Shy No Longer

Module 3

Progressive Muscle Relaxation
Introduction2

Progressive Muscle Relaxation3

Preparing for Relaxation

3

Relaxation Technique

4

The Calming Technique: Body and Breath

6

Difficulties with Relaxation

7

Module Summary

9

About the Modules

10

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Introduction
Learning to change your breathing habits can help to reduce general levels of anxiety. Once you’ve
practiced the calming technique consistently, it can be especially helpful in anxious situations. Anotherhelpful strategy is to practise using muscle relaxation techniques. You may recall from Module 1 that one of
the body reactions in the fight/flight response is muscle tension. This can result in feeling “tense”, or canlead to muscle aches and pains, as well as leaving some people feeling exhausted.
Think about how you respond to anxiety. Do you “tense up” when you’re feeling anxious? Sometimes thechange may be so subtle that we don’t even notice it happening, but perhaps you clench your teeth slightly
so your jaw ends up feeling tight, or maybe your shoulders become tense, resulting in a feeling of tightness
in your neck and shoulders. Muscle tension can also be associated with backaches, muscle spasms, andtension headaches. Different people respond to anxiety with muscle tension in different parts of the bodyand to different extents.
Muscle Tension Scan
Consider your own body for a moment. You may have noticed that in the past certain parts of your body
felt tense, especially after a stressful day or a particularly anxious experience. Where do you often feeltension and “tightness” in your body?

 Forehead Shoulders

 Lower legs

 Mouth and/or jaw

 Arms Other: Neck Back Other: Chest Upper legs

 Other:

Don’t worry if you can’t remember all the different places that you feel tension. This is just to help you tostart thinking about muscle tension in your body.
Muscle relaxation can be particularly helpful in cases where anxiety is especially associated to muscle
tension. It can help to interrupt the development of anxiety by providing you with the skills to responddifferently to muscle tension. This module is designed to help you reduce the tension that you may
experience as a result of anxiety.

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Progressive Muscle Relaxation
One method of reducing muscle tension is through a technique called Progressive Muscle Relaxation.
Relaxation based on this method has been used for many years. Many people have found it helpful in
reducing muscle tension that has resulted from prolonged periods of anxiety. In progressive muscle
relaxation exercises, you tense up particular muscles and then relax them, and then you practise thistechnique consistently.
There are a few important steps involved in learning how to use progressive muscle relaxation.
1. Differentiating between muscle groups. For those of us who don’t think about our muscles
very often, when we try to tense up our hand and forearm, we may end up tensing our wholearm. Learning this technique involves learning to tense and relax specific parts of our body.
2. Learning how to tense different muscle groups and what that tension feels like
3. Allowing yourself to relax and let go of the tension
4. Practice, practice, practice and more practice
The technique is relatively simple, although it may take a while to get used to it. After all, it is a normal
fight/flight response to tense your muscles in response to fear. However, by practicing to relax yourmuscles in response to tension, your body can learn to cope better with anxious situations where thefight/flight response is not essential for survival. This tensing and relaxing of muscles helps you to become
more aware of the sensations of tension in your muscles and increases your ability to relax them.

Preparing for Relaxation
When you are beginning to practice progressive muscle relaxation exercises there are some points to keep
in mind. This will help you to take full advantage of the exercises. You need to prepare your mind, bodyand the environment for relaxation.
Physical injuries. If you have any injuries, such as sporting injuries, or have a history of physicalproblems that may cause muscle pain, you should consult your doctor before attempting any muscle
relaxation exercises. Talk to your doctor if you have any concerns or queries about how these
exercises may affect you.

 Select your surroundings. When you first learn to use these techniques, think about minimising the
distraction to your five senses. Turn off the TV, the radio, take the phone off the hook, have soft
lighting and so on. For most people who have a family, this can sometimes be a challenge.
 Make yourself comfortable. Try to find a chair that comfortably seats your whole body, including
your head. For example, a reclining sofa is more beneficial than a kitchen chair. Wear loose,
comfortable clothing and take off your shoes. This all helps with providing a comfortable environment
for your body to relax.
 Internal mechanics. Avoid practicing after big, heavy meals, and do not practice after consuming any
intoxicants, such as alcohol.
 Practice means progress. Only through practice can you become more aware of your muscles,
how they respond with tension, and how you can relax them. Training your body to responddifferently to stress is like any training – practising consistently is the key.
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Relaxation Technique
The following section describes the relaxation programme. This includes the general procedure, a fulldescription of how to tense particular muscle groups, and the order in which to tense and relax them.
Once you are familiar with the routine and understand how to tense particular muscle groups, you can use
the brief outline of the procedure as a quick guide to how to do the full programme.

GENERAL PROCEDURE

1. Choose your surroundings and make yourself comfortable, as described in the previous section.
2. Use the calming technique described in Module 2 to help you let go of the stress and anxiety that may
have existed in your day so far. Do this for 3-5 breaths.
Calming Technique:• Breathe in for 4 seconds (through your nose)• Hold for 2 seconds• Breathe out for 6 seconds(If you are still getting used to changing your breathing, use a 2-in, 1-hold, and 3-out cycle)
3. When you are ready to begin, tense the muscle group described.
• Make sure you can feel the tension, but not so much that you feel a great deal of pain.
• It is more important to focus on what the tension feels like and how the tension builds up, rather
than trying to overstrain the muscle.
• Keep the muscle tensed for approximately 5 seconds.
4. Relax the muscles• Relax the muscle, and keep it relaxed for approximately 10 seconds• It may be helpful to say something like “Relax” as you relax the muscle.
• Focus on the difference between how the muscle feels when it is relaxed compared to when it istense.
5. You can tense and relax each muscle group twice before moving on to the next muscle group.
6. When you have finished the relaxation procedure, remain seated for a few moments allowing yourself
to become alert. Continue your breathing exercises using the calming technique, and get up slowly.

RELAXATION SEQUENCE
1. Right hand and forearm. Make a fist with your right hand. Focus on the tension in your hand andyour arm (below the elbow) and hold the tension for 5 seconds. Relax your hand and arm, releasing
the tension for about 10 seconds. Notice the difference between the tension and the relaxation.
2. Right upper arm. Bring your right forearm up to your shoulder. The closer you
bring your hand to your shoulder, the more tense your upper arm will become.
Focus on the muscles in between your elbow and your shoulder - try not to tense
your forearm or your hand too much. Hold the tension for 5 seconds, then releasefor 10 seconds.
3. Left hand and forearm. Repeat as for right hand and forearm.
4. Left upper arm. Repeat as for right upper arm.

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5. Forehead. Focus on your face now, raising your eyebrows as high as they will go, as though you were
surprised by something. Feel the tightness in the muscles above your eyes. When you release thetension of the muscles around your forehead, focus on them becoming smooth and relaxed.
6. Eyes and cheeks. Squeeze your eyes tight shut. Focus on the tension around your eyes and yourcheeks. Notice how the tension is released as you relax those muscles.
7. Mouth and jaw. Open your mouth as wide as you can, as some people do when they have a big yawn.
Feel all the muscles in the hinge of your jaw tightening, and notice the tension around your mouth.
When you relax your mouth and jaw you can leave your lips slightly apart and just let your jaw hangfreely.
8. Neck. !!! Be careful as you tense these muscles. Focus on the muscles in your neck byfacing forward and then pulling your head back slowly, as though you are looking up to
the ceiling. Feel the tension in the muscles in the back of your neck, as this is often an
area that becomes tense. Relax these muscles by bringing your head back down to aloose, resting position, noticing how the tension is released.
9. Shoulders. Tense the muscles in your shoulders as you bring your shoulders up towards
your ears. Focus on the tightness in your shoulders. Hold it for 5 seconds, and then let go of
the tension by dropping your shoulders right down to a relaxed position. It is very common
for people to keep tension in their shoulders, so notice the comparison between tensed andrelaxed.
10. Shoulder blades/Back. Push your shoulder blades back, trying to almost touch them
together, so that your chest is pushed forward. Hold the tension in the muscles, feeling thetightness in your upper back and in your shoulder blades. Release the tension by dropping
your shoulders into a resting, relaxed posture, feeling the tension fade away.
11. Chest and stomach. Breathe in deeply, filling up your lungs and chest with air. Feel thetension in your chest and stomach muscles. Hold it for 5 seconds, and as you slowly breatheout, feel the muscles relaxing.
12. Hips and buttocks. Squeeze your buttock muscles, noticing the tension in your buttocks and hips.
Try not to tense up your legs, just focus on tightening up the buttock and hip muscles. Relax themuscles, and feel them loosen up.
13. Right upper leg. Tighten your right thigh, concentrating on the tension in that area. You may getsome tension in your hip and in your calf muscle, but try to focus most of the tension in your thighmuscle. Release the tension and feel the muscle relax.
14. Right lower leg. !!! Do this slowly and carefully to avoid cramps. Pull your toes towards you to feelthe tightness in your calf muscle. Hold it, then relax it and notice all the tension fade away from themuscle.
15. Right foot. Curl your toes downwards to feel the tension in your right foot. Hold the tension andthen relax your toes, bringing them into their normal resting position.
16. Left upper leg. Repeat as for right thigh.
17. Left lower leg. Repeat as for right calf.
18. Left foot. Repeat as for right foot.

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The Calming Technique: Body and Breath
Follow this guide to practise a calming technique in which you will be controlling your breathing and relaxing yourmuscles. This is a shorter method of relaxation than the full progressive muscle relaxation exercise. Make sure you
are sitting comfortably and relaxed. You may find it easier to close your eyes while you are doing this exercise.
CALMING YOUR BREATH
Using your nose to breathe in and your mouth to breathe out, start by observing your breath. Note the quality ofyour breath as you inhale and exhale…
• Now try to slowly lengthen each inhalation by drawing your breath down towards the abdominal area in asmooth and steady fashion. Have a brief pause before you observe the slow, smooth and steady fashion in whichyour breath is released as you exhale.
• Now that you are paying attention to your breath, you are ready to commence the counting rhythm:
Breathing in 2, 3, 4
Hold for 2
Breathing out 2, 3, 4, 5, 6
Try to maintain this slow, even, and controlled rhythm in your breathing by continuing to count in your head.
CALMING YOUR BODY
Next, start paying attention to your body, scanning it for areas of muscular tension. To do this, try to work with therhythm of your breathing, by scanning and observing your body as you inhale, and releasing tension as you exhale.
Try to observe, 2, 3, 4
Hold, for 2
Release 2, 3, 4, 5, 6
It may help to scan your body in a systematic fashion, for example, by directing your attention from the bottom up• That is, you may start with observing whether there is any muscular tension in your feet, ankles, and calf muscles,
and releasing tension in those muscles as you exhale in a slow and steady fashion…letting go of tension in theseareas each time you breathe out. Become aware of your feet resting heavily and comfortably on the floor• Next, direct your attention upwards; observe your thighs, buttocks, and hips as you breathe in….releasing
muscular tension with each slow, and steady exhalation.
• Draw your attention to your abdominal region, scanning for tension in the form of knots or butterflies, releasing
tension each time you breathe out….
• Next, scan your upper body for muscular tension. Observe areas of tension as you inhale slowly to the count of
four…and release tension as you slowly exhale to the count of six.
• Pay some attention to your shoulder region, observing signs of tension and releasing tension with each exhalation,
allowing your shoulders to sink down and rest low.
• Observe whether there is any muscular tension in your hands, wrists, and arms, and releasing tension in thosemuscles as you exhale in a slow and steady fashion…letting go of tension in those areas each time you breathe
out….Become aware of your hands and arms resting heavily and comfortably.
• Once again, direct your attention upwards, back towards the shoulder region, observing and releasing tension as
you slowly and steadily breathe in and out….
• Observe the sensation in your neck…scanning for tension and releasing tension as you exhale. See if you can findthe point of balance where your head balances most comfortably and effortlessly on the top of your neck.
• Next, direct your attention towards your facial muscles, starting with your forehead and brow, releasing any
tension and smoothing these areas each time you breathe out….
• Observe tensions around your eyes, releasing tensions each time you exhale, allowing your eyeballs to fall backinto their sockets.
• Take note of muscular tension in and around your mouth and jaw, allowing your lips to relax, your jaws tounclench and your tongue to settle more heavily in the bottom of your mouth each time you breathe out. ….

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Now that you have scanned most of the common areas for muscular tensions, continue to breathe slowly, smoothly,and steadily, maintaining your count…inhaling to the count of 4, holding your breath for the count of 2, and exhaling
to the count of 6….
For the final few moments, you may wish to redirect your attention to any part of your body in which you are stillaware of muscular tension and attempt to gradually release more and more tension each time you exhale.
If you notice that your mind is starting to wander, do not make yourself tense in trying to stop your thoughts. Simply
observe your mind’s activity as you slowly inhale and release the thoughts as you breathe out, observing the thoughts
drift away….
Throughout try to maintain the slow and steady rhythm of breathing in, 2, 3, 4, hold for 2, and out, 2, 3, 4, 5, 6….
Finally, see if you can maintain the nice and evenly controlled quality of your breath as you cease counting, becomeaware of your surroundings, and get ready to open your eyes….

Difficulties with Relaxation
Sometimes, especially when people first start using relaxation techniques, it may feel quite unusual. Somepeople feel uncomfortable with how their body responds to relaxation or they may feel like it isn’t working.
Some of these difficulties include:•

Fear of losing control:

Sometimes people feel like they may lose control, perhaps because they have never used relaxation
techniques before and don’t know what to expect, or perhaps it is so different to what they’re used to thatthey’re not sure what will happen. Remind yourself that we are in control of our mind, body and feelings
and that relaxation can be stopped at any time.
•

Unusual bodily sensations:

Some people feel tingling or hot and/or cold sensations, ‘jumping’ muscles or heaviness in the limbs. These
are all normal sensations which are experienced as we loosen up and become more aware of the different
muscles in the body.
•

Limited success in the beginning:

Relaxation is a skill like any other. The more you practice the easier it gets, so try to persevere with yourrelaxation sessions.
•

A wandering mind:

Turtle Tip

When an individual begins practising relaxation exercises, they may
have difficulty concentrating or focusing on what they are supposed
to be doing. This may be frustrating. If your mind starts to wander,
just allow the thought to pass by, and then bring your attention backto the relaxation exercise.
Once you have practised PMR and know how to relax your muscles,
you might wish to use a version of the calming technique that focuses
on relaxing your breath and your body.

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Learning to train
your body torespond differently
takes time. It mightfeel strange at first,
but practising is the
key to getting yourbody used torelaxing.

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MONITORING YOUR RELAXATION LEVELAs explained it’s important to practice relaxation to achieve the best results, as this is a new skill you’relearning. It is useful to monitor you own progress by keeping a relaxation diary that records the when,
where and how of your practice. You’ll also be able to identify particular situations and / or times of the
day when you are most tense.
The following table is an example of a recording method that might be useful. On this scale:
10 represents the most tense or anxious you have ever been.
0 represents the most relaxed and calm you have ever been.
Date & Time

Comments / Reactions

Relaxation
Level
0-10

Comments / Reactions:• What parts of your body relaxed easily?
• What sensations were you aware of in your body?
• Was your mind relaxed?
• What sorts of images were most relaxing for you?
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Module Summary•

Muscle tension is a common symptom of anxiety. One method of reducing muscle tension
is through a technique called progressive muscle relaxation. In progressive muscle
relaxation exercises, you tense up particular muscles and then relax them, and then you
practise this technique consistently.

•

Progressive Muscle Relaxation involves learning to differentiate between different muscle
groups, learning how to tense each muscle group separately, allowing yourself to relax andlet go of the tension, and consistent practice sessions as the key to successful relaxation.

•

When preparing for relaxation, you need to consider the following”• be aware of any injuries,• make your surroundings and your body as comfortable and distraction-free as possible,• avoid practising after heavy meals or alcohol, and• remember that the key to progress is practise!

•

Progressive Muscle Relaxation starts with the calming technique to slow down yourbreathing. After this, you begin tensing each muscle group, keeping it tensed forapproximately 5 seconds, then relaxing the muscle group for approximately 10 seconds. At
the end, give yourself some time to slowly become alert again.

•

Once you have become used to relaxing your muscles, you can start to use the body andbreath technique.

•Some difficulties with relaxation include a fear of losing control, unusual bodily sensations,limited success in the beginning, and a wandering mind. All of these difficulties tend to
subside with consistent practice that allows your body to adjust to the change fromtension to relaxation.

In the next module we will
start to look at thinking
reactions and how yourthoughts can influence yourfeelings.

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About The Modules
BACKGROUNDThis module was created in 2003 by Patrick Kingsep at the Centre for Clinical Interventions, under thesupervision of the Centre’s Founding Director, Paula Nathan.
The concepts and strategies in these modules have been developed from evidence-based psychologicalpractice, primarily Cognitive-Behaviour Therapy (CBT). CBT for social anxiety is based on the approachthat anxiety is a result of problematic cognitions (thoughts) and behaviours.

REFERENCES

These are some of the professional references used to create the modules in this information package.
Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D.
A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69–93). New
York: Guilford Press.
Heimberg, R. G. & Becker, R. E. (2002). Cognitive-behavioral group therapy for social phobia. New York: Guilford
Press.
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research
and Therapy, 35, 741–756.

“SHY NO LONGER”
This module forms part of:Kingsep, P., & Nathan, P. (2003). Shy No Longer. Perth, Western Australia: Centre for ClinicalInterventions.

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