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Guided Imagery and Progressive Muscle Relaxation
A majority of Americans experience stress in their daily lives. Thus, an important goal of
psychological research is to evaluate techniques that promote stress reduction and relaxation. Two
techniques that have been associated with reduced stress and increased relaxation in psychotherapy
contexts are guided imagery and progressive muscle relaxation (McGuigan & Lehrer, 2007). Guided
imagery aids individuals in connecting their internal and external experiences, allowing them, for
example, to feel calmer externally because they practice thinking about calming imagery. Progressive
muscle relaxation involves diaphragmatic breathing and the tensing and releasing of 16 major muscle
groups; together these behaviors lead individuals to a more relaxed state (Jacobson, 1938;
Trakhtenberg, 2008). Guided imagery and progressive muscle relaxation are both cognitive
behavioral techniques (Yalom & Leszcz, 2005) in which individuals focus on the relationship among
thoughts, emotions, and behaviors (White, 2000).
Guided Imagery
Features of Guided Imagery
Guided imagery involves a person visualizing a mental image and engaging each sense (e.g.,
sight, smell, touch) in the process. Guided imagery was first examined in a psychological context in
the 1960s, when the behavior theorist Joseph Wolpe helped pioneer the use of relaxation techniques
such as aversive imagery, exposure, and imaginal flooding in behavior therapy (Achterberg, 1985;
Utay & Miller, 2006). Patients learn to relax their bodies in the presence of stimuli that previously
distressed them, to the point where further exposure to the stimuli no longer provokes a negative
response (Achterberg, 1985).
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Guided Imagery in Group Psychotherapy
Guided imagery exercises improve treatment outcomes and prognosis in group psychotherapy
contexts (Skovholt & Thoen, 1987). Lange (1982) underscored two such benefits by showing (a) the
role of the group psychotherapy leader in facilitating reflection on the guided imagery experience,
including difficulties and stuck points, and (b) the benefits achieved by social comparison of guided
imagery experiences between group members. Teaching techniques and reflecting on the group
process are unique components of guided imagery received in a group context (Yalom & Leszcz,
2005).
Progressive Muscle Relaxation
Features of Progressive Muscle Relaxation
Progressive muscle relaxation involves diaphragmatic or deep breathing and the tensing and
releasing of muscles in the body (Jacobson, 1938). Edmund Jacobson developed progressive muscle
relaxation in 1929 (as cited in Peterson et al., 2011) and directed participants to practice progressive
muscle relaxation several times a week for a year. After examining progressive muscle relaxation as
an intervention for stress or anxiety, Joseph Wolpe (1960; as cited in Peterson et al., 2011) theorized
that relaxation was a promising treatment. In 1973, Bernstein and Borkovec created a manual for
helping professionals to teach their clients progressive muscle relaxation, thereby bringing
progressive muscle relaxation into the fold of interventions used in cognitive behavior therapy. In its
current state, progressive muscle relaxation is often paired with relaxation training and described
within a relaxation framework (see Freebird Meditations, 2012, for more).
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Progressive Muscle Relaxation in Group Psychotherapy
Limited, but compelling, research has examined progressive muscle relaxation within group
psychotherapy. Progressive muscle relaxation has been used in outpatient and inpatient hospital
settings to reduce stress and physical symptoms (Peterson et al., 2011). For example, the U.S.
Department of Veterans Affairs integrates progressive muscle relaxation into therapy skills groups
(Hardy, 2017). The goal is for group members to practice progressive muscle relaxation throughout
their inpatient stay and then continue the practice at home to promote ongoing relief of symptoms
(Yalom & Leszcz, 2005).
Guided Imagery and Progressive Muscle Relaxation in Group Psychotherapy
Combinations of relaxation training techniques, including guided imagery and progressive
muscle relaxation, have been shown to improve psychiatric and medical symptoms when delivered in
a group psychotherapy context (Bottomley, 1996; Cunningham & Tocco, 1989). The research
supports the existence of immediate and long-term positive effects of guided imagery and progressive
muscle relaxation delivered in group psychotherapy (Baider et al., 1994). For example, Cohen and
Fried (2007) examined the effect of group psychotherapy on 114 women diagnosed with breast
cancer. The researchers randomly assigned participants to three groups: (a) a control group, (b) a
relaxation psychotherapy group that received guided imagery and progressive muscle relaxation
interventions, or (c) a cognitive behavioral therapy group.
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Conclusion
Limitations of Existing Research
Research on the use of guided imagery and progressive muscle relaxation to achieve stress
reduction and relaxation is compelling but has significant limitations. Psychotherapy groups that
implement guided imagery and progressive muscle relaxation are typically homogeneous, time
limited, and brief (Yalom & Leszcz, 2005). Relaxation training in group psychotherapy typically
includes only one or two group meetings focused on these techniques (Yalom & Leszcz, 2005);
thereafter, participants are usually expected to practice the techniques by themselves (see Menzies
et al., 2014). Future research should address how these relaxation techniques can assist people in
diverse groups and how the impact of relaxation techniques may be amplified if treatments are
delivered in the group setting over time.
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BIBLIOGRAPY
Achterberg, J. (1985). Imagery in healing. Shambhala Publications.
Baider, L., Uziely, B., & Kaplan De-Nour, A. (1994). Progressive muscle relaxation and guided
imagery in cancer patients. General Hospital Psychiatry, 16(5), 340–347.
https://doi.org/10.1016/0163-8343(94)90021-3
Bottomley, A. (1996). Group cognitive behavioural therapy interventions with cancer patients:
A review of the literature. European Journal of Cancer Cure, 5(3), 143–146.
https://doi.org/10.1111/j.1365-2354.1996.tb00225.x
Freebird Meditations. (2012, June 17). Progressive muscle relaxation guided meditation
[Video]. YouTube. https://www.youtube.com/watch?v=fDZI-4udE_o
Cohen, M., & Fried, G. (2007). Comparing relaxation training and cognitive-behavioral group
therapy for women with breast cancer. Research on Social Work Practice, 17(3), 313–323.
https://doi.org/10.1177/1049731506293741
Hardy, K. (2017, October 8). Mindfulness is plentiful in “The post-traumatic insomnia
workbook.” Veterans Training Support Center. http://bit.ly/2D6ux8U
Jacobson, E. (1938). Progressive relaxation (2nd ed.). University of Chicago Press.
McGuigan, F. J., & Lehrer, P. M. (2007). Progressive relaxation: Origins, principles, and clinical
applications. In P. M. Lehrer, R. L. Woolfolk, & W. E. Sime (Eds.), Principles and practice of stress
management (3rd ed., pp. 57–87). Guilford Press.
Lange, S. (1982, August 23–27). A realistic look at guided fantasy [Paper presentation].
American Psychological Association 90th Annual Convention, Washington, DC.
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Menzies, V., Lyon, D. E., Elswick, R. K., Jr., McCain, N. L., & Gray, D. P. (2014). Effects of guided
imagery on biobehavioral factors in women with fibromyalgia. Journal of Behavioral Medicine, 37(1),
70–80. https://doi.org/10.1007/s10865-012-9464-7
Peterson, A. L., Hatch, J. P., Hryshko-Mullen, A. S., & Cigrang, J. A. (2011). Relaxation training
with and without muscle contraction in subjects with psychophysiological disorders. Journal of
Applied Biobehavioral Research, 16(3–4), 138–147. https://doi.org/10.1111/j.1751-
9861.2011.00070.x
Skovholt, T. M., & Thoen, G. A. (1987). Mental imagery and parenthood decision making.
Journal of Counseling & Development, 65(6), 315–316. http://doi.org/fzmtjd
Trakhtenberg, E. C. (2008). The effects of guided imagery on the immune system: A critical
review. International Journal of Neuroscience, 118(6), 839–855. http://doi.org/fxfsbq
Utay, J., & Miller, M. (2006). Guided imagery as an effective therapeutic technique: A brief
review of its history and efficacy research. Journal of Instructional Psychology, 33(1), 40–43.
White, J. R. (2000). Introduction. In J. R. White & A. S. Freeman (Eds.), Cognitive-behavioral
group therapy: For specific problems and populations (pp. 3–25). American Psychological Association.
https://doi.org/10.1037/10352-001
Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.).
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