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Progressive Muscle Relaxation

a b c d e a
Martha S. McCallie BSW , Claire M. Blum RN
f g a
& Charlaine J. Hood
a
College of Social Work, University of Tennessee ,
Knoxville, TN, USA
b
Oasis Halfway House Program, Council for
Alcohol and Drug Abuse Services, Inc. (CADAS) ,
Chattanooga, TN, USA
c
National Association of Social Workers, National
Association of Alcohol & Drug Abuse Counselors ,
USA
d
Tennessee Association of Alcohol & Drug Abuse
Counselors , USA
e
Tennessee Association of Alcohol & Drug Abuse
Services , USA
f
American Diabetes Association , USA
g
American Association of Diabetes Educators , USA
Published online: 04 Oct 2008.

To cite this article: Martha S. McCallie BSW , Claire M. Blum RN & Charlaine J.
Hood (2006) Progressive Muscle Relaxation, Journal of Human Behavior in the Social
Environment, 13:3, 51-66

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 Progressive Muscle Relaxation
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Martha S. McCallie
Claire M. Blum
Charlaine J. Hood

ABSTRACT. Progressive muscle relaxation [PMR] was first identified

by Jacobson in 1934 as tensing and releasing of 16 muscle groups. Wolpe
adapted it for use with systematic desensitization in 1948 and Bernstein
and Borkovec in 1973 studied adjustments to the technique to fit cognitive
behavioral stress management. Some of these adjustments are: 7 and 4
muscle groups, relaxation through recall, recall and counting, and count-
ing. Empirical evidence supports the use of PMR in high level tension re-
sponses and mind body techniques such as: reducing tension headaches,
insomnia, adjunct treatment in cancer, chronic pain management in in-
flammatory arthritis and irritable bowel syndrome. This article analyzes
the development of PMR, reviews current research, and discusses the im-
plications to social work practice. [Article copies available for a fee from The
Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address:
<[email protected]> Website: <http://www. HaworthPress.com>
© 2006 by The Haworth Press, Inc. All rights reserved.]

Martha S. McCallie, BSW, is an MSSW student, College of Social Work, University of

Tennessee, Knoxville, TN. She is also the manager of the Oasis Halfway House Program,
Council for Alcohol and Drug Abuse Services, Inc. (CADAS), Chattanooga, TN. She is a
member of National Association of Social Workers, National Association of Alcohol &
Drug Abuse Counselors, the Tennessee Association of Alcohol & Drug Abuse Counselors,
and the Tennessee Association of Alcohol & Drug Abuse Services. Claire M. Blum, RN, is
a Certified Diabetes Educator, and an MSSW student, College of Social Work, University
of Tennessee, Knoxville, TN. She is a member of the American Diabetes Association and
the American Association of Diabetes Educators. Charlaine J. Hood is an MSSW student,
College of Social Work, University of Tennessee, Knoxville, TN. She is a licensed mentor
with the Kairos Foundation.
Address correspondence to: Martha S. McCallie, BSW, 118 Palm Beach Avenue,
Rossville, GA 30741 (E-mail: [email protected] or [email protected]).
Journal of Human Behavior in the Social Environment, Vol. 13(3) 2006
Available online at http://www.haworthpress.com/web/JHBSE
© 2006 by The Haworth Press, Inc. All rights reserved.
doi:10.1300/J137v13n03_04 51
 52 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT

KEYWORDS. Progressive muscle relaxation, relaxation, cognitive be-

havior stress management, 16 muscle groups, relaxation through recall,
7 and 4 muscle groups, high level tension responses
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There is a general consensus that stress, specifically somatic stress,

negative emotion, and worry appear to be the precursor to illness (Gaff,
2001). Dr. Edmund Jacobson himself once said, “An anxious mind can-
not exist in a relaxed body” (1974). The University of Michigan Health
System (2004) reported that The National Institutes of Health recognize
relaxation responses have broad health benefits including reduction of
pain, restoration of sleep, increased energy, and decreased fatigue. It is
also shown to increase motivation, productivity and improve decision
making ability. It lowers stress hormone levels and lowers blood pres-
sure. For those suffering from stress, physical symptoms, or psychopa-
thology, an optimistic and accepting belief in internal healing powers
may assist in reduction of distress. Such clients may be most receptive
to the internal healing power of relaxation (Smith, 2001).

REVIEW OF RESEARCH

Edmund Jacobson developed Progressive muscle relaxation through

his research at Harvard University. Relaxation of muscle fibers, i.e.,
complete absence of all contractions, was seen as the direct physiologi-
cal opposite of tension and was therefore a logical treatment for the
overly tense or anxious person. He discovered that by systematically
tensing and releasing various muscle groups and by learning to attend to
and discriminate the resulting sensations of tension and relaxation, a
person may almost completely eliminate muscle contractions and expe-
rience a feeling of deep relaxation (Bernstein & Borkovec, 1973).
Joseph Wolpe began the second phase of this technique in working
with the counterconditioning of fear responses in 1948. He was a major
founder of the discipline of behavior therapy and revived the dormant
procedure of Jacobson. His adaptation of progressive muscle relaxation
training was a central feature of systematic desensitization, a clinical
procedure that opened the door to behavioral treatments of anxiety dis-
orders (Poppen, 1998). In his studies with cats, he demonstrated that a
conditioned fear reaction could be eliminated by evoking an incompatible
response while gradually presenting the feared stimulus (Bernstein &
 McCallie, Blum, and Hood 53

Borkovec, 1973). His research was important for two reasons. He em-
phasized the occurrence of anxiety rather than the anxiety response as a
learned behavior that can be eliminated by developing an incompatible
response and investigating the situations which elicit the response. The
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second development was the modification of the relaxation training. Ja-

cobson had spent from one to nine hour-long daily sessions on each
muscle group for a total of fifty-six sessions. Wolpe’s modification re-
sulted in a training program that could be completed in six twenty-min-
ute sessions with two fifteen-minute daily home sessions (Bernstein &
Borkovec, 1973).
There is a succession of events that must occur with respect to each
muscle group. The client’s attention should be focused on the muscle
group (Bernstein & Borkovec, 1973). At the direction of the therapist,
the muscle group is tensed. Tension is maintained for a period of 5-7
seconds but only 5 seconds for the feet to avoid cramping. At the direc-
tion of the therapist, the muscle group is released. The client’s attention
is held on the muscle group as it relaxes. It is recommended that the in-
dividual take three to five abdominal breaths before beginning the re-
laxation process. They suggest that each muscle group hold tension for
five seconds and relax for ten seconds (Successful Aging website, Octo-
ber 30, 2004).
The order in which the muscle groups are tensed and released is:
(1) Dominant hand and forearm, (2) Dominant biceps, (3) Nondominant
hand and forearm, (4) Nondominant biceps, (5) Forehead, (6) Upper
cheeks and nose, (7) Lower cheeks and jaws, (8) Neck and throat,
(9) Chest, shoulders, and upper back, (10) Abdominal or stomach re-
gion, (11) Dominant thigh, (12) Dominant calf, (13) Dominant foot,
(14) Nondominant thigh, (15) Nondominant calf, (16) Nondominant
foot (Bernstein & Borkovec, 1973; Bernstein, Borkovec, & Hazlett-
Stevens, 2000; Harmsen, 2002; Richmond, 2004). Termination of
the training sessions was done by counting backwards from four to
one. On the count of four the client should begin to move legs and
feet, on the count of three move arms and hands, on the count of two
move the head and neck, and on the count of one the client should
open his/her eyes (Bernstein & Borkovec, 1973).
Bernstein and Borkovec (1973) also discussed variations on the basic
procedures. There were techniques for seven muscle groups, four mus-
cle groups, relaxation through recall, through recall and counting, and
counting alone. The seven muscle group technique divides the body
muscles into (1) the right hand and arm, (2) the left hand and arm, (3) the
face, (4) the shoulders and neck, (5) the chest, back and belly, (6) the
 54 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT

right leg, and (7) the left leg. The four muscle group technique divides
the body into (1) both hands and arms; (2) the face, neck and shoulders;
(3) the chest, back and belly; and (4) both legs (Bernstein & Borkovec,
1973; Harmsen, 2002).
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Relaxation through recall employs the same four muscle groups as

the previous procedure. In this procedure the therapist need only pro-
vide for two sequential events; first, the careful focusing of the client’s
attention on any tension in a particular muscle group, and second, the in-
struction to the client to recall the feelings associated with release of that
tension. The therapist would then tell the client to relax those muscles
by asking the client to remember what it felt like to release those mus-
cles in previous exercises. The system is analogous to the tension-re-
lease system, the only difference is the actual production of tension is
eliminated (Bernstein & Borkovec, 1973).
The Relaxation by Recall and Counting procedure adds counting to
10 at the end of the completed recall session. This provides a deeper re-
laxation experience. This portion of the procedure was added to allow
the client to experience deeper relaxation during the daily home practice
sessions (Bernstein & Borkovec, 1973).
When the Recall and Counting procedure is integrated in to the home
sessions and the therapist is certain that it is associated with deep relax-
ation, the Relaxation by counting alone can be attempted. This proce-
dure entails the therapist counting from one to ten and giving indirect
suggestions of relaxation. It is beneficial for office settings. Some cli-
ents report they find it helpful in facing real-life situations (Bernstein &
Borkovec, 1973).
Bernstein and Borkovec (1973) discussed the validity and efficacy of
tape recorded relaxation training. Yet today ample instruction and di-
rection are found on the internet in thousands of websites with simple
and easy to follow directions. One web site instructs individuals to prac-
tice twice a day for about a week before moving to a shortened form of
relaxation (Richmond, 2004). It is also suggested that practice should be
done in a quiet place with no electronic distractions, even music. It also
suggests that Progressive muscle relaxation should be done alone. It
further suggests that the individual wear loose clothing, practice before
eating and never use intoxicants. It directs the individual to get up
slowly after practice to avoid orthostatic hypotension (Mindspring
website, October 1, 2004). Special considerations should include cau-
tion in tensing the neck and back and overtightening the toes, as
overtightening can result in muscle or spinal damage or cramping in the
feet and toes (Davis, Eshelman, & McKay, 2000).
 McCallie, Blum, and Hood 55

Today even children experience enough stress to benefit from Progres-

sive muscle relaxation. The symptoms of stress in children are headaches,
nausea and abdominal pain, excessive worry, low self-esteem, sleep dis-
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turbances, excessive anger, moodiness, poor concentration, and being

easily upset. The variation of Progressive Muscle Relaxation for children
was developed to have an adult guide them through the process. A tape or
CD is ideal as a guide (Allen, 2004).
The technique for children is designed much like the four muscle
group technique. The toes and fingers are pointed simultaneously and
the muscles of the limbs contracted. The knees are drawn to the chest
with the arms wrapped around the knees. The head is brought forward
toward the knees. The muscles are tightened and the body is held in a
ball and then relaxed (Allen, 2004).
Much of the research material reviewed for this paper combined two
or more types of relaxation methods. These methods can be reduced to
nine fundamental world approaches to self-relaxation. They are: (1) Iso-
metric Squeeze Relaxation, (2) Yogaform Stretching, (3) Integrative
Breathing, (4) Somatic Focusing–Beginning Exercises, (5) Somatic Fo-
cusing–Advanced Exercises, (6) Thematic Imagery, (7) Contemplation,
(8) Centered Focus Meditation and (9) Open Focus Meditation (Smith,
1989).

POPULATIONS APPLIED

Progressive muscle relaxation techniques have been used on thou-

sands of groups of people. Studies have been conducted on cardiac pa-
tients, insomnia, chronic pain, anxiety. It has been compared to other
stress management techniques, yoga, and ABC relaxation theory.
Lengthy articles have been written on the positive effects of progressive
muscle relaxation on caregivers and active duty military.
In discussion of target populations for the use of progressive muscle
relaxation, Bernstein, Borkovec and Hazlett-Stevens (2000, p. 9) make
it clear that “Relaxation training is not a panacea and should not be pre-
sented as such to clients,” emphasizing the need for therapists to be
aware of the kinds of problems and situations for which relaxation train-
ing is most effective and appropriate. After a comparative review of
various stress management techniques, Lehrer, Carr, Sargunaraj, and
Woolfolk (1994, p. 353) found that in general:
 56 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT

Disorders with a predominant muscular component (e.g., tension

headaches) are treated more effectively by muscularly oriented
methods, while disorders in which autonomic dysfunction predomi-
nated (e.g., hypertension, migraine headaches) are more effectively
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treated by techniques with a strong autonomic component. Anxiety

and phobias tend to be most effectively treated by methods with
both strong cognitive and behavioral components.

Bernstein et al. (2000, p. 10) states that the most appropriate targets for
relaxation training are those with uncomfortably high-level tension re-
sponses that interfere with their performance or behavior, such as in-
somnia, tension headaches, or less specific complaints of general tense-
ness.
Progressive muscle relaxation and applied relaxation methods are of-
ten used effectively as treatments by themselves, but they are also com-
monly used in combination with other treatment methods, with many
applications that are well supported by research. Ost (1996) demon-
strates the probable long-term effectiveness of applied relaxation with
systematic desensitization in the case of specific phobias, and Heimberg
and Juster (1995) show its application in conjunction with cognitive be-
havioral therapy in the treatment of social phobias. Brokovec and
Whisman (1996) discuss the use of in conjunction with cognitive be-
havioral therapy as a well established treatment for generalized anxiety
disorders. Panic Disorders, with or without agoraphobia, show a well
established response to progressive muscle relaxation in conjunction
with cognitive behavioral therapy (Michelson & Marchione, 1991).
Otto, Penava, Pollack, and Smoller (1996) show that posttraumatic
stress disorders have probable response to applied relaxation and stress
inoculation training for rape victims. Marcotte (1997) and Lewinsohn,
Hoberman and Clarke (1998) demonstrate the use of progressive mus-
cle relaxation applications for clinical depression used in conjunction
with a course for coping with depression. Hypertension has been shown
to respond to progressive muscle relaxation in conjunction with cogni-
tive-behavioral stress management and comprehensive hypertension
control treatments (Rosen, Brondolo, & Kostis, 1993). The use of pro-
gressive muscle relaxation plus biofeedback in treatment of headaches
is very well established (Holroyd & Penzien, 1994). Chronic pain has
been shown to respond to progressive muscle relaxation and is well es-
tablished as a treatment for rheumatic disease in conjunction with cog-
nitive behavioral therapy (Wilson & Gil, 1996). Carey and Burish (1988)
show the use of progressive muscle relaxation in conjunction with sys-
 McCallie, Blum, and Hood 57

tematic desensitization and guided imagery in treatment of the psycho-

logical side effects of chemotherapy. Lichstein and Riedel (1994) dis-
cuss the efficacy of progressive muscle relaxation in conjunction with
systematic desensitization and guided imagery for the treatment of in-
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somnia. Irritable bowel syndrome has been demonstrated to respond

with probable efficacy to the use of progressive muscle relaxation in
conjunction with cognitive behavioral therapy (Blanchard, 1993). The
use of progressive muscle relaxation in combination with self-control
desensitization has been researched in the treatment of dysmenorrhea
with response of probable efficacy (Denny & Gerrard, 1981), and ap-
plied relaxation plus distraction has been demonstrated to help in the
case of tinnitus (Anderson, Melin, Hagnebo, & Scott, 1995).
As evidenced by the preceding studies, progressive muscle relax-
ation has been applied to a wide variety of clinical conditions, and there
is abundant evidence that it is effective in the treatment of insomnia and
headache (Barrows & Jacobs, 2002), with insomnia being one of the
most extensively studied conditions in progressive muscle relaxation
literature (Barrows & Jacobs, 2002). A review of the literature in 1999,
by the American Academy of Sleep Medicine, concluded that progres-
sive muscle relaxation was one of only three nonpharmacologic treat-
ments empirically supported by the literature and well established for
treatment of chronic insomnia (Morin, Hauri, & Espie, 1999). A
meta-analysis of 29 progressive muscle relaxation studies on a variety
of clinical conditions, including tension, migraine headache, tolerance
of chemotherapy, and tinnitus, found that the average effect size of all
the studies was moderately strong, with studies of the effect of progres-
sive muscle relaxation on headache being especially high (Carlson &
Hoyle, 1993). A randomized clinical trial of progressive muscle relax-
ation versus alprazolam in 147 cancer patients with anxiety and depres-
sion showed both treatments effective, although alprazolam was slightly
faster (Holland, Marrow, & Schmale et al., 1991), and another study,
without an independent control group, showed that a combination of
progressive muscle relaxation and guided imagery reduced psychologic
distress in cancer patients (Baider, Uziely, & Kaplan De-Nour, 1994).
In yet another randomized clinical trial, contrary to the author’s hypoth-
esis, progressive muscle relaxation improved the quality of life measure
of muscle function, reducing joint tenderness in patients with inflamma-
tory arthritis (Stenstrom, Arge, & Sundbom, 1996), and a randomized
clinical trial of 24 irritable bowel syndrome patients who underwent
treatment as usual versus treatment as usual plus behavioral therapy that
included progressive muscle relaxation, showed improved overall
 58 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT

well-being and significant irritable bower syndrome symptom reduc-

tion with progressive muscle relaxation (Heymann-Monnikes, Arnold,
Florin et al., 2000). Barrows and Jacobs (2002) concluded, in summary
of their review of the literature, that progressive muscle relaxation has
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strong evidence supporting its use in insomnia and headache, and that
evidence although less abundant, exists for the efficacy of reducing psy-
chologic distress in cancer patients and improving well-being in pa-
tients with inflammatory arthritis and irritable bowel syndrome.
On the flip side, other studies have shown no benefit from the use of
progressive muscle relaxation, as in a study of 89 chronic obstructive
pulmonary disease patients in a randomized controlled experimental
study (Sassi-Dambron, Eakin, Ries et al., 1995), and in a study evaluat-
ing the effectiveness of progressive muscle relaxation for chronic neck
pain, Viljanen et al. (2003) concluded that “dynamic muscle training
and relaxation training do not lead to better improvements in neck pain
compared with ordinary activity.” Other studies have shown mixed
benefits in the use of progressive muscle relaxation, such as those in a
study of high school students showing a decrease in state anxiety scores
after training in progressive muscle relaxation, but no reduction in trait
anxiety (Rasid & Parich, 1998; Roome & Romney, 1985). Also, in a
meta-analysis of progressive muscle relaxation for the treatment of pe-
diatric migraine the benefit was less clear (Herman, Kim, & Blanchard,
1995), as was the case in another study involving the short-term effects
of relaxation training in children, leading the investigators to speculate
that the program may not have been long enough to produce the re-
quired level of experience (Lohaus, Klein-Heßling, Vögele, & Kuhn-
Hennighausen, 2001), supporting the belief of Bernstein, Borkovec,
and Hazlett-Stevens (2000) that the requirements for learning relax-
ation skills eliminates most very young children. Children, however,
can be taught progressive muscle relaxation with the use of adaptive
techniques (Allen, 2004), as can mentally retarded adults with signifi-
cant benefit (Maranti & Freedman, 1984).
Bernstein, Borkovec, and Hazlet-Stevens (2000) believe that
progressive relaxation training is clearly an effective technique for reducing
tension, anxiety, and physiological arousal. It is therefore understand-
able that it is most widely used as an element in treatment of generalized
anxiety disorder, or chronic anxiety conditions thought by Barlow
(1988) to be the “basic” anxiety disorder. Research in the use of pro-
gressive muscle relaxation most strongly supports its use as a stress
management approach that produces positive benefits amongst many
different patient populations, including the variables of heart rate and
 McCallie, Blum, and Hood 59

state anxiety, as seen in a study of patients in cardiac rehabilitation who

indicated a high degree of subjective satisfaction with progressive muscle
relaxation as a means to reduce stress in their lives (Wilk & Turkoski,
2001). However, although another investigative study with the use of
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muscle relaxation and guided imagery techniques showed significant im-

provements in depression and quality of life measures in a study of ad-
vanced cancer patients, it did not show significant improvements in
measures of anxiety within that population (Sloman & Hons, 2002).
Abbreviated forms of progressive muscle relaxation therapy, often
referred to as abbreviated progressive relaxation therapy, are increas-
ingly being studied due to a desire to find more cost and time effective
uses for progressive muscle relaxation. In a meta-analysis of 29 such
studies, all of which used the Bernstein and Borkovec protocol (1973),
researchers concluded that abbreviated progressive relaxation therapy
can be an effective treatment for a range of disorders, although effec-
tiveness varied considerably according to the condition being treated,
the size of the group and other factors (Carlson & Hoyle, 1993). Carlson
and Hoyle (1993) concluded that among the groups studied, abbreviated
progressive relaxation therapy was most successful with reducing ten-
sion headaches.
More current studies using interesting applications of progressive
muscle relaxation include a study done with students and physicians
whose debilitating test anxiety was associated with failure to pass the
United States Medical Licensing Examination (Powell & Douglas,
2004). The treatment featured progressive muscle relaxation systematic
desensitization, a self-control triad, behavioral rehearsal and a psycho-
educational component, with the result of having ninety-three percent
of the clients eventually pass the examination–a substantially higher rate
than the national average for repeat examination test takers (Powell &
Douglas, 2004). Limitations of this treatment method were that it
seemed too elaborate for some medical trainees and was less effective
with those who had difficulty evoking anxiety (Powell & Douglas,
2004). Another pilot study involving the use of guided imagery and pro-
gressive muscle relaxation justifies further investigation of its effective-
ness as a self-management intervention to reduce pain and mobility
difficulties associated with osteoarthritis (Baird & Sands, 2004). Yet
another interesting concept for the use of progressive muscle relaxation
involves its impact on salivary cortisol and its immunoenhancement ef-
fects (Palow & Jones, 2002). The theory behind the field of immuno-
enhancement implies that as relaxation occurs, the immune system ben-
efits, and results from the salivary cortisol study indicate that a behav-
 60 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT

ioral manipulation of the body’s stress hormone is possible, lending

support to the theory that the negative effects of stress on the immune
system may be reversible (Palow & Jones, 2002), and according to
Palow and James (2002) “The clinical implications for possible uses of
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relaxation as an inexpensive, effective means of improving people’s

health are enormous.”

PRACTICE ISSUES

There are several issues to consider with progressive muscle relax-

ation. (1) There is an absence of social work research on the topic. Do
social workers see progressive muscle relaxation as empirically valid
techniques to enhance their practice? (2) Should progressive muscle re-
laxation be used in conjunction with other mind-body techniques? Will
all clients benefit from this ‘package’ of techniques? (3) There is also
the debate over self teaching versus therapist taught progressive muscle
relaxation techniques.
There is an absence of research on this topic by social workers (Fin-
ger & Arnold, 2002). Finger and Arnold (2002) state that much of the
evidence they present is mainly from studies conducted in other disci-
plines. This is also true for this discussion.
Social workers must produce their own studies on progressive muscle
relaxation and other mind body interventions and publish their research
to contribute to the knowledge base of the social work profession. Recent
findings indicate that social workers have knowledge of mind-body tech-
niques and many of them use these techniques. Yet, there is still no infor-
mation about how social workers learned the techniques, nor data about
the outcomes of their interventions (Finger & Arnold, 2002). This brings
up another concern. Do social workers see these techniques as empiri-
cally valid interventions that can enhance their practice? Obviously
they are using the techniques. Why the lack of valid information on the
techniques? Finger and Arnold (2002) encourage the teaching of mind-
body interventions, including progressive muscle relaxation, in gradu-
ate level social work programs, as one potential method of expanding
the scope of practice in this area. They theorize that it might keep the
profession competitive with other disciplines currently providing this
information in curricular opportunities.
Another issue is whether progressive muscle relaxation should be
used in combination with other mind-body techniques (Finger & Ar-
nold, 2002). Much of the literature obtained for this paper analyzed the
 McCallie, Blum, and Hood 61

combinations of techniques (Ghoncheh & Smith, 2004; Barrows &

Jacobs, 2002; Davis et al., 2000; Finger & Arnold, 2002; Scheufele,
2002). The information obtained from the internet also used combina-
tions of techniques with progressive muscle relaxation (Allen, 2004;
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UMHS, 2004; Weber, 2004). Joseph Wolpe in 1948 modified Jacob-

son’s technique and used it in conjunction with his studies of anxiety. It
has been manipulated ever since.
Finger and Arnold (2003) provided the following conclusions.
Empirical support exists for the use of meditation, progressive muscle
relaxation, biofeedback and guided imagery, whether used alone or
together, as an effective way to change many health-related behaviors or
problems. Not all clients will benefit from the same types of interven-
tions or combinations of interventions. This will depend on the type of
problem. These types of mind-body interventions can be tailored to
meet the individual client’s needs. Thus creating flexibility in program
design and use. The interventions mentioned above can be used in con-
junction with cognitive-behavioral interventions (Finger & Arnold,
2002).
It is important to note that social work is grounded in social context
which is separate from medicine. Progressive muscle relaxation is an al-
ternative medicine approach that is practiced by most Americans. It is
easily learned in continuing education courses or on-the-job training. It
can be taught to clients who can incorporate it into their daily lives (Fin-
ger & Arnold, 2002).
Progressive muscle relaxation techniques are promoted as easily
learned and used by one group, but touted as needing extensive training
for use by another. Bernstein, Borkovec, and Hazlett-Stevens (2000)
state that the success of any therapeutic technique is partly dependent on
the therapist’s ability to secure the client’s confidence and cooperation.
It may be difficult for the therapist to be seen as important in learning
progressive muscle relaxation, when the relaxation techniques are ac-
cessible on the internet. Our culture is also fond of narratives that em-
phasize our ability to take responsibility for our lives, exercising our
capacity for choice and self-determination in the face of whatever chal-
lenges confront us (Rothery & Enns, 2001). The concern here is the
negative effects of self-reliance. Going on the internet and acquiring
knowledge of these techniques may be safe for some individuals, but
others with emotional/behavioral issues would benefit from the guid-
ance of a therapist.
Improving performance and fine tuning skill may draw clients to the
therapist if they believe that the therapist can aid in improving individ-
 62 JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT

ual technique (Broucek, Bartholomew, Landers, & Linder, 1993). Here

the question becomes does this change the social work practice to that of
an occupational therapist? Harris (2003) points out that where progres-
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sive muscle relaxation is being considered for use in eliminating a phys-

ical complaint (e.g., headache), the therapist should rule out the
existence of a strictly organic basis for the problem because such prob-
lems require another treatment approach. The organic needs must be ad-
dressed medically, whereas, the emotional or environmental issues fall
under the expertise of the therapist. Those clients coming to the therapist
for technique only may find that the professional knowledge base of the
therapist will be of further benefit to them. Richmond and McCroskey
(2004) speak about the importance of the therapist speaking with confi-
dence so that he or she will be perceived as competent. If the therapist is
confident in his or her skills and training, the client will be aware of this
confident ability and desire to work with the therapist.

SUMMATION

This technique is easy to learn and to teach and is especially helpful

for patients experiencing chronic pain who display high levels of
arousal (Stiefel & Stagno, 2004). Learning relaxation is like any other
skill . . . you have to start with the basics and build up; you have to prac-
tice; and you have to be patient (Smith, 1989).

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