Relaxation training is a verbally mediated event in which the practitioner helps the patient change his or her physiology through the use of actions. For Jacobson, the preferred model was one of tensing and releasing various muscle groups. That is, the therapist instructs the patient about how to tense and release muscles in iso- lation, with an emphasis upon downtraining.
A typical beginning session works on the upper ex- tremity. The patient is instructed to progress up the fore- arm, one arm at a time, through the following muscles:
1. Wrist extensors:“Lift the wrist up, tensing the muscle responsible for this up here on your upper arm until you can feel the tension in that muscle. Then let go of that tension quickly. Let your wrist drop, and feel the tension leave your arm. Relax that muscle completely for the next minute.”
2. Wrist flexors:“Next, push your wrist down. Tense the muscles, making that movement happen until you can feel them on the bottom of your arm. Then suddenly let go of that tension. Feel the tension leave the muscle, letting the arm relax as completely as it can for the next minute.”
3. Biceps:“Next, bend your arm up at the elbow, tensing the muscle of your upper arm until you can clearly feel the tension in that muscle. Then suddenly let it go. Feel the tension leave your upper arm as you let it relax as completely as you possibly can for the next minute.”
4. Triceps:“Next, let your arm go straight, tensing the muscle responsible for the movement so that you can feel the tension on the back of your upper arm. Then let it go quickly, feeling the tension leave that muscle as you relax to the best of your ability for the next minute.”
Figure 9–1and Figure 9–2show the effects of pro- gressive relaxation over a course of sessions. In Figure 9–1, the tensing and releasing of each specific muscle group affects other sites as well. There is an overgener- alization of the muscular effort to multiple sites, resulting from the patient’s moving the extremity in an effort to feel and sense a particular site. The patient is treated using a combination of SEMG feedback and progressive relaxation procedure. Figure 9–2 shows that by the third session, the patient demonstrates a good ability to make very specific small isometric contractions at the
pletely. It is the relaxation component that has the greatest therapeutic effect. “Tense with will, relax and feel.” The “relax and feel” component is at least twice as important as tensing the muscle.
Third, a long period of quiet time and relaxation fol- lows each tension cycle. The ratio of tension to relax- ation should be 1 to 5.
Fourth, opposing pairs of muscles are systematically activated. This systematic activation is intended to maintain a healthy balance in the neuronal pool of spinal segments that control these muscles. At a seg- mental and suprasegmental level, the output from the Golgi tendon organ and muscle spindles provides col- lateral excitatory or inhibitory influences on related contralateral or opposing lower motor neurons (see Chapter 2).
Finally, the practitioner progresses from one muscle group to another, working through the various kinetic chains. The second session might work on the arms and then address the muscles of the shoulder and upper back. The third session might work on the arms, the various sites without the excessive spillover of muscular
efforts seen in Figure 9–1.
Progressive relaxation training involves several com- ponents. Initially, the patient is asked to move the joint associated with the muscle as he or she intentionally tenses the muscle to the point of tension perception. As training progresses across sessions, the practitioner en- courages the patient to become more aware of tension at lower levels of activation. Toward the end of training, the patient is able to activate and sense a specific mus- cle group without moving the associated joint. It takes a very relaxed muscle and a fair amount of training for the patient to sense a brief burst of isometric tension in a muscle. In the 1960s, Whatmore demonstrated that SEMG instrumentation and feedback made this task much easier.7
Second, the practitioner must teach the patient to “let go” of tension. The preceding example suggests that practitioners teach the patient to let go quickly.
Jacobson used the term “zero down” to describe what it means to let go of muscle tension quickly and com-
Figure 9–1 Surface EMG recordings from forearm extensors and flexors (wide placement), biceps, and triceps are shown during voluntary activation of each site. Note the lack of specificity of activation, as there is spillover of muscular effort to multiple sites.
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Figure 9–2 After a few sessions of SEMG feedback and progressive relaxation training, SEMG recordings from forearm extensors and flexors (wide placement), biceps, and triceps sites are shown during voluntary activation of each site. (A) Isolated wrist extensor and flexor activity, (B) isolated bicep and tricep activity.
Source:Copyright ©Clinical Resources, Inc.
phrase, one in which the patient is asked to close his or her eyes and mentally visualize the part(s) on which he or she is going to work. Then the practitioner speaks a phrase to the patient to repeat internally. This phrase is fol- lowed by a minimum of a 30-second observation period in which the patient observes what is happening.
Finally, the exercise is terminated by asking the patient to move the part(s) of interest vigorously, breathe out heavily, and open his or her eyes. This process is fol- lowed for each autogenic phrase or set of phrases, and the patient is asked to note any discharges that result from the procedure. These discharges are thoughts, feel- ings, or physical sensations associated with the auto- genic phrase.
In summary, the autogenic phrases are spoken to the patient, and the patient thinks the phrases himself or herself, five or six times over the course of 30 to 60 sec- onds per phrase. During the first visit, the practitioner usually begins with one phrase and goes through the en- tire cycle. On subsequent visits, the practitioner adds more phrases to the patient’s suggestions, making the training sessions longer and deeper. The standard auto- genic phrases are as follows:
• My right (left) arm is heavy.
• My right (left) leg is heavy.
• My right (left) arm is warm.
• My right (left) leg is warm.
• Both my arms (legs) are heavy.
• Both my arms (legs) are warm.
• I am at peace.
• My heart beat is slow and regular.
• My breathing is slow and regular.
• It breathes me.
• My abdomen (solar plexus) flows warmly.
• My forehead is cool.
For a more in-depth review of autogenic training, see Luthe’s Autogenic Therapy: Autogenic Methods, vol- ume 1. In addition, a tremendous amount of literature is available on the physiological effects of this tech- nique. The reader is referred to volume 4 of the