Progressive Relaxation Techniques – Intervention for anxiety

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              Your heart starts pounding faster as your breath quickens. Your senses become sharper and you are aware an uneasiness creeping up onto you. Your thoughts run wild and in a moment, you feel breathless as if someone is choking your neck and a big rock weighing in your heart. Your body starts to feel cold or you may experience sweaty hands and /or feet. The more you think, the more you feel insecure. Your mouth starts to become dry and tingling of numbness sensation in your hand and feet coming to you. Perhaps you may start feeling dizzy or even nausea. And the last you may realize is your muscle tightness in your whole body.

              Anxiety is a normal human emotion that most experiences at time especially for those who lives in this stimulating and complex city. It can cause numerous stress symptoms which vary from person to person. The most common symptoms are often stiffness and soreness on the body. When you sense danger (whether is real or imagined) the body defenses in a way which is known as an automatic process called the “fight or flight” reaction or rather the generic stress response. This response is the body’s way of protecting you. Often when we feel anxious, we avoid doing things of what we intend to do and worry about the outcome. Anxiety can habitually follow us and subconsciously you may not be even aware although it may be part and parcel of daily life stressors.

              The therapist will need to understand and find out from the client where and how is this anxiety being formed, where is it located at and what words will be best to describe it. These notions are important during the progressive relaxation therapy as it helps the therapist to choose their words and imagery accordingly during hypnosis. As therapist slowly guides client into relaxation mode with their eyes close, control breathing technique will be apply and client will learn to identify and recognize the intense sensation when they scan through their body from head to toe. Direct suggestions will be apply for generalized relaxation in client when they achieve a light to medium trance. Some clients’ response well in a structural method for progressive relaxation by bringing awareness to each individual part of their body and bringing attention to each individual muscle groups focusing from the head to leg or vice versa until all muscle groups are relaxed.

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              Your eyes are closed and you begin by getting into a comfortable position. Now breathe in slowly and exhale gently to empty your lung as much as possible. Keep breathing and as slowly as you can. It may be very difficult at first but that is okay. As you breathe in and out gently, notice and feel where the tensions are located at. Inhale slowly, letting the rhythm of your breathing to slow down. Feel the relaxation beginning at the bottom of your feet. It may have a tingling sensation as if you are stepping on the warm floor or simply loose and limp. Let the tension seep through your feet to the toes and allow the relaxation to spread all over your feet and up to your ankles. Allow this relaxation to spread to your tight calf and feel the tension slowly disappearing. Let your calf relax… limp and slack. Let this flow of relaxation continue to spread to your knees and up to the thighs. Feel the sensation of tightness disappearing and let your thigh muscles relax. Let it be loose… limp and slack. Allow this relaxation to continue to spread throughout your body. And now this relaxation is rising up to your hips and slowly to your upper body, to your stomach and lower back. Now to your chest and upper back. Gently breathe in and breathe out slowly. Feel the muscles on your lower body are totally relaxed, limp and slack. And this relaxation continues to spread to your arms, elbows and wrists. Now when you see your hands, hold it tight and clench your hands into fists. Feel the stiffness and tension on both your hands and squeeze it tight when you breathe in. Now open your hands slowly when you exhale and relax. Notice how your hands and arms are feeling now. Feel the relaxation in your hands and arms… loose and relaxed. Feel your body relaxing further and allow your shoulders to ease back slightly. Feel yourself sinking deeper and deeper into the chair. While you breathe in gently, you see the tension emitting out from your shoulder when you breathe out slowly. Allow your upper back to relax even further, let your shoulder fully relax, and your neck, let it sink deeper and deeper into the chair. Feel this sensation of relaxation continue to spread to your chin, to your mouth, your cheeks, and nose and to your eyes. Your eyelids are heavy and relaxed. Your forehead is light and cool, let this relaxation spread further to the back of your head and slowly moves to the top of your head. Your entire body is fully relaxed and calm. You can even relax further as you let your spine to relax completely. Feel the relaxation flowing throughout your body now. Breathe in slowly and hold your breath now, gently exhale out from your nose and relax your muscles totally. Let all the tension in your body leaving with each breath out. Continue to breathe slowly and smoothly as you scan your body looking for any possible remaining tension.

              Edmund Jacobson (1934a, 1934b, 1938, 1964, 1967, 1970) who originated and developed the method of progressive muscle relaxation (PMR) stated that muscle relaxation has been an important therapeutic technique in the modern treatment of anxiety disorders. When the client has already achieved significant tension reduction, appropriate deepening procedures are used such as fractionalization technique. Client is asked to open their eyes for a moment, and then close their eyes. These steps will be repeated consecutively up to five times when therapist gently swift their hands down from the client’s face or with a snap of their fingers to bring client right back to an even more satisfying level of deeper relaxation and concentration.
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              Anxious people also hold on to many negative cognitive thoughts on why they are behaving that way and don’t necessarily always link to negativity. You can face anxiety even when you are experiencing positivity with high demand when you just received a promotion, buying a house or getting married, relocation or going to college. This stress response helps you to meet and face your challenges and also leads you to tension on your body muscle. A study researcher, Jens C. Pruessner, PhD (2011), director of the Douglas Mental Health Institute at McGill University in Montreal stated that living in big cities with many, many people surrounding you sensitizes you to respond more strongly to stress. It’s a stronger response of those areas that typically regulate fear and emotion. Pruessner (2011) reported that city dwellers’ mental health is negatively affected: mood and anxiety disorders are more prevalent in city dwellers and the incidence of schizophrenia is strongly increased in people born and raised in cities. In their finding, they use functional magnetic resonance imaging in three independent experiments, that urban upbringing and city living have dissociable impacts on social evaluative stress processing in humans. Current city living was associated with increased amygdala activity, whereas urban upbringing affected the perigenual anterior cingulate cortex, a key region for regulation of amygdala activity, negative affect and stress.

              Long term stress can rewire the brain and leads you to anxiety and depression vulnerability. The challenge since young when we are culturally mold to be more cautious and fear of losing out; often we, in Singapore context are being labeled as “kiasu” which literally means “fears of losing”. Since young, these memes have been passed down through the generations which resonate very well with my family and own values. Our humane brain functions very reactively and stored many hidden treasures in it that causes anxiety which distort the breathing patterns and subconscious fear. The conceptual style of creating a safe place with reality of perception and going through the progressive muscle relaxation with the anxious client do prove a certain success rate in controlling anxiety for a long period of time. Jacobson (1938) cited that progressive muscle relaxation originated from the theory that a psychobiological state called neuromuscular hypertension is the basis for a variety of negative emotional states and psychosomatic diseases. Jacobson asserted that relaxation of muscles would lead to relaxation of the mind, “because an emotional state fails to exist in the presence of complete relaxation of the peripheral parts involved”. Client will learn how to recognize and identify the contraction and relaxation of muscle in various parts of their body in a certain order. Grawe, Donati, and Bernauer (2001) found 66 studies in which progressive muscle relaxation or one of its successors was applied as a therapeutic intervention.

              Epictetus, a Greek Stoic philosopher quoted: “Man is not worried by real problems so much as by his imagined anxieties about real problems”.
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References

Grawe, K., Donati, R., & Bernauer, F. (2001). Psychotherapie im Wandel: Von der Konfession zur Profession (5th ed.). Go¨ttingen: Hogrefe.

Jacobson, E. (1938). Progressive relaxation (2nd ed.). Chicago: University of Chicago Press.

Jacobson, E. (1934a). Electrical measurements concerning muscular contraction (tonus) and the cultivation of relaxation in man: relaxation times of individuals. American Journal of Physiology, 108, 573–580.

Jacobson, E. (1934b). Electrical measurements concerning muscular contraction (tonus) and the cultivation of relaxation in man: studies on arm flexors. American Journal of Physiology, 107, 230–248.

Jacobson, E. (1938). Progressive relaxation (2nd ed.). Chicago: University of Chicago Press.

Jacobson, E. (1964). Anxiety and tension control: a physiologic approach. Philadelphia: Lippincott.

Jacobson, E. (1967). Tension in medicine. Springfield, IL: Thomas.

Jens C. Pruessner (2011). City living and urban upbringing affect neural social stress. Nature. Print on June 23, 2011, from http://www.nature.com/nature/journal/v474/n7352/abs/nature10190- f1.2.html#supplementary-information.





Mabel Ang from The School of Positive Psychology