Progressive muscle relaxation (or PMR) is a technique for reducing anxiety by alternately tensing and relaxing the muscles. It was developed by American physician Edmund Jacobson in the early 1920s. Jacobson argued that since muscle tension accompanies anxiety, one can reduce anxiety by learning how to relax the muscular tension. PMR entails a physical and mental component.
The physical component involves the tensing and relaxing of muscle groups over the legs, abdomen, chest, arms and face. With the eyes closed and in a sequential pattern, a tension in a given muscle group is purposefully done for approximately 10 seconds and then released for 20 seconds before continuing with the next muscle group.
The mental component focuses on the difference between the feelings of the tension and relaxation. Because the eyes are closed, one is forced to concentrate on the sensation of tension and relaxation. In patients with anxiety, the mind often wanders with thoughts such as “I don’t know if this will work” or “Am I feeling it yet.” If such is the case, the patient is told to simply focus on the feelings of the tensed muscle. Because of the feelings of warmth and heaviness are felt in the relaxed muscle after it is tensed, a mental relaxation is felt as a result. With practice, the patient learns how to effectively relax and deter anxiety when it becomes at an unhealthy level where an anxiety attack would otherwise occur.
Jacobson trained his patients to voluntarily relax certain muscles in their body in order to reduce anxiety symptoms. He also found that the relaxation procedure is effective against ulcers, insomnia, and hypertension. There are many parallels with autogenic training, which was developed independently. The technique has also proven effective in reducing acute anxiety in people with Schizophrenia.
Jacobson’s Progressive Relaxation has remained popular with modern physical therapists.
Relaxation method
Progressive relaxation involves alternately tensing and relaxing the muscles. A person using PMR may start by sitting or lying down in a comfortable position. With the eyes closed, the muscles are tensed (10 seconds) and relaxed (20 seconds) sequentially through various parts of the body. The whole PMR session takes approximately 30 minutes. As this is a technique, practice with PMR does make perfect and will usually not work effectively as it should the first couple of times. An entire progressive muscle relaxation protocol in audio format is available here.
Patients with generalized anxiety disorder who first try PMR with anxiety may become frustrated, feel rushed, or feel an increase in anxiety for various reasons such as being afraid to “let your guard down.” As with doing anything new, this is to be expected and simply practiced again once or twice a day.
Attention restoration theory
Attention Restoration Theory (ART) asserts that people can concentrate better after spending time in nature, or even looking at scenes of nature. Natural environments abound with “soft fascinations” which a person can reflect upon in “effortless attention”, such as clouds moving across the sky, leaves rustling in a breeze or water bubbling over rocks in a stream. The theory was developed by Rachel and Stephen Kaplan in the 1980s in their book The experience of nature: A psychological perspective, and has since been found by others to hold true in medical outcomes as well as intellectual task attention, as described below.
Directed attention
Attention Restoration Theory describes a person as being in several states of attention:
- Directed attention
- Directed attention fatigue
- Effortless attention
- Restored attention
Tasks that require mental effort draw upon “directed attention”. People must expend effort to achieve focus, to delay expression of inappropriate emotions or actions, and to inhibit distractions. That is, they must concentrate on the higher task, avoiding distractions. Performing the actual task also requires other knowledge and skills.
In Peopleware, a landmark book on office work, Tom DeMarco and Tim Lister report that in an office environment, workers may take 15 minutes to achieve this state of flow in their concentration, and that it will be destroyed in a moment by an interruption such as a telephone call.
The task may be fascinating so that it allows “effortless attention”, or may have sufficient scope to sustain interaction without boredom, or may simply be more compatible with a person’s interests. However, after a period of directed attention, people begin to suffer “directed attention fatigue”. They become distracted, irritable, impatient. They become less effective in performing their tasks.
Attention may be “restored” by changing to a different kind of task that uses different parts of the brain, as in the familiar idiom “a change is as good as a rest”. Alternatively, exposure to natural environments and wilderness has psychological benefits including attention restoration.
Nature has an abundance of fascinating objects. “Soft fascinations” such as clouds in the sky or leaves rustling in a breeze, gain our attention relatively effortlessly and are compatible with our wants and needs. This is by comparison to snakes and spiders, which gain our attention out of fear. The Biophilia hypothesis argues that people are instinctively enthusiastic about nature.
After spending some time of effortless attention to soft fascinations removed from their day to day tasks, people may have a chance to reflect. This brings a “restorative” benefit which allows further attention.
Stress reduction
Nature can help reduce a person’s stress, as well as improve attention.
After medical surgery, patients resting in rooms overlooking trees recovered better than those in rooms with only a view of a brick wall. They experienced fewer complications from the surgery, recovered faster, and asked for fewer painkiller drugs. Similarly, natural scenes can reduce stress before an event.
Women with breast cancer who walked in a park, watched birds, or tended flowers, achieved better attention after surgery. Merely keeping sight of natural features improves self-discipline in inner-city girls. Children in New York State were less stressed by adversity, if they lived in rural areas. Stress in college examinations was similarly reduced by viewing natural scenes. Viewing scenes of urban streets and artifacts excluding nature did not achieve any stress reduction, in a similar study upon workers viewing a film about industrial accidents.
Taking breaks outside in settings that contained some nature has been shown to reduce stress, leaving nurses feeling refreshed, relaxed, and energized upon return to work.
Stress ball
A stress ball is a malleable toy, usually not more than 7 cm in diameter. It is squeezed in the hand and manipulated by the fingers, ostensibly to either help relieve stress and muscle tension or to exercise the muscles of the hand.
There are many types of stress balls. Many are a closed-cell polyurethane foam rubber. This type of stress ball is made by injecting the liquid components of the foam into a mold. The resulting chemical reaction creates carbon dioxide bubbles as a byproduct, which in turn creates the foam.
Stress balls, especially those used in physical therapy, can also contain gel of different densities inside a rubber or cloth skin. Another type uses a thin rubber membrane surrounding a fine powder. The latter type can be made at home by filling a balloon with baking soda. Some balls similar to a footbag are marketed and used as stress balls.
Despite the name, many stress balls are not spherical. Many stress toys are molded in amusing shapes and screen or transfer printed with corporate logos. They are presented to employees and clients as promotional gifts. Stress balls are the third most popular promotional gift in the UK. Stress toys are a staple of cubicles where repetitive stress injuries such as carpal tunnel syndrome are common. Because of the many shapes now available, stress balls are generically known as stress relievers.