Written by Helen Cooke and the CAM-Cancer Consortium.
Updated July 7, 2015

Progressive Muscle Relaxation

What is it?

Progressive muscle relaxation (PMR) is a relaxation technique that involves the sequential tensing and releasing of major skeletal muscle groups with the aim of inducing relaxation.

Application and dosage

PMR may be taught by health care professionals, including clinical psychologists and nurses, as well as hypnotherapists, yoga instructors, and other complementary practitioners. Training may be conducted in groups or one-on-one, during one or a series of sessions, or via a CD/audiotape as a self-help technique.

Training may be offered before, during, or after medical treatment or procedures. PMR sessions commonly last for 20 to 30 minutes, but are not standardized and may therefore vary in duration, frequency and the number of involved muscle groups, and may also include deep breathing techniques.

History and provider

Edmund Jacobson, an American physician, drew on studies in psychology and physiology, to develop his own understanding of the mind-body relationship and its role in health, and a method of stress reduction that he described it in his book Progressive Relaxation, published in 1938.

He stated that the mind and voluntary muscles work together in an integrated way. Keeping the mind calm allows muscles to relax, and freeing the body of tension reduces sympathetic activity and anxiety. He initially developed PMR to induce relaxation by promoting awareness of tension in skeletal muscles. Bernstein and Borkovec later developed a shortened, modified procedure that is now the most frequently used form of PMR1.

Claims of efficacy/mechanism of action/alleged indication(s)

PMR is a technique based on a theory that a psychobiological state called neuromuscular hypertension is the basis for a variety of negative emotional states and psychosomatic diseases and that the body’s muscle tension develops from anxiety-provoking thoughts and events.15 The cognitive and physiological pathways involved in negative emotional states are complex and the extent to which learning to relax muscles is an efficient way to overcome self-reported tension in anxiety disorders is presently unclear. Although the exact mechanism of action is unclear,  muscle relaxation techniques are reportedly effective in decreasing muscle tension in the body.21

 Alterations in sympathetic nervous system activity, including decrease in pulse rate, blood pressure, and musculoskeletal tone, and altered neuroendocrine function, have been observed in relaxed subjects. It has been suggested that deep somatic restfulness reduces anxiety and physical arousal2 and that muscular relaxation may directly inhibit anxiety and the muscular activity that generally precedes nausea and vomiting. It has been proposed that learning relaxation techniques can help people feel more in control of side effects and therefore less anxious.2

Some researchers have suggested that PMR may serve as a distraction for patients who undergo chemotherapy,3 whereas others propose that distraction is only part of the effectiveness of such interventions.4

Prevalence of use

A population-based study carried out in the USA of 4 000 cancer survivors who were followed up 10 to 24 months after their diagnosis found that 43 percent used some form of relaxation therapy5.

Legal issues

Although many institutions and individuals offer PMR training, what they teach is not standardized, and no credentialing process is available for PMR instructors.

Cost(s) and expenditures

PMR can be administered or taught relatively easily and is therefore in most cases a relatively inexpensive therapy.

Citation

Helen Cooke, CAM-Cancer Consortium. Progressive Muscle Relaxation [online document]. http://www.cam-cancer.org/The-Summaries/Mind-body-interventions/Progressive-Muscle-Relaxation. July 7, 2015.

Document history

Last revised and updated in July 2015 by Helen Cooke.

Summary last updated in December 2013 by Helen Cooke.

Summary fully revised and updated in July 2012 by Helen Cooke.

Summary first published in July 2011, authored by Helen Cooke.

References

  1. Jacobson, E.: Progressive Relaxation. Chicago, University of Chicago Press, 1938
  2. Payne, R and Donaghy, M. 2010. Fourth Edition. Payne’s Handbook of Relaxation Techniques: a practical guide for the health care professional. London: Churchill Livingstone, Elsevier.
  3. Arakawa S. Relaxation to reduce nausea, vomiting, and anxiety induced by chemotherapy in Japanese patients. Cancer Nursing. 1997; 20(5):342-914.
  4. Kwekkeboom K, Wanta B, Bompus M. Individual difference variables and effects of progressive muscle relaxation and analgesic imagery interventions on cancer pain. Journal of Pain and Symptom Management. 2008; 36(6): 604-615
  5. Gansler T, Kaw C, Crammer C, Smith T. A population-based study of prevalence of complementary methods use by cancer survivors: a report from the American Cancer Society's studies of cancer survivors. Cancer.2008: 113(5):1048-57.
  6. Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psycho-Oncology. 2001; 10(6):490-502.
  7. Simeit R, Deck, R and Conta-Marx, B. Sleep management training for cancer patients with insomnia. Supportive care in Cancer. 2004; (3): 176-83.
  8. Cannici J, Malcolm R, Peek LA. Treatment of insomnia in cancer patients using muscle relaxation training. Journal of Behavior Therapy and Experimental Psychiatry. 1983; 14:251– 256.
  9. Demiralp MF, Oflaz, et al. Effects of relaxation training on sleep quality and fatigue in patients with breast cancer undergoing adjuvant chemotherapy. Journal of Clinical Nursing. 2010; 19(7-8): 1073-83.
  10. Holland JC, Morrow GR, Schmale A, Derogatis L, Stefanek M, Berenson S, et al. A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. Journal of Clinical Oncology. 1991; 9(6):1004-11.
  11. Cheung YL, Molassiotis A, Chang AM, Cheung YL, Molassiotis A, Chang AM. The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Psycho-Oncology. 2003; 12(3):254-66.
  12. Cotanch PH, Strum S. Progressive muscle relaxation as antiemetic therapy for cancer patients. Oncology Nursing Forum. 1987; 14(1):33-7.
  13. Campos de CE, Martins FT, dos Santos CB. A pilot study of a relaxation technique for management of nausea and vomiting in patients receiving cancer chemotherapy. Cancer Nursing. 2007; 30(2):163-167.
  14. Isa MR, Moy FM, Razack AH, Zainuddin ZM, Zainal NZ. Impact of applied progressive deep muscle relaxation training on the health related quality of life among prostate cancer patients--a quasi experimental trial. Preventive medicine. 2013; 57 Suppl:S37-40.
  15. Isa MR, Moy FM, Abdul Razack AH, Zainuddin ZM, Zainal NZ. Impact of applied progressive deep muscle relaxation training on the level of depression, anxiety and stress among prostate cancer patients: a quasi-experimental study. Asian Pacific journal of cancer prevention : APJCP. 2013;14(4):2237-42.
  16. Pathak P, Mahal R, Kohli A, Nimbran V. Progressive Muscle Relaxation: An Adjuvant Therapy for Reducing Pain and Fatigue Among Hospitalized Cancer Patients Receiving Radiotherapy. Int J Adv Nurs Stud. 2013;2:58-65.
  17. Lee EJ, Bhattacharya J, Sohn C, Verres R. Monochord sounds and progressive muscle relaxation reduce anxiety and improve relaxation during chemotherapy: a pilot EEG study. Complementary therapies in medicine. 2012;20(6):409-16.
  18. Goerling U, Jaeger C, Walz A, Stickel A, Mangler M, van der Meer E. The efficacy of short-term psycho-oncological interventions for women with gynaecological cancer: a randomized study. Oncology. 2014; 87(2):114-24. 
  19. Song QH, Xu RM, Zhang QH, Ma M, Zhao XP. Relaxation training during chemotherapy for breast cancer improves mental health and lessens adverse events. Int J Clin Exp Med. 2013;6(10):979-84.
  20. Yilmaz SG, Arslan S. Effects of progressive relaxation exercises on anxiety and comfort of Turkish breast cancer patients receiving chemotherapy. Asian Pac J Cancer Prev. 2015;16(1):217-20.
  21. Conrad A, Roth WT. Muscle relaxation therapy for anxiety disorders: It works but how? Journal of Anxiety Disorders. 2007; 21: 243-264.