Progressive muscle relaxation

Practicing to tense and relax muscles in sequence can help with anxiety and insomnia

Progressive muscle relaxation is a stress-reduction exercise in which you slowly tense and relax muscle groups in sequence. It is an evidence-supported treatment for anxiety[1] and insomnia[2], as well as psychosomatic aspects of various medical conditions.[3] PMR has the nice property of being easy to learn and use in an immediate way, like when you're trying to sleep, and I find it has a nice sense of "concreteness" to it due to the physical component.

The exercise was defined by Edmund Jacobson in the early 1900s.[4] His original version was pretty intense and involved some 30 muscle groups; current forms are more abbreviated. Weirdly, I found that some 5000+ citations of Jacobson's 1938 second edition book were misattributed by Google Scholar to a random two-page document intended for students at Masaryk University in Czechia. It's kind of charming to read because of the poor translation. "Grit both your fists so strong!"

While Jacobson believed it impossible to feel anxious when your muscles are fully relaxed, modern research is not convinced on this point. Anxious people do consistently report tenser muscles than nonanxious controls. However, perceived muscle tension doesn't match that well with the actual physiological contraction measured by electromyography, and it has not consistently been shown that PMR actually decreases muscle tension even though it successfully decreases anxiety.[5] PMR works for many people, but we're not entirely sure why-- it may be partly a meditation in disguise, operating on your perceptions as much as on your muscles.[6]

Below are instructions for a short version of PMR based on the University of Michigan Health Library. If you're interested in the full form as practised by therapists, you might want to look at the Bernstein & Borkovec training manual[7] that is mentioned in the review papers.

For each muscle group:

  1. Breathe in, while tensing the muscles hard (so long as it is not painful).

  2. Maintain tension for ~5 seconds.

  3. Breathe out, and suddenly and completely relax the muscle group.

  4. Focus your attention on the area as it relaxes. Can you feel how it is different from the tense state?


Muscle groupWhat to do
HandsClench them.
Wrists and forearmsExtend them, and bend your hands back at the wrist.
Biceps and upper armsClench your hands into fists, bend your arms at the elbows, and flex your biceps.
ShouldersShrug them (raise toward your ears).
ForeheadWrinkle it into a deep frown.
Around the eyes and bridge of the noseClose your eyes as tightly as you can. (Remove contact lenses before you start the exercise.)
Cheeks and jawsSmile as widely as you can.
Around the mouthPress your lips together tightly. (Check your face for tension. You just want to use your lips.)
Back of the neckPress the back of your head against the floor or chair.
Front of the neckTouch your chin to your chest. (Try not to create tension in your neck and head.)
ChestTake a deep breath, and hold it for 4 to 10 seconds.
BackArch your back up and away from the floor or chair.
StomachSuck it into a tight knot. (Check your chest and stomach for tension.)
Hips and buttocksPress your buttocks together tightly.
ThighsClench them hard.
Lower legsPoint your toes toward your face. Then point your toes away, and curl them downward at the same time. (Check the area from your waist down for tension.)

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Written by Mispy

References

  1. Manzoni, G. M., Pagnini, F., Castelnuovo, G. & Molinari, E. (2008). Relaxation training for anxiety: a ten-years systematic review with meta-analysis BMC psychiatry.
  2. Taylor, D. J. & Roane, B. M. (2010). Treatment of insomnia in adults and children: a practice-friendly review of research Journal of Clinical Psychology. [scihub]
  3. Hoyle, R. H. & others (1993). Efficacy of abbreviated progressive muscle relaxation training: A quantitative review of behavioral medicine research Journal of consulting and clinical psychology. [scihub]
  4. Jacobson, E. (1938). Progressive relaxation Univ. Chicago Press.
  5. Pluess, M., Conrad, A. & Wilhelm, F. H. (2009). Muscle tension in generalized anxiety disorder: a critical review of the literature Journal of anxiety disorders. [pdf]
  6. Conrad, A. & Roth, W. T. (2007). Muscle relaxation therapy for anxiety disorders: It works but how? Journal of anxiety disorders. [scihub]
  7. Bernstein, D. A., Borkovec, T. D. & Hazlett-Stevens, H. (2000). New directions in progressive relaxation training: A guidebook for helping professionals Greenwood Publishing Group. [libgen]