Handbook of Psychology

Behavioral Treatment 255

TABLE 11. 5Outline of Progressive Muscle Relaxation Training Program

Introduction Number of Muscle
and Treatment Muscle Deepening Breathing Relaxing Discrimination Relaxation Cue-Controlled
Week Session Rationale Groups Exercises Exercises Imagery Training by Recall Relaxation

11 X 14 X X

214XXX

23 14 X X X X

414XXXX

35 8 X X X X

68XXXXX

47 4 X X X X X

58 4 X X X X X X

69 4 X X X X X X

7 none

810 4 X X X X X X

Source:Andrasik (1986).

TABLE 11.6 Fourteen Initial Muscle Groups and Procedures for
Tensing in 18 Steps

1. Right hand and lower arm (have client make “st, simultaneously tense
   lower arm).


2. Left hand and lower arm.


3. Both hands and lower arms.


4. Right upper arm (have client bring his or her hand to the shoulder and
   tense biceps).


5. Left upper arm.


6. Both upper arms.


7. Right lower leg and foot (have client point his or her toe while tensing
   the calf muscles).


8. Left lower leg and foot.


9. Both lower legs and feet.


10. Both thighs (have client press his or her knees and thighs tightly
    together).


11. Abdomen (have client draw abdominal muscles in tightly, as if bracing
    to receive a punch).


12. Chest (have client take a deep breath and hold it).


13. Shoulders and lower neck (have client •hunchŽ his or her shoulders or
    draw his or her shoulders up toward the ears).


14. Back of the neck (have the client press head backward against headrest
    or chair).


15. Lips/mouth (have client press lips together tightly, but not so tight as to
    clench teeth; or have client place the tip of the tongue on the roof of the
    mouth behind upper front teeth).


16. Eyes (have client close the eyes tightly).


17. Lower forehead (have client frown and draw the eyebrows together).


18. Upper forehead (have client wrinkle the forehead area or raise the
    eyebrows).

TABLE 11.7 Abbreviated Muscle Groups

Eight Muscle Groups

1. Both hands and lower arms.


2. Both legs and thighs.


3. Abdomen.


4. Chest.


5. Shoulders.


6. Back of neck.


7. Eyes.


8. Forehead.
   Four Muscle Groups


9. Arms.


10. Chest.


11. Neck.


12. Face (with a particular focus on the eyes and forehead).

with thermal biofeedback, which also places an emphasis on
warming of the hands, leading to a treatment termed •auto-
genic feedbackŽ by Sargent et al. (1973). Autogenic training
involves the verbatim repetition of the selected phrases, “rst
demonstrated by the therapist. Tape recordings of sessions or
printed copies of verbatim scripts may be helpful until patients
learn the phrases and their sequence as well as the ability to
elicit the desired sensations.

Biofeedback

A number of biofeedback interventions have been applied to

recurrent headache disorders, including: EMG, thermal,

electrodermal, cephalic vasomotor, transcranial doppler, and

EEG biofeedback (see Andrasik, 2000). EMG biofeedback

and thermal biofeedback are described here, as these have

the most empirical support and they are the biofeedback

approaches most widely used in clinical practice (they are

the •workhorsesŽ of the biofeedback •general practitionerŽ).

The other approaches require more specialized training and

equipment.

EMG and thermal biofeedback interventions are com-

monly employed in conjunction with relaxation training

and/or autogenic training. As with relaxation training and au-

togenic training, a rationale for ef“cacy is provided to the pa-

tient at the start of biofeedback treatment (see Andrasik, 1986,

and Blanchard & Andrasik, 1985, for verbatim explanations).

The therapist will often be present and active in •coachingŽ