When asked to describe their experience, people who suffer from anxiety more commonly cite a cluster of physical symptoms than emotional or mental sensations. Things like shortness of breath, muscle tension, hyperventilation, and palpitations are just a few examples of what people with anxiety may experience during a flare-up.
So when it comes to working with anxious clients, clinicians should build awareness around and make it a point to address these experiences during treatment. With practice, clients can learn to help themselves by attending to their physical symptoms, loosening the grip that anxiety has on them in their lives.
“An anxious mind cannot exist in a relaxed body,” said Edmund Jacobson, MD, a physician and author of the classic Progressive Relaxation. Jacobson’s technique, called progressive muscle relaxation (PMR), is based on the premise that the body responds to anxiety-inducing thoughts with muscle tension. This muscle tension induces more anxiety and triggers a vicious cycle. Therefore, if you stop the muscle tension, you stop the cycle.
In the revised second edition of his book, Coping with Anxiety: Ten Simple Ways to Relieve Anxiety, Fear, and Worry, Edmund Bourne, PhD, says that PMR is especially useful for clients who struggle with tension headaches, backaches, tightness in the jaw, tightness around the eyes, muscle spasms, high blood pressure,insomnia, racing thoughts, and an overall feeling of being “uptight” or generally tense. Clients who have injuries in certain parts of their bodies should consult their doctors before attempting PMR in the area of the injured muscle group.
For a free, step-by-step progressive muscle relaxation exercise that you can teach your clients, click here. First, check out Bourne’s guidelines for practicing PMR effectively. You’ll want to share these with your clients before and after you teach them the exercise.
1. Regularity and consistency
Bourne recommends practicing PMR for at least twenty minutes per day, twice per day if possible. Depending on the client, between-session homework may present a challenge, but it’s worth sharing that daily practice is a requirement for obtaining “generalization.” Generalization means that after two or three weeks of regular practice, the relaxation the client experiences during practice will begin to spread through the rest of her day, or at least for several hours after it.
To that end, advise clients to practice at regular times. Immediately after waking up, before bed, or prior to eating a meal are the best times. Though it may seem somewhat counterintuitive, food digestion can disrupt relaxation. But whichever time works, reiterate to clients that a consistent routine will increase the likelihood of generalization.
2. Location
In order to achieve maximum relaxation, it’s important that clients find a quiet place to practice where they won’t be distracted. You may want to suggest that she turn her cell phone on silent, if possible. If she shares a living space, has loud neighbors, or lives in an otherwise noisy environment, you might suggest she use a fan or a white noise machine to lessen the impact of excess background noise.
3. Comfort
The entire body, including the head, should be supported during PMR. Lying down on a sofa or bed, or sitting in a reclining chair are two good options that provide complete support. If your client feels tired before practice, she should sit up during the session in order to experience the full depth of the relaxation response consciously without going to sleep.
Remind your client to wear clothes that are not too tight, restrictive, itchy, or otherwise ill-fitting. She should remove her shoes, watch, glasses, distracting jewelry, and so on.
4. Detachment
While it would be misguided and unrealistic to ask that a client abolish all thoughts of worry from their minds during practice, remind her to give herself permission to do her best to put aside the concerns of the day. She should strive to make peace of mind her highest priority during practice times.
Encourage the client to adopt a “let it happen” attitude toward the exercise. There is no need to evaluate how well she is doing the technique, or even to make a conscious effort to relax the body. Letting go is the number one requirement. If it helps, she may want to say to herself, “I am relaxing,” during each relaxation period between successive muscle groups.
5. Mindfulness
Without judgment, your client should do her best throughout the exercise to stay focused on her muscles. Remind her that when her attention wanders, as it inevitably will, she should gently bring it back to the particular muscle group she’s working on. Doing this over and over again is an excellent practice that comes with a range of benefits.
For more about progressive muscle relaxation and anxiety treatment, check out Coping with Anxiety.
Part 2: What to Do When a Client Is Participating in Self-Judgment?