260 ASSESSMENT AND INTERVENTION STRATEGIES
The induction of deep relaxation became an essential tool in the behavior therapist’s
armamentarium for inhibiting anxiety. Wolpe discovered that the autonomic effects of
relaxation can only counter a weak anxiety response, but once a weak stimulus is no
longer anxiety- provoking a slightly stronger anxiety- provoking stimulus can be repeat-
edly paired with relaxation until it too ceases to arouse anxiety (Wolpe & Lazarus,
1966). Gradually, with repeated presentations, deep relaxation will inhibit successively
stronger anxiety responses until even the most intense anxiety- provoking situation no
longer elicits anxiety.
The systematic tensing and releasing of specific muscle groups that was pioneered
by Edmund Jacobson is still the most common approach to relaxation training used in
CBT. Clients are instructed to tense a specific muscle group “as hard as possible without
causing pain,” to hold the tension for 5–7 seconds, to notice the tension in the muscle
group, then to relax and release the tension, and to notice the feeling of relaxation that
occurs when the tension is released (Bernstein & Borkovec, 1973). The purpose of this
“tense– release” cycle is to facilitate tension detection and sharpen the client’s ability to
discriminate between sensations of tension and relaxation. Although many different
PMR variations exist, we present a 10-muscle group protocol in Table 7.5 that can be
initially taught to clients. It is derived from lengthier protocols described in Bernstein
and Borkovec (1973), and Cautela and Groden (1978).
Rationale and Instructions
Before initiating a relaxation training session, it is important to provide a rationale for
the procedure. The following is one possible explanation and set of instructions for
PMR that can be used with clients. (For other examples of rationales and instructions
for PMR, see Bernstein & Borkovec, 1973; Bourne, 2000; Cautela & Groden, 1978;
Craske & Barlow, 2006; Foa & Rothbaum, 1998; Goldfried & Davison, 1976.)
“Today I am going to teach you how to use relaxation to mange your anxiety.
This procedure, called deep muscle relaxation, was first introduced 75 years ago
by a Harvard University physiologist, Dr. Edmund Jacobson. He found that indi-
viduals could learn to induce a state of deep relaxation by tensing and then releas-
ing specific groups of muscles. The important part of this procedure is learning the
difference between feeling tense and feeling relaxed, so you will be coached on how
to pay especially close attention to the feelings and physical sensations associated
with your muscles being tense and then relaxed. Do you recall from the earlier
assessment session that one of the anxiety symptoms that you noticed was muscle
tension? Could you remind me of what that is like for you. [Have client describe
the discomfort associated with feeling physically tense or uptight when anxious.]
When you feel tense, certain muscles in your body tighten; that is, the muscle fibers
actually contract, producing that tense feeling. Progressive muscle relaxation is
a technique that interrupts the anxiety process by relaxing the muscles. It liter-
ally reverses one of the main symptoms of anxiety, physical tension, by releasing
unwanted muscle contraction or tension. Once you’ve mastered the skill of inducing
deep relaxation, you can use it in a variety of situations to interrupt a rise in your
anxiety level.