©1995 All Rights Reserved.
Commercial use of this material is prohibited .
By Dr. Steve Frisch, Psy.D.
We would rather be
ruined than changed;
We would rather die in our dread
Than climb the cross of the moment
And let our illusions die.
-W. H. Auden
topic of this booklet focuses on relaxation techniques. The techniques oulined below are
adapted from the Association For Advanced Training In The Behavioral Sciences. The
information in this booklet is intended to provide the reader with information about three
techniques. Those techniques are 1) relaxation through the utilization of guided imagery
contained in the relaxation scene,
2) Deep Muscle Relaxation (DMR), 3) Systematic Desensitization. These techniques can be
utilized to lower stress by training yourself how to relax your body, reduce levels of
stress through the use of guided imagery, and reduce anxiety through the use of Systematic
Desensitization. If you are currently doing psychotherapy with a therapist, I highly
recommend that you consult with your therapist prior to using the techniques outlined in
Reducing Anxiety and Stress
effects of fear, anxiety, and stress are unfortunately familiar to many of us. For
example, fear may interfere with you getting involved in an activity that youve
always wanted to try. The presence of stress may be sapping you of your vitality to
experience the many joys and wonders of life.
method which has consistently proven to be effective in the lessening of fear and anxiety
is called systematic desensitization. Although originally developed by Joseph Wolpe to be
administered by a therapist, research has shown that self-administered systematic
desensitization is also effective.
following method, self-administered systematic desensitization, will help you free
yourself from some of the anxiety that you experience in your life. The procedure is
similar to the one used by Wolpe, with minor modifications which make it possible for you
to learn systematic desensitization at your convenience and without the aid of a
practicing desensitization, familiarize yourself with the instructions I provide by
reading each step once or twice. Make note of the recommended time requirements where
relevant and arrange your schedule to accommodate these periods of time. Also note any
materials you may need for each step and have these available before starting.
three steps included in the self-administered systematic desensitization procedure
include: 1) deep muscle relaxation, 2) constructing your hierarchy, and 3) pairing
relaxation with the situations described in your hierarchy.
Step One: Deep Muscle Relaxation: The following describes the relaxation procedure and the
use of cue-controlled relaxation and a relaxation scene. Appendix A presents a suggested
schedule for learning deep muscle relaxation.
Overview of Deep Muscle Relaxation
relaxation procedure will teach you to relax voluntary muscles by a process of first
tensing certain muscle groups and then relaxing them. This will enable you to recognize
the difference between tension and relaxation and allow muscle tension to become a cue for
you to relax. After learning deep muscle relaxation, youll be able to induce
relaxation at the first signs of the tension that accompanies anxiety. (Be sure to consult
with your physician before practicing DMR if you have a history of back problems, muscle
spasms, or related problems).
muscle groups youll learn to relax are: Group #1 hands and wrists; group #2-biceps
and triceps; group #3-shoulders; group #4-neck; group #5 tongue and mouth; group #6-eyes,
nose and forehead; group #7-back group; group #8-abdominal region (stomach); #9-thighs;
group #10-calves and feet; and group #11-toes.
you tense one muscle group it may feel natural to you to also tense other muscle groups.
Therefore, when practicing DMR, be careful to tense only those muscle groups which you are
learning to relax.
may choose to practice all muscle groups during your first relaxation session or you may
decide to divide the muscle groups into four areas (arms and shoulders; neck and face;
midsection; legs) and to learn one area during each of four sessions (repeating the area
two or three times during the session). If you choose the latter method, you will not
practice all muscle groups until the fifth session (See appendix A). Its recommended
that you practice DMR at least twice a day for two weeks or, if its more convenient
for your schedule, once a day for four weeks.
practicing the full procedure for the recommended time, youll then use a shortened
form of DMR which requires no more than five to ten minutes of practice daily.
Instructions for the shortened form of DMR follow the full length DMR instructions. This
shortened form can be practiced at any time-for example, while riding the bus or waiting
in the dentists office. To maintain your relaxation skills at an optimum level,
its recommended that you practice the full DMR procedure at least once during week
four. When you are ready to start using the shortened form of DMR, you should begin to
construct your anxiety hierarchy.
session 5, when you are familiar with DMR, youll begin practicing cue-controlled
relaxation. Cue-controlled relaxation involves the following: While relaxing each muscle
group after tensing it, focus on your breathing. Each time you exhale while you are
relaxed, say the word relax (or another word you choose) to yourself. By
associating the cue word with a state of relaxation, the cue word itself will eventually
produce a relaxed state. You will find that cue-controlled relaxation is useful for
inducing relaxation not only during the desensitization procedure, but also during times
of tension in your daily life.
is useful to use a relaxation scene during desensitization to facilitate
relaxation. Like cue-controlled relaxation, the relaxation scene can also be used at other
times to reduce your tension. When developing your scene, describe it in enough detail to
provide a clear image. It should include descriptions of related visual, auditory and
tactile sensations and should induce in you feelings of complete calm and relaxation.
Its recommended that you write your scene on index cards and that you have this
written description available during relaxation sessions, or that you tape record the
scene. After several rehearsals, youll have memorized the scene in
sufficient detail so that you will no longer need the cards or tape recording. Practice
imagining your relaxation scene for at least one to two minutes at the end of each
example of a relaxation scene is given below. You may choose to use this scene or you may
create a similar scene of your own.
You are in a forest. Its not a dark, threatening
forest, but instead, its inviting. You arent lost, but youre alone
because you wanted to take a long, calming walk. The air around you is cool and
refreshing. Trees hang over your head and make the forest cool and shadowy, but there are
bright spots of sunshine on the ground where the sun has filtered down through the leaves.
You are walking barefoot and the leaves and moss feel soothing and soft on your feet, like
a thick rug. The birds are singing soft, sweet songs in the trees and the sound makes you
content and comfortable. Youve been walking for a long time and your muscles feel
very loose and relaxed from the exercise. The leaves feel so soft and pleasant beneath
your feet that you want to fall down and just close your eyes and rest. You can barely
keep your eyes open when you come to a small stream. Its making a soft, bubbling
noise that makes you even more relaxed. Next to the stream is the most beautiful place
that you have ever seen. Its a little patch of tall soft grass protected all around
by the tall tress. Its lit and warmed by sunlight. You see that it would be the
perfect place to rest. You are so relaxed and loose that you can barely walk over to the
grassy place. But you do walk over and you sink down to your knees and then fall gently
into the soft, warm grass. Your eyes close immediately and you realize you have never laid
in a softer place in your life. Even your bed is not as soft. You have never been so
relaxed. Your eyes are closed and you hear the soft pleasant bubbling of the stream and
the singing of the birds. You are completely comfortable and no tightness is left
anywhere in your body, from your toes to the top of your head, is completely loose
and limp and very comfortable.
may want to rehearse the instructions at least once with your friend before beginning a
session or before tape recording them. During the sessions, you should tense muscles for
at least eight seconds and relax for at least 15 to 30 seconds; therefore, at the end of
each tensing and relaxing instruction, you or your friend should pause in order to provide
this required amount of time.
you choose to read the instructions to yourself each session, rather than taping them or
having a friend read them, we suggest that you practice reading them for each muscle group
prior to beginning your sessions. After several sessions, youll probably have
memorized the instructions and be able to use prompts rather than the full instructions.
These prompts can be written on index cards and you can refer to them when you need to.
Prompts should include the name of the muscle group and a short phrase describing the
exercise-for example: hands and wrists; tighten fists.
practice DMR in a moderately lit and quiet room. Eliminate as many distractions as
possible (e.g., no radio or TV, ask friends and family not to enter the room). Also loosen
any tight clothing, remove your shoes and refrain from smoking, eating or drinking during
a session. Sit in a comfortable chair which supports your entire body. If you have
one available, a reclining lounge chair is best. Before beginning a session, always
position yourself comfortably in the chair and take several breaths.
Instructions for Full Deep Muscle Relaxation
#1-Hands and Wrists. Make your hands into tight fists. Squeeze hard until your knuckles
turn white and hold for at least eight seconds (remember if youre recording or
having a friend read the instructions, to pause at this point for at least eight seconds).
Now let go. Let all the tightness and pain flow through your fingertips. Feel your fingers
and wrists relax and become loose and limp. Notice the difference: when you let go, you
began to relax. Stay relaxed for at least 15 seconds. Now clench your fists again; feel
the tension. Now relax. Notice the difference between the two feelings.
#2-Biceps and Triceps. Put your right hand around your left wrist. Now try to pull your
left arm in towards your body, but at the same time, push outward with your right arm.
Focus on your lower arms. Feel how tight they are getting. Now relax your arms and feel
the difference. Feel the tension flow out through your fingers and disappear. Now repeat
the exercise. Notice the difference between the feeling of tension and the feeling of
relaxation. Repeat the exercise with your left hand on your right wrist. Again, focus on
the tension as you pull your right arm toward your body and push outward with your left
arm. Then relax. Feel the tension disappear. Repeat. Now wrap your arms around
yourself, as though you were hugging yourself, but instead of hugging, squeeze yourself
very hard using your upper arms. Feel the tension. Now relax and let go. Feel the warmth
flow through your arms. Repeat the exercise, first tensing, then relaxing.
#3-Shoulders. Reach above yourself; stretch your arms as far as they will go while you
stay seated. Feel your shoulder muscles tighten. Then relax, let your arms fall to your
sides. Let your shoulders and arms relax. Make them loose and comfortable. Now repeat the
exercise. Notice the difference between tension and relaxation.
#4-Neck. Bend your head downward so that your chin points into your chest. Push your chin
hard against your chest. Then return your head to the headrest. Focus on the tension at
the front of the neck (the pull on the back of the neck is strain and should be ignored).
Now relax. Feel the tension disappear from the front of your neck. Now bend your neck
backwards as though you were trying to see the wall behind you. Push the base of your head
downward into your back. Feel the tension in the back of your neck (again, ignore the
strain in the front of your neck). Now return your head to an upright position. Feel the
difference between the tension in the back of your neck and the feeling of relaxation. Now
bend your head downwards toward your right shoulder (dont raise your shoulder); push
your right ear downwards to your shoulder. Feel the tension on the left side of your neck.
Relax. Repeat all four positions: front, back, right, left. Notice the difference between
tension and relaxation in your neck muscles.
#5-Tongue and Mouth. Put the tip of your tongue on the roof of your mouth right behind
your front teeth. Push hard, until your tongue feels solid, tight and hard. Let your
tongue rest naturally in a comfortable position. Once again push your tongue against the
roof of your mouth and then relax. Open your mouth as wide as you can. Feel the tension in
your jaw. Now relax. Feel the tension disappear. Repeat this exercise. Now purse your lips
together. Tighten your lips together as hard as you can. Then relax. Feel the tension
around your mouth disappear. Repeat.
#6-Eyes, Nose, and Forehead. Close your eyes as tightly as possible. Squeeze your eyelids
together so that your nose wrinkles up. Keep squeezing. Now relax your eyes and nose. You
dont have to open your eyes all the way; just let your eyelids relax until all the
tightness is gone and they feel very comfortable. Tightly close your eyes again. Then
relax. Notice the difference between tension and relaxation. Focus on your forehead and
tense the muscles until you are frowning and your forehead is wrinkled. Now relax. Feel
your forehead becoming smooth. Allow the relaxation to spread from your forehead to your
scalp. Now frown again and then relax.
Group #7-Back. Straighten your arms out from your sides and stretch them backwards as far
as they will go. Press your shoulder blades toward the back of your chair and push the
center of your body forward. Feel the muscles in your upper back tense. Now let your arms
fall to your sides and your shoulders hunch forward. Feel the tension and tightness
disappear. Repeat. Notice the difference between tension and relaxation.
#8. Take in a deep breath and suck in your stomach as hard as you can. Try to continue
breathing while you hold in your stomach. Try to touch your backbone with the front wall
of your stomach. Now let go and relax until all the tightness is gone. Feel the difference
between tension and relaxation in your stomach region. Now take a deep breath and push
your stomach forward as though you were preparing for a punch in your abdomen. Then
relax. Breathe deeply and exhale slowly. Repeat both exercises: pulling in your stomach
and then relaxing, and pushing out your stomach and relaxing.
#9-Thighs. Put your right hand on your left knee. Push your knee upwards and at the same
time push down with your hand. Focus on the thigh muscle and push harder with that muscle.
Feel the tension in your thigh (you will also feel tension in your arm). Now relax. Repeat
the exercise using your left hand and right leg. Feel the tension in your right thigh.
Relax. Notice the difference between tension and relaxation. Repeat the exercise for both
#10-Calves and Feet. With your legs supported (use a footstool if you are not seated in a
reclining lounge chair), allow your thighs to remain relaxed while you draw your toes of
both feet upward toward your head and tense the calf muscles. If you feel any cramping
during this exercise, relax immediately and shake out your legs. Now relax.
Feel the difference between tension and relaxation. Now point both feet downwards and feel
the tension on the front of your legs and ankles. Then relax. Once again point the feet
upwards and relax. Then point the feet downwards and relax.
Group #11. Now sit straight in your chair with your feet flat on the floor. Curl your toes
downward. Push them into the floor. Now relax. Repeat.
Once you have tensed and relaxed all muscle groups, close your eyes and relax all the
muscle groups. When you are ready to get up, open your eyes, stretch your body and slowly
rise from the chair.
Instructions for Shortened Form of DMR
shortened form of DMR reduces the eleven muscle groups to four groups: arms, shoulders and
neck; face; back and stomach; lower limbs. Perform each exercise twice.
Step 1 for Shortened DMR
#1-Arms, Shoulders and Neck. Move your arms toward the center of your body and bend both
arms at the elbow. Tighten your hands into fists and at the same time tense the muscles in
your upper arms and shoulders. Hold for ten seconds and then relax for fifteen to twenty
Group #2-Face. Tense your facial muscles by wrinkling your forehead and pursing your lips.
Hold for ten seconds. Then relax for fifteen to twenty seconds.
#3-Back and Stomach. Take a deep breath and suck in your stomach as hard as possible for
eight to ten seconds. Then exhale and relax for fifteen to twenty seconds.
#4-Lower Limbs. With your legs supported on a footrest, straighten both legs. Tense
the muscles of your entire leg and pull your toes toward your head (keeping your feet on
the stool). Hold for eight to ten seconds and then relax for fifteen to twenty seconds.
repeat your cue word to yourself when you exhale during relaxation. Also, end each
shortened form practice session by imagining your relaxation scene for one or two minutes.
Step Two: Constructing the Anxiety
of the anxiety hierarchy. In explaining the anxiety hierarchy, I will use the example of
test anxiety. Items included in an anxiety hierarchy describe situations which produce
varying levels of anxiety. The hierarchy you construct will contain situations or scenes
related to test taking. The situations you choose can include ones you have actually
experienced, as well as ones you only fear experiencing. For example, you may want to
include the item time is almost up and I have not finished the exam because
you fear this may happen, even if you have never had trouble finishing a test within the
items you include on your hierarchy should be described in enough detail so that you can
vividly imagine each one. For example, a brief phrase such as sitting in the testing
room waiting for the examination should be imagined vividly. When you imagine a
situation, make sure you are not merely acting as an observer, watching yourself in the
scene, but that you are instead actually experiencing yourself in the
your anxiety hierarchy. Your final hierarchy will contain 10 to 15 items. However, since
some items may be eliminated in the ordering or grading process, it is suggested that you
begin with 16 or 17 situations. Write each situation on a separate index card so that you
can easily rearrange and/or eliminate some of them.
situations or scenes included in your hierarchy should represent an evenly spaced
progression in terms of the level of anxiety each produces. Use Wolpes Subjective
Anxiety Scale (SUDS) to provide a basis for ordering your situations. Begin by
assigning the SUDS value of 100 to the highest level of anxiety you can remember
experiencing and the SUDS value of 0 to the most relaxed state you can remember
experiencing. Then, assign values to your hierarchy situations in terms of a scale where
100 is the highest level of anxiety and 0 is a state of relaxation.
may be easier for you to order situations if you initially grade them in terms of the
following anxiety categories (i.e., divide the items into five groups according to the
descriptions in the left-hand column):
Moderate High Anxiety
you have separated your items into these five categories, you should have at least two
situations in each category. If you dont, create new items or modify an existing
item from an adjacent category so that it can be placed into the deficient category. For
instance, let me use the example of test taking anxiety. You might have the following
three items in the Intense Anxiety category: reading over the questions on the examination
paper; the instructor is passing out the examinations; standing in the corridor in front
of the testing room minutes before the examination begins. Your Moderately High Anxiety
category may have only one item: talking to friends about the exam over breakfast
an hour before the exam begins.
this case you need to delete one item from your Intense Anxiety category and add one to
your Moderately High Anxiety category. To do this, first consider the three items in the
Intense Anxiety category and determine which of the items produces the least anxiety. This
is the item which youll delete. Now try modifying this item so that it produces a
slightly lower level of anxiety and then place it into your Moderately High Anxiety
category. If you choose to modify rather than eliminate an item, the item can be changed
by altering its temporal and spatial elements. For example, standing in the corridor
in front of the testing room minutes before the examination begins can be changed to
entering the building where the test is to be held twenty minutes before the
examination begins. Since you can have up to three items in any category, rather
than eliminating an item from your Intense Anxiety category, you may decide to develop an
additional item for your Moderately Intense Anxiety category.
you have at least two situations in each category, order the items within each category by
assigning appropriate values to each one. Write these values on the back of each index
card. For example, if you have three items in the Moderately High Anxiety category, each
item should be assigned a SUDS value between 60 and 79. When you have labeled each index
card with an appropriate SUDS value, arrange all cards in order from the lowest level of
anxiety to the highest level of anxiety produced by the situations.
differences in value between items should be approximately equal. In other words, if you
have assigned item 10 a SUDS value of 92 and item 9 a value of 82, then item 8 should have
a value of approximately 72. As before, you may find that you need to eliminate or modify
some items (if their SUDS value are identical or only one or two points apart) or that you
need to develop new items in order to achieve approximately equal intervals. Remember,
SUDS values are subjective; therefore, a truly equal difference between all items is
unnecessary. It is important, however, that your hierarchy represent a relatively smooth
progression from a lower level of anxiety to a high level of anxiety.
check the accuracy of your ordering, shuffle the index cards a few days after you have
ordered them and then reorder them. Check the values on the back of your cards to see if
your second ordering is the same as your first. If not, you may need to make some
Sample Anxiety Hierarchy for Test Anxiety
help you get started, I am including a sample hierarchy that was created by Joseph Wolpe
for a university student suffering from test-taking anxiety.
Item #1: A month before an exam
Item #2: Two weeks before an exam
Item #3: A week before an exam
Item #4: Five days before an exam
Item #5: Four days before an exam
Item #6: Three days before an exam
Item #7: Two days before an exam
Item #8: The night before an exam
Item #9: The night before an exam
Item #10: The exam paper lies face down before her
Item #11: Awaiting the distribution of papers
Item #12: Standing before the unopened doors of the exam room
Item #13: In the process of answering an exam paper
Item #14: On the way to the university on the day of an exam
Step Three: Pairing Relaxation
with the Situations in Your
Anxiety Hierarchy-Systematic Desensitization:
Overview of the pairing procedure: The aim of the systematic desensitization process is to
desensitize you to all aspects of the anxiety situation, thereby depriving anxiety-related
situations of their power to arouse your anxiety. This is accomplished by confronting each
situation while you are in a state of relaxation.
attempting to confront these situations, you should be able to easily put yourself in a
state of deep muscle relaxation using the shortened form of DMR, cue-controlled
relaxation, and your relaxation scene. In addition, you need to have constructed your
Systematic desensitization should be conducted in an environment free from distractions,
under the conditions I described for DMR. Prior to beginning each desensitization session,
assemble the following materials so that they will be readily available during your
desensitization sessions: your anxiety hierarchy, your relaxation scene,
instructions for the shortened form of DMR and instructions for systematic
sessions should not exceed 30 minutes. Its recommended that you do not attempt more
than three of your anxiety hierarchy items during a session. The sessions (after the first
one) should begin with the last item you successfully completed during the previous
session (i.e., the last item presented without producing anxiety). For a ten item
hierarchy, a suggested schedule of sessions would be:
a schedule of two sessions per week, the desensitization procedure can be completed in
1. Induce relaxation using the shortened form of DMR, cue-controlled relaxation and/or
your relaxation scene. Although youll use additional techniques later in the
session, at the beginning of each session, use the shortened form of DMR to initially
establish a state of relaxation.
2. Read the appropriate situation on your hierarchy. In the first session this will be the
first item. In later sessions, the first item you read will be the last one you
successfully completed in the previous session.
3. Stop imagining the situation and determine the amount of anxiety you are experiencing
in terms of a SUDS value. If any anxiety has been produced by the situation, re-establish
a state of relaxation using the shortened form of DMR, cue-controlled relaxation or the
relaxation scene (whichever you prefer) and relax
for 20-30 seconds.
4. Re-read the description of the situation. Imagine yourself in the scene for 30 seconds.
5. Stop and determine your level of anxiety in terms of SUDS value. If anxiety is
present, repeat steps 3 and 4 until the situation can be imagined without producing
anxiety. If no anxiety has been produced, go to step 6.
6. Once a scene has been introduced without producing anxiety, you are ready to introduce
the next scene on the hierarchy. Repeat steps 1 through 5 for the next item.
to end each of your sessions in a state of relaxation. Whenever possible, end your
sessions when an item has been presented without producing anxiety. You may also want to
end your sessions by imagining your relaxation scene for one or two minutes.
facilitate their use during desensitization sessions, transfer the desensitization
instructions to index cards in a shortened form. Write one instruction per card. A
suggested shortened form is:
Read anxiety situation. Imagine for 10 seconds.
Stop. Determine anxiety level. If anxiety is present, re-establish
Read situation. Imagine for 30 seconds.
Stop. Determine anxiety level. If anxiety is present, repeat steps
three and four. If no anxiety, go to step 6.
Repeat steps 1-5 for next anxiety situation.
that for the first presentation of each item you should imagine yourself in the situation
for 30 seconds. When you reach items on the hierarchy which produce high levels of anxiety
(e.g., items 7-10 on a 10 item hierarchy), you may want to reduce the length of time you
imagine yourself in the scene on the second and subsequent presentations. For example, on
the second presentation of item 8, and extremely high level of anxiety may occur after
imagining the scene for only 15 seconds. Stop imagining the scene at this point and
re-establish relaxation. Slowly increase the amount of time you imagine the situation in
subsequent presentations until you are able to imagine the situation for 30 seconds with a
moderate or mild amount of anxiety; then repeat desensitization until the situation
produces no anxiety. Also, with an item which initially produces a high level of anxiety,
repeat presentation of the item one time after it has been presented without producing
anxiety in order to reinforce your ability to relax in that situation.
noted, you should end each session in a state of relaxation, preferably when you have
successfully completed a hierarchy item, and the next session should begin with the last
item successfully completed in the previous session.
chemical dependency and its toxic impact on family members. Raise your
children to choose to be alcohol and other drugs
free. Learn how
to in Dr. Frischs, Psy.D. Recovery book series.