Progressive Muscular Relaxation

Description of the Strategy

Relaxation training is a set of procedures used in clinical practice to alter an individual's physiological, behavioral, cognitive, and emotional functioning. Relaxation is often incorporated into treatment to allow clients to respond to life events with increased physical and emotional self-control and with a more positive phenomenal experience. Although several variations of relaxation training exist, the most commonly used approach is progressive relaxation that involves learning how to regulate muscle tension through the systematic tensing and releasing of major muscle groups throughout the body.

Progressive relaxation training originated in the early part of the century, when Edmund Jacobsen applied relaxation skills with his clients suffering from tension disorders. He conceptualized relaxation as a way to limit the amount of energy expended when skeletal muscles become overactive. In turn, adenosine triphosphate (ATP), one of the body's principal energy sources, would be conserved, and fatigue could be reduced. Consistent use of relaxation skills would therefore increase the likelihood that bodily functioning would remain at a more optimal level.

Further physiological explanations for the utility of relaxation often refer to reduced activation in the sympathetic branch of the autonomic nervous system. By using relaxation skills in response to perceived stressors, an individual may reduce excessive skeletal muscle activity that creates the experience of tension. Progressive relaxation may also activate the parasympathetic branch of the autonomic nervous system, which leads to reduced arousal. This explanation is often referred to as the relaxation response.

Assessment

Clinical assessment is most useful when it informs effective treatments that fit the unique needs of each client. For relaxation training to serve as an effective treatment tool, it is crucial for several issues to be addressed during the assessment phase. First, the clinician should determine whether a medical condition, like untreated hypertension, primarily accounts for the client's presenting symptoms. It is often appropriate for clients to have a medical evaluation in order to rule out organic bases for presenting complaints. In addition, the clinician should assess the client's frequency and amount of stimulant use, because use of stimulants may contribute to increased physiological activity as well as muscle tension. If possible (e.g., not part of a medical prescription), a plan to decrease stimulant use should be made. Second, several factors may contribute to reports of anxiety and tension that can be appropriately targeted through relaxation training. Such areas include autonomic overactivation reflected in quality of sleep, drug/alcohol use, adherence to rituals, withdrawal from others, change in appetite/sex drive, interpersonal problems, feeling fatigued, depressed, or in pain. Third, clinicians should note the degree to which clients are able to concentrate during sessions. To acquire effective relaxation skills, it will be necessary for a client to be able to focus on bodily sensations and be as free from cognitive distractions as possible. Finally, antecedents contributing to and consequences resulting from anxiety or tension should be discussed. Once [Page 450]clients are able to understand the role environmental factors play in the maintenance of anxiety and tension, they may be more likely to intervene appropriately. In fact, it is possible for a subgroup of highly anxious clients to experience increased subjective distress and physiological arousal when they reach a relaxed state. Clinicians may at this point consider using another type or relaxation procedure or inform the client that relaxation training will initially serve as an exposure exercise to the aversive sensations and thoughts and eventually move toward its intended use, to induce relaxation. It is important for clinicians to discuss with clients their expectations regarding treatment to be sure that expectations are reasonable before treatment begins. The clinician may also recommend to clients that they practice self-monitoring to increase awareness of the frequency and severity of muscle tension or anxiety as the associated environmental factors.

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