264 ASSESSMENT AND INTERVENTION STRATEGIES
part of the exercise is omitted and the client simply focuses on releasing tension in vari-
ous muscle groups starting at the top of the head and progressing downward to the toes
(Taylor, 2000). Having daily practiced deep muscle relaxation for at least a month, indi-
viduals are now so well accustomed to the relaxed state that they are able to feel relaxed
simply through recall (Bernstein & Borkovec, 1973). When asked to release the tension
from particular muscle groups, this can be done by recalling their previous relaxed
state. In release-only relaxation, the client is first instructed to breathe calmly and then
to relax the various muscles of the face, neck, shoulders, arms, stomach, back, and
legs (see Öst, 1987a, for detailed instructions). Once again individuals should practice
release-only relaxation twice per day for at least 1 week. The protocol can be recorded
to assist with homework practice and then faded out as the client masters this skill (Tay-
lor, 2000). Clients who have mastered release-only relaxation now have a coping skill
that can be used in almost any situation involving naturally occurring anxiety. It is a
highly portable, efficient technique that enables the individual to achieve a relaxed state
in 5–7 minutes (Öst, 1987a).
Clinician Guideline 7.8
Progressive muscle relaxation is an adjunct intervention that can be used by the cognitive
therapist as preliminary skills training to reduce extreme levels of anxiety so the client will
engage in self- directed exposure or to provide coping strategies for individuals with severe
intolerance of anxiety. However, any relaxation training must be carefully monitored to
ensure it is not used to avoid anxiety or to undermine the benefits of exposure-based behav-
ioral experimentation.Applied Relaxation
Applied relaxation (AR) is an 8- to 10-week treatment program developed by Lars-
Göran Öst (1987a) at the Psychiatric Research Center, University of Uppsala, Sweden.
It is an intensive, systematic, graded form of relaxation training that builds from PMR
through cue- controlled relaxation to the application of rapid relaxation skills to anxi-
ety elicited in natural situations. Because the final stage of AR involves within- and
between- session practice in applying relaxation to anxiety- arousing situations, AR
actually involves repeated brief situational and interoceptive exposure and so can not be
considered a purely relaxation-based intervention for anxiety (Taylor, 2000). Neverthe-
less, what makes AR of interest is its conceptualization in terms of a coping perspective
on anxiety and empirical evidence of its effectiveness for GAD in particular (e.g., see
meta- analysis by Gould, Safren, Washington, & Otto, 2004). Öst (1987a) states that the
purpose of AR is to teach individuals how to recognize the early signs of anxiety and
learn to cope with anxiety rather than feel overwhelmed by their anxiousness. Table 7.6
presents a breakdown of the AR procedure as described by Öst (1987a).
Öst (1987a) reviewed 18 controlled outcome studies from his own lab that uti-
lized AR and concluded that 90–95% of individuals were able to acquire the relaxation
skill, with AR significantly more effective than no treatment or nonspecific treatment
comparisons. The strongest empirical evidence for the effectiveness of AR comes from