Behavioral Interventions 263
The following example illustrates how to coach a client on the tense– release cycle.
We have chosen the stomach muscle group to illustrate the instructional set that should
be employed with each muscle group.
“Now I would like you to tense your stomach muscles. Tighten your stomach by
pulling it in and making is as hard as a board. NOW, tighten your stomach muscles
[therapist uses firm, moderately loud voice]. HOLD IT! Feel the tension, the tightness
of your stomach muscles, HOLD IT, HOLD IT! Focus your attention on the hard-
ness of your stomach [5–7 seconds after the NOW] And noowww, RELAXXXX!
[Therapist drags out the “now relax” in a lower, soothing voice.] Let all the tension
go from your stomach, let it flow out of your muscles, and notice the difference
between feeling tense and relaxed. You feel your stomach muscles go further and
further into relaxation. [For 30–40 seconds therapist makes suggestive statements
about relaxation.] You focus all your attention on the pleasant feeling of relaxation.
You notice how the stomach muscles now feel slack, loosened, and smoothed out
compared to their hard, stiff, and tight state when you were tensing them. Continue
to focus your attention on the feeling of relaxation as we move to your right leg.”In the first training session of PMR, it may be advisable to repeat each muscle group
twice before proceeding to the next set of muscles. Also allow a few seconds of silence
between muscle groups so that the whole process does not become too hurried. During
each phase of release the client should subvocally repeat the word “relax” or “calm.”
Furthermore, the therapist can add a pleasant imagery suggestion at the end of the
relaxation session in order to enhance the experience of deep relaxation.
Abbreviated PMR
If PMR is to have any utility as a coping response for anxiety in the naturalistic setting,
clients must quickly learn more efficient, abbreviated relaxation protocols that can be
employed anytime and in any place. If the client has mastered 10-muscle deep relax-
ation after 2 weeks of daily practice, the therapist can proceed with a 4-muscle group
protocol described in Bernstein and Borkovec (1973). This consists of the following
procedure:
- Tense and release the arms—both arms are held out in front of the person with
a 45° bend at the elbow. Make a tight fist in each hand and hold the tension. - Face and neck—all of the face and neck muscles are tensed simultaneously by
making a frown, squinting the eyes, wrinkling the nose, clenching the teeth,
making an exaggerated grin, and pulling the chin downward to the chest. - Chest and abdomen—take a deep breath and then hold it while at the same time
sitting forward, pull the shoulders back so that the shoulder blades are being
pushed together, and tighten the stomach. - Both legs—lift both legs off the floor, point the toes up, and rotate the feet
inward.
If deep muscular relaxation can be achieved after 2 weeks of daily practice, the cli-
ent is ready to proceed to the final stage of PMR, release-only relaxation. Here the tense