you can then induce relaxation without even bothering with the tension-relaxation process. All you need to do is use your imagination to think of and then relax the various muscle groups using your cue word(s). Usually this is done by starting at the top of your head and then working down through your body, as if relaxation were being poured over your head and flowing down over all of your body. This process is called Deep Muscle Relaxation.

And, anywhere, anytime, you can simply perform a quick “body scan” to recognize where in your body you might be holding muscle tension and then, using imagery and your cue word/phrase, let it go. There are other approaches toward combating insomnia that can work well too.

Other techniques that can help you improve your sleep habits are stimulus control, paradoxical intention and sleep restriction. All three techniques have to do with changing your habits and reframing your current way of thinking about sleep. As you sleep better, you will create positive associations with sleep based on your new practices.

Stimulus control - Stimulus control therapy derives from the idea that a person with chronic insomnia associates bedtime and the bedroom with not being able to sleep. The technique limits the amount of time spent in the bedroom for non-sleep activities to retrain the brain to associate bedtime and the bed/bedroom with successful sleep attempts rather than sleeplessness. The general guidelines of stimulus control are:

  • Go to bed only when you are sleepy.
  • Don’t read, watch television, eat or do other non-sleep things in bed.
  • If you are not asleep within 15 minutes, leave the bedroom and don't return until you are sleepy.
  • If you are awake at night for more than 15 minutes, get out of bed.
  • Have a consistent wake time every day, regardless of how much sleep you got.
  • Avoid naps.

Paradoxical intention - Paradoxical intention is a psychological approach that is based on doing the opposite of what you want or fear and taking it to extreme. Some people who experience insomnia may continue to experience insomnia because they fear another sleepless night or they fear the thoughts and worries that accompany going to bed, and their fear keeps them awake.

Paradoxical intention focuses on confronting, and hopefully, eliminating the fear so that it stops getting in the way of sleep. This approach is used for other fears as well. Rather than trying, unsuccessfully, to go to sleep night after night, try to stay awake and do something instead. Turning your attention to something else removes the fear of not being able to sleep and may allow you to relax and eventually go to bed.

Sleep restriction - Sleep restriction is based on the idea that people require different amounts of sleep, and that often, a person with insomnia stays in bed thinking that they will get more sleep, when staying in bed really just increases frustration and sleep difficulty.

Sleep restriction therapy reduces the amount of nonsleeping time a person with insomnia spends in bed. To practice sleep restriction, you determine your average total sleep time by keeping a log of your sleep habits for two weeks. If you usually sleep 6 hours per night, but spend 8 hours a night in bed (tossing and turning, watching TV, reading, staring at the ceiling for the other 2 hours), sleep restriction therapy will only allow to spend 6 or 6 1/2 hours in bed at first.

In the beginning, you might not sleep all of the time, but gradually, the time spent sleeping should increase. If you continue to have trouble sleeping, the time allowed in bed is further restricted to encourage sleep when you are in bed. The overall time spent in bed is adjusted as it becomes clear how much sleep you need.