Progressive muscle relaxation for anxiety: how it works and how to do it

Anxiety is not only a feeling of worry. NHS inform lists physical symptoms of generalised anxiety disorder that include muscle aches and tension, trembling or shaking, restlessness, a fast or irregular heartbeat, shortness of breath and difficulty sleeping. NICE Clinical Knowledge Summaries also lists muscle tension among the features used to recognise it. Many people carry tension in the jaw, neck, shoulders or stomach without noticing.

Progressive muscle relaxation works with that physical side. NHS inform, which publishes the technique on behalf of Public Health Scotland, describes it as tensing and relaxing the muscles one area at a time. A Royal Brompton and Harefield hospital guide describes a guided exercise that brings together relaxation of the mind and body to reduce anxiety and tension that can build up in the muscles.

NHS inform sets out the exercise. Lie on your back and get comfortable; if you have lower back issues, a pillow under your knees can help. Take a breath in and tense the muscles in one area of the body, hold the tension for a few seconds, then breathe out and release the tension, letting the muscles relax. Repeat in different parts of the body, working through the list in the table.

When you have gone through the list, NHS inform suggests focusing on each body part in turn and, if you notice any remaining tension, allowing it to release as you breathe out. Noticing the difference between tension and relaxation is the point of the exercise, and over time it can help you spot early signs of tension in everyday life before it builds.

The Royal Brompton and Harefield guide offers practical advice that applies to most relaxation exercises: set aside about 15 to 30 minutes, find a place where you will not be interrupted, and practise when you are not feeling stressed or anxious, because it is easier to use during a difficult moment once it is familiar. It suggests practising once or twice a day for the first week or two, adding that the better you become at it, the quicker the relaxation response will kick in when you need it. Recordings of guided versions, including a progressive muscle relaxation exercise, are provided by the hospital.

The NHS generalised anxiety disorder self-help advice lists learning to relax using calming breathing exercises or activities such as yoga or pilates among things that may help, alongside regular exercise, enough sleep and talking about your feelings.

PMR is generally gentle, but tensing muscles should never be painful. NHS inform says you can miss out any painful area. If you have an injury, a medical condition affecting your muscles or circulation, or are pregnant, ask your clinician how to adapt it. Do not tense hard enough to cause cramp. Some people feel more aware of their body or anxious at first when they focus on physical sensations; if so, stop and try another approach such as slow breathing.

Relaxation does not treat the underlying cause of an anxiety disorder. The NHS says treatments for generalised anxiety disorder include talking therapies such as cognitive behavioural therapy and, in some cases, medicines, and you can refer yourself to NHS talking therapies if you are 18 or over.

NHS inform advises contacting your GP practice if anxiety is affecting your daily life, you are not looking after yourself, or you are finding it hard to manage your responsibilities. The NHS says to see a GP if you think you might have generalised anxiety disorder or if you have been diagnosed and treatments are not helping. The NHS also says support is available if you or someone you know is having a mental health crisis, and points to where to get urgent help for mental health.

Relaxation techniques like this one are free to use and are taught by NHS talking therapies services, psychologists and physiotherapists. Private therapists, apps and classes also teach them. They can be useful alongside, not instead of, evidence-based treatment where an anxiety disorder has been diagnosed.