Progressive Muscle Relaxation Progressive muscle relaxation

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					Progressive muscle relaxation
       C. Jeffrey Terrell, Ph.D., M.Div.
       Psychological Studies Institute
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.
    Jacobson’s 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.
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.
Theoretical Foundations
of 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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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
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.
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.
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.
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.”
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 relaxation…just
  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.
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.

				
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