Cue-Controlled Deep Muscle Relaxation for Anxiety
Generalized Anxiety Disorder
When a person thinks about a situation related to his anxiety, mental images activate the muscles into particular patterns of tension, as though bracing for a blow to the body. Dr. Edmund Jacobson was the first to propose that physical relaxation and anxiety are mutually exclusive. In other words, if one learns how to recognize which muscle groups are tense and can physically let go of that tension, then he will lower his emotional anxiety at that moment.
This first exercise gives you an opportunity to learn how you personally experience tension, and then to change that tension. Called Cue-Controlled Deep Muscle Relaxation (CC-DMR), it is based on well researched and time-tested methods for training your mind to notice the subtle cues of muscle tension — and to release that tension. CC-DMR, which takes approximately twenty minutes, trains your body’s large muscles to respond to the cues you give. Your task is to consciously notice what muscle tension feels like in specific areas of your body and to consciously release that tension. Learning this particular technique is not essential to conquering panic. It is, however, one of the best ways to learn about your tension and how to alter it. If you have learned a different technique that produces these results, or if you have already mastered this skill, feel free to move on to the next sections of the book.
When I teach a client this method, I give him or her a prerecorded audio-CD with these instructions. For your convenience, you may purchase this prerecorded tape. (See Resources) I suggest that my clients practice the exercise twice a day, every day, for one weeks, then once a day, every day, for four weeks.
Why so often for so long? Because this is a straightforward, mechanical exercise that physically trains the muscles to release their tension. At certain intervals during the exercise, you are asked to repeat a cue word, such as “loosen” or “relax.” It seems to take about five weeks of practice before the physical loosening of the muscles becomes associated with that cue word. (You will be creating new “circuits” between your brain and your muscles.) Once that learning has taken place, the muscles will be prepared to release their tensions rapidly when that cue word is spoken (along with several other “cues” that I will mention later).
There are three stages to this twenty-minute exercise:
Stage 1: Tense and then relax each muscle group. You will be instructed to tense a particular muscle group for a few seconds, then release the muscles and allow them to loosen. (ten minutes)
Stage 2: Allow all the muscle groups to loosen and relax. (five minutes)
Stage 3: Support and reinforce the muscle relaxation through imagery. (five minutes)
How to do it
Each day, find a comfortable and quiet place to practice. Take the phone off the hook or arrange for someone else to take calls. This a special time, just for you.
Begin by sitting comfortably in a chair; take off your shoes and loosen any tight clothing. Close your eyes and take three deep breaths, exhaling slowly. On each exhale, say the word “relax” silently. Or you may select a word that produces more comfort for you, such as “loosen,” “quiet,” “peace,” or “calm.”
First, you will tense and relax each muscle group once (Stage 1). During each relaxation phase, you will repeat the word “relax” (or your selected word) with every exhale.
Next you will follow in your mind a visual image of the sun warming and loosening all the muscles of your body (Stage 2). You needn’t feel frustrated if you don’t actually “see” the sun in your mind’s eye, or “feel” the sensations of loosening or warming. It is essential, however, that you maintain your attention on each muscle group as it is mentioned and imagine the possibility of warmth and loosening of the muscles. You may be surprised at your growing ability over time if you don’t try too hard. Just open your mind to the possibility of change.
During the last few minutes of the exercise you will be asked to “go to your safe place” in your mind’s eye (Stage 3). Take a moment now to picture a scene that symbolizes comfort, relaxation, safety, warmth, and the absence of outside pressures. You might imagine yourself in some location where you were relaxed in the past: a vacation spot, fishing, sitting on a mountain top, floating on a raft, soaking peacefully in the bath, or lying on a chaise lounge in the back yard. Or you could choose to create an image of your ideal vacation dream (like your own private South Seas island) or fantasy (such as floating on a cloud).
Regardless of the image you choose, spend a few minutes developing all your senses within that scene. Look around you in your mind’s eye to see the colors and patterns of the scene. Hear any sounds appropriate to the environment: perhaps birds singing, wind blowing, ocean waves crashing on the shore. You may even develop an aroma, such as honeysuckle or flowers, perhaps the salt air or the fresh odor after a rain shower. Enjoy all your senses in an easy, effortless manner. This is the kind of image you can use for your “safe place.”
At the end of the exercise, open your eyes, stretch your body, and slowly rise from the chair. Several guidelines will help you as you begin:
1. The more you practice a skill, the greater your ability. So, be dedicated to this project and practice, practice, practice.
2. During the ten seconds of tensing, tense only the muscle groups described. Let the rest of your body be relaxed and loose.
3. Always continue breathing while you are tensing a muscle group. Never hold your breath while tensing.
4. During each fifteen-second relaxation phase, focus on your breathing and mentally say your cue word — “relax” or “loosen” — with each exhalation.
5. Don’t evaluate or judge how well or how poorly you do during each practice. This is not a test. Simply practicing each day, no matter what you experience, will ensure progress. You are creating new, unconscious circuits in your brain. How you feel consciously is not a measure of your progress.
6. Some days you will find it quite hard to concentrate. Your mind will tend to wander to a variety of thoughts: “I’ve got to get back to my housecleaning.” “What should I make for supper?” “This isn’t working. I’m still tense.” “I’ve got to remember to pay those bills.” These kinds of distracting thoughts are normal; everyone experiences them. It does not mean that the process is failing.
As soon as you notice that you have drifted off course, let go of those distracting thoughts and return to your task. Do not feel angry or disappointed with yourself. Do not let that be a reason to quit the exercise. Your body and mind are still benefiting, still learning about control, still creating those new circuits. Stay with it.
7. You may do the exercise any time during the day or evening. It is best to avoid starting immediately after a meal, since your body is busy with digestion then and you are less alert mentally.
8. Do not expect immediate and magical relief from the practice. This process, repeated over time, trains your muscle groups to respond to a cue.
Some people will notice changes from the practice. You may find that you are more alert and rested, have an improved appetite and sleep better, are in a more positive mood and feel less overall tension. If any of these take place, consider them “icing on the cake.” Your primary task is to practice every day for five weeks.
9. Some people have difficulty developing images to use during the “safe place” visualization at the end of the program. An alternative to the “safe place”, called “One Hundred Counts”, is presented in Chapter 14 of the self-help book Don’t Panic.