DEEP MUSCLE, CUE-CONTROLLED, AND DIFFERENTIAL RELAXATION SCRIPT
I am going to show you the muscle groups that you are going to be tensing and relaxing. Sometimes people feel uncomfortable about these exercises, especially when they are doing the face exercises, because they are afraid they look strange or funny. I am going to be doing the exercises right along with you, so we can look funny together.
Proceed through the muscle groups in order, demonstrating tension and relaxation for each group. Begin as follows:
Close your eyes. Just allow yourself to relax as much as you would like, and focus on each muscle group as we proceed. Now focus your attention on your right fist. Clench your right fist. Hold it [use a firm and moderately loud, but not aversive, voice with the client], feeling the tension – hold it, hold it [wait 10 seconds] – and Relax [say this with a soothing voice; wait 30 seconds]. Let go further and further, noticing the difference between tensing and relaxing, allowing all of the tension to flow out of these muscles, as if it’s flowing out of your fingertips. Say to yourself the world “calm” or “relax.” Now let’s do that again. [Repeat, and then instruct the patient to do 10 breaths between each muscle group; continue on with other muscle groups.]
List of muscle groups (replaces underlined phrase above):
o Clench your fists.
o Bend your hands backward at wrists.
o Flex your bicep muscles.
o Push your shoulders back into chair.
o Hunch shoulders up toward your ears.
o Tilt your head to the left shoulder.
o Tilt your head to the right shoulder.
o With your head down, tuck your chin toward your chest.
o Press your head back against the chair.
o Breathe air in deeply through your lungs, and hold for a few seconds.
o Tense your stomach by contracting your muscles as if hit in the stomach.
o Wrinkle up your forehead and brow.
o Close your eyes tightly.
o Open your mouth wide.
o Purse your lips.
o Bear down slightly on your back teeth.
o Tense your buttocks.
o Arch your back.
o Stretch out your right leg and bend your toes back.
o Stretch out your left leg and bend your toes back.
o Stretch out your right leg and point your toes away from your body.
o Stretch out your left leg and point your toes away from your body.
o Curl up your toes in your shoes.
It is helpful to make statements during the relaxation phase to encourage the client to relax, such as the following:
o Allow your muscles to relax.
o Let go further and further.
o Notice the difference between tensing and relaxing.
o Say the word “calm” or “relax” [or whatever the client’s cue word is] to yourself.
o Let yourself relax as much as you feel comfortable.
o This is your time to relax. (You will not be hurried.)
ADDING PLEASANT IMAGERY
Can you think of a scene that is particularly pleasant for you to imagine (e.g., walking on a beach, walking through the woods, listening to music)?
Can you describe that scene to me?
Once the client has selected a scene, continue as follows:
Please imagine this scene as vividly as possible, bringing in the smells, sounds, colors, and textures that are around you as you imagine it. I want you to stay with that image in your private sanctuary and allow your muscles to go limp and relax. I will ask you to breathe slowly until I speak to you again. This is your time to relax. You will not be hurried. I want you to keep your eyes closed and imagine your pleasant scene. Go to that private sanctuary and see the colors around you, inhale the pleasant scents, listen to the sounds, and relax, further and further. [Pause for 3-5 minutes.] In a moment, I will count backward from 4 to 1. On the count of 4, I’d like you to move your legs and your feet. On the count of 3, move your arms and your hands. On the count of 2, move your head and your neck, and on the count of 1, open your eyes, feeling refreshed and relaxed. Take your time opening your eyes. You have been relaxing, and there is no need to rush.
When the client opens her eyes after imagining the pleasant scene, ask for feedback.
How did you like it?
Did you have any difficulty with any of the muscle groups?
Offer encouragement for completing the exercise.
CUE-CONTROLLED RELAXATION
Now I am going to teach you another relaxation strategy, called “cue-controlled relaxation.” Cue-controlled relaxation can be used daily to reduce tension, especially in situations that remind you of the assault. When you feel stressed out or anxious, which of your muscles are first affected?______________________________________________
This week, pay attention to which muscles in your body feel tense, and use this tension as a cue to use breathing and relaxation. For example, let’s say you have had a difficult day at work because you were unable to concentrate, and you notice that you are clenching your jaw. This will be your cue to start your breathing exercises and to say your cue word (e.g., “calm” or “relax”) to help you reduce your tension. Do you notice any muscle group in which there is tension right now, or not as relaxed as the rest?
Elicit from the client the area of tension currently in her body, and have her use this as the area for practicing cue-controlled relaxation. Have the client practice breathing, using her cue word, and allowing her muscles in that area to go limp and relax for about 5 minutes.
DIFFERENTIAL RELAXATION
Let’s run a couple of experiments to demonstrate this principle. First, I’d like you to focus on the amount of tension that you feel in your muscles as you sit in the chair. What muscles are feeling tense right now? What are the essential muscle groups that you need to sit in the chair?
Even when we are using muscles for an activity, we do not need a high degree of tension – say, the amount when we are tensing the muscles during deep muscle relaxation. Try to keep the minimal amount of tension required for that activity. Now try to reduce the degree of tension that you feel in the muscle groups that are essential for you to sit in the chair, and try to allow the other muscles to relax completely. Do you notice a difference?
Next, give the client a piece of paper and a pencil. Ask her to write her name, using only the muscle groups she needs for this activity. Ask her the following:
What muscles are you able to relax while you are writing?
What are the muscle groups that you need to write your name? (hand, lower arm)
Ask the client to stand up and notice the muscle groups she needs to maintain her balance and posture. Stand up with the client and model a relaxed stance. Ask her:
What muscles are you able to relax while you are standing there? (arms, face, buttocks)
What are the muscle groups that you need to maintain your balance? (shoulders, back, legs)
Ask the client to walk around the room and notice what muscle groups are essential for her to walk and maintain her balance. Ask her:
What muscles are you able to relax while you are walking and balancing on your legs? (arms, face)
What are the muscle groups that you need to maintain your balance? (shoulders, back, hips, legs)