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The Mystery of Muscle Relaxation
Last reviewed on October 24, 2012
By Michael Craig Miller, M.D.
Harvard Medical School
Muscle relaxation has been used for decades to relieve anxiety. The idea is that patients can calm their minds by learning how to relax their bodies.
A 2007 article in the Journal of Anxiety Disorders, however, challenges this idea and raises questions about how this therapy actually works.
The Belief Behind Muscle Relaxation
Muscle relaxation was developed in the 1930s by the psychologist Edmund Jacobson. It was called "progressive muscle relaxation." Psychotherapists have used some version of his technique since then. According to research, its beneficial.
Here's how it's done: A therapist asks the patient, who is sitting in a comfortable chair, to tense muscle groups one by one. The patient is then asked to release the tension. With practice, the patient can recognize muscle tension and release it in real-life situations when feeling anxious.
People who use muscle relaxation believe it relieves anxiety by creating a physical state that opposes the fight-or-flight response the adrenaline rush that is triggered during an emergency. Muscle relaxation is supposed to work as an antidote by lowering heart rate, blood pressure and stress hormone levels. This leads to positive changes in emotions and thinking.
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Do Relaxed Muscles Reduce Stress?
In the middle of the twentieth century our understanding of the physical basis of stress was limited. Psychologists assumed that muscle relaxation was calming psychologically. They weren't concerned with physical responses they couldn't see that involved nerves and hormones. Now, however, scientists are obligated to ask whether reducing muscle tension actually reduces stress overall.
Measuring muscle tension has also improved in the past 50 years. Today it's measured by a special device called an electromyograph (EMG). An EMG measures electrical activity in the muscle. This can be done either by placing electrodes on the skin (convenient but not highly accurate) or by inserting a needle into muscle tissue (more accurate, but uncomfortable). Electrical activity is higher when a muscle is contracted, or tensed. It's lower when the muscle is relaxed or inactive. In biofeedback, patients use EMG recordings to help train themselves to relax.
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Muscles May Not Matter
Muscle relaxation therapy assumes that anxious people have tense muscles. It also assumes that this tension is associated with other signs of anxiety, such as a racing heart and high stress hormone levels. The theory is that practicing muscle relaxation will relieve anxiety as muscles relax.
According to the authors of the recent study, there is a problem with this logic. There is little evidence to prove that muscle relaxation is necessary for stress reduction. Few studies have recorded the electrical activity of muscles during relaxation therapy. Even fewer have shown a connection between muscle tension and heart rate, stress hormones or patients' own reports of anxiety. Better studies are needed according to the authors, especially ones that record activity in many muscles rather than a few, and that compare people with anxiety disorders to healthy controls.
Despite their skepticism, the authors do think that muscle relaxation works for some patients. But they believe it may work because of its effect on thinking, rather than its effect on muscles. In their view, muscle relaxation works like other forms of cognitive therapy. The therapeutic benefit comes because patients end up thinking differently. And, according to the authors, when patient's feel better, it is because they are in better control of their physical responses.
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Muscle Relaxation Is Still Useful
Though it is not clear exactly how it works, people are likely to continue using this therapy. Some people are suspicious of medications or don't take well to cognitive therapy. They may be frightened by a kind of treatment called exposure therapy where you are confronted with the things that scare you and practice managing your responses. Many people believe that muscle tension equals emotional tension. Thus, muscle relaxation simply makes more sense to them than other approaches.
If muscle relaxation works for someone, he or she has good reason to believe in it. It can be an active way to manage anxiety. As confidence in the technique grows, a person's dread of anxiety-provoking situations tends to improve.
So, if you have a problem with anxiety or stress, you may want to try muscle relaxation. As with many mental disorders, mental health clinicians often recommend combining a few different effective treatments. Relaxation techniques can be easily used with medications or as part of psychotherapy. Compared to other treatments for anxiety, muscle relaxation is pretty cost effective: It requires little training and experience on the part of the therapist. Some people can learn the technique quickly through practice.
Ultimately, if muscle relaxation techniques give you a greater feeling of control over your reactions, you will be able to stay engaged in meaningful activities and take more pleasure in your life.
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Michael Craig Miller, M.D. is Editor in Chief of the Harvard Mental Health Letter. He is also associate physician at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School. He has been practicing psychiatry for more than 25 years and teaches in the Harvard Longwood Psychiatry Residency Program.