OCTC PRACTICAL GUIDES

RELAXATION SCRIPTS
Helen Kennerley
May 2016

Relaxation training is an invaluable strategy in the CBT therapist’s armoury, so there will be times when you
encourage your patients to practice relaxation exercises between sessions. However, some of them will struggle
to remember all the stages in a systematic relaxation exercise, others might be able to recall an exercise but
have difficulty getting the pacing just right while some people get distracted and drift off task very easily. In
these instances it can be really helpful to provide a recorded guide. There are various ways of doing this: in
some departments a single person makes recordings that can be distributed to clients in general, some
therapists make their own recordings for particular patients, making it more “bespoke”, and sometimes
patients are coached in making their own recordings. You need to decide what best suits you and the person
with whom you are working.

As you will want to make as soothing a recording as possible, do choose a time when you (or your patient) are
feeling reasonably relaxed and your voice is not strained and you are not hurried. Also - a regular breathing
pattern is fundamental to achieving a relaxed state, so it can be good idea to begin with getting this right.

Preliminary regular breathing

This exercise is brief and simple. It prompts a relaxed breathing pattern.

Instructions:

‘Find a comfortable position and let your body grow heavy.

Attend to your breathing for a moment just allowing this to be as natural as possible.
Try to breathe through your nose if you can, making your breathing smooth and even.

On the next out-breath try to empty your lungs, right down to your diaphragm - as if you were breathing from your
stomach.
Take a gentle in-breath counting slowly to five: one, two, three, four, five.
Imagine filling your lungs completely, right down to your diaphragm.
Breathe out slowly: one, two, three, four, five, six.
Imagine emptying your lungs.
Breathe in: one, two, three, four, five.
Breathe out slowly: one, two, three, four, five, six.
Breathe in: one, two, three, four, five.
Breathe out slowly: one, two, three, four, five, six.

Try to keep this pattern during your relaxation exercises.’

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Relaxation Exercise: Progressive relaxation or deep relaxation
This exercise is based on Jacobsen’s Progressive Muscular Relaxation (PMR) and it helps us distinguish
between muscular tension and relaxation whilst instructing them us to relax at will. It is particularly useful for
those who are so used to being tense that they find it difficult to even appreciate that they are tense! It is also
an excellent exercise for people who struggle to let go of tension in the muscles and for those who need a step-
by-step training because they are so unfamiliar with the sensations of relaxation. The procedure involves
working through various muscle groups first tensing and then relaxing them. Exercises tend to start with the
feet, working up through the body slowly and smoothly, letting the sensation of relaxation deepen at its own
pace. However, if there were good reason to start elsewhere in the body it would be fine to do so.

People should be instructed to tense their muscles – but not to overdo this. The aim is to tighten muscles but
not to strain. No-one should get pain or cramps!

Instructions:

‘First, get as comfortable as you can ... Lie flat on the floor with a pillow under your head, or snuggle in your chair ...
If you wear glasses, remove them … Kick off your shoes and loosen any tight clothing ... Relax your arms by your
sides and have your legs uncrossed. Close your eyes, and don’t worry if they flicker – this is quite usual. Don’t worry if
random thoughts enter your mind – this is also quite usual. Just let them go and then re-focus on relaxing.

(READ ONCE) ‘You are beginning to relax …. Breathe out slowly … Now, breathe in smoothly and deeply ….
Now, breathe out slowly again, imagining yourself becoming heavier and heavier, sinking into the floor (or your chair)
... Keep breathing rhythmically, and feel a sense of relief and of letting go …. Try saying “relax” to yourself as you
breathe out … Breathe like this for a few moments more ….

‘Now, begin to tense and relax the muscles of your body ... Think of your feet ... Tense the muscles in your feet and
ankles, curling your toes towards your head … Gently stretch your muscles … Feel the tension in your feet and ankles
... Hold it ... Now let go ... Let your feet go limp and floppy ... Feel the difference … Feel the tension draining away
from your feet … Let your feet roll outwards and grow heavier and heavier … Imagine that they are so heavy that
they are sinking into the floor … More and more relaxed … Growing heavier and more relaxed …(REPEAT)

‘Now, think about your calves … Begin to tense the muscles in your lower legs ... If you are sitting, lift your legs up
and hold them in front of you, feeling the tension … Gently stretch the muscles …. Feel that tension ... Hold it ...
Now release … Let your feet touch the floor and let your legs go floppy and heavy ... Feel the difference … Feel the
tension leaving your legs, draining away from your calves ... Leaving your calves feeling heavy ... Draining away from
your feet … Leaving them feeling heavy and limp ... Imagine that your legs and feet are so heavy that they are sinking
into the floor … They feel limp and relaxed ... Growing more and more heavy and relaxed … (REPEAT)

‘Think about your thigh muscles ... Tense them by pushing the tops of your legs together as hard as you can … Feel
the tension building ... Hold it ... Now, let your legs fall apart ... Feel the difference … Feel the tension draining away
from your legs … They feel limp and heavy ...Your thighs feel heavy ... Your calves feel heavy … Your feet feel heavy
... Imagine the tension draining away ... Leaving your legs ... Leaving them feeling limp and relaxed … Leaving them

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 feeling so heavy that they are sinking into the floor or your chair ... Let the feelings of relaxation spread up from your
feet … Up through your legs … Relaxing your hips and lower back ...
(REPEAT)

‘Now tense the muscles of your hips, and lower back by squeezing your buttocks together ... Arch your back, gently ...
Feel the tension ... Hold the tension ... Now let it go ... Let your muscles relax … Feel your spine supported again ...
Feel the muscles relax … Deeper and deeper ... More and more relaxed … Growing heavier and heavier ... Your
hips are relaxed … Your legs are relaxed … Your feet are heavy … Tension is draining away from your body ….
(REPEAT)

‘Tense your stomach and chest muscles, imagine that you are expecting a punch in the stomach and prepare yourself for
the impact ... Take in a breath, and as you do, pull in your stomach and feel the muscles tighten ... Feel your chest
muscles tighten and become rigid ... Hold the tension ... Now slowly breathe out and let go of the tension … Feel your
stomach muscles relax … Feel the tightness leave your chest ... As you breathe evenly and calmly, your chest and
stomach should gently rise and fall ... Allow your breathing to become rhythmic and relaxed … (REPEAT)

‘Now think about your hands and arms ... Slowly curl your fingers into two tight fists ... Feel the tension ... Now
hold your arms straight out in front of you, still clenching your fists ... Feel the tension in your hands, your forearms
and your upper arms ... Hold it ... Now, let go … Gently drop your arms by your side and imagine the tension
draining away from your arms … Leaving your upper arms ... Leaving your forearms … Draining away from your
hands ...Your arms feel heavy and floppy … Your arms feel limp and relaxed …(REPEAT)

‘Think about the muscles in your shoulders ... Tense them by drawing up your shoulders towards your ears and pull
them in towards your spine … Feel the tension across your shoulders and in your neck ... Tense the muscles in your
neck further by tipping your head back slightly ... Hold the tension ... Now relax … Let your head drop forward ...
Let your shoulders drop … Let them drop even further ... Feel the tension easing away from your neck and shoulders
... Feel your muscles relaxing more and more deeply ... Your neck is limp and your shoulders feel heavy … (REPEAT)

‘Think about your face muscles ... Focus on the muscles running across your forehead … Tense them by frowning as
hard as you can … Hold that tension and focus on your jaw muscles ... Tense the muscles by biting hard … Feel
your jaw muscles tighten ... Feel the tension in your face ... Across your forehead … Behind your eyes ... In your jaw
... Now let go ... Relax your forehead and drop your jaw ... Feel the strain easing ... Feel the tension draining away
from your face … Your forehead feels smooth and relaxed … Your jaw is heavy and loose … Imagine the tension
leaving your face ... Leaving your neck ... Draining away from your shoulders …Your head, neck, and shoulders feel
heavy and relaxed. (REPEAT)

‘Think of your whole body now ...Your entire body feels heavy and relaxed … Let go of any tension ... Imagine the
tension flowing out of your body ... Listen to the sound of your calm, even breathing … Your arms, legs and head feel
pleasantly heavy ... Too heavy to move … You may feel as though you are floating … Let it happen ... It is part of
being relaxed ...
‘When images drift into your mind, don’t fight them ... Just acknowledge them and let them pass ... You are a

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 bystander: interested but not involved … Enjoy the feelings of relaxation for a few more moments … If you like,
picture something that gives you pleasure and a sense of calm . . .
‘In a moment, I will count backwards from four to one . . . When I reach one, open your eyes and lie still for a
little while before you begin to move around again … You will feel pleasantly relaxed and refreshed … Four:
beginning to feel more alert … Three: getting ready to start moving again ... Two: aware of your surroundings ... One:
eyes open, feeling relaxed and alert.’

Relaxation Exercise: Shortened progressive relaxation

When the first exercise is used successfully, you can shorten the routine by missing out the tensing stage.
Alternatively, some people are able to begin relaxation training at this stage.

Instructions:

(READ ONCE) ‘You are relaxing …. Breathe out slowly … Now, breathe in smoothly and deeply ... Now, breathe
out slowly again, imagining yourself becoming heavier and heavier, sinking into the floor (or your chair) ... Keep
breathing rhythmically, and feel a sense of relief and of letting go … Try saying “relax’’ to yourself as you breathe out
… Breathe like this for a few moments more …

‘Now, begin to relax the muscles of your body … Think of your feet ... Let your feet go limp and floppy ... Feel the
tension draining away from your feet … Let your feet roll outwards and grow heavier and heavier … Imagine that
they are so heavy that they are sinking into the floor ... More and more relaxed … Growing heavier and more relaxed
. . . (REPEAT)

‘Now, think about your calves … Let your feet touch the floor and let your legs go floppy and heavy ... Feel the
tension leaving your legs, draining away from your calves ... Leaving your calves feeling heavy ... Draining away from
your feet … Leaving them feeling heavy and limp ... Imagine that your legs and feet are so heavy that they are sinking
into the floor … They feel limp and relaxed ... Growing more and more heavy and relaxed … (REPEAT)

‘Think about your thigh muscles ... Feel the tension draining away from your legs … They feel limp and heavy ...
Your thighs feel heavy ... Your calves feel heavy … Your feet feel heavy ... Imagine the tension draining away ...
Leaving your legs ... Leaving them feeling limp and relaxed … Leaving them feeling so heavy that they are sinking
into the floor (or your chair) ... Let the feelings of relaxation spread up from your feet … Up through your legs …
Relaxing your hips and lower back ... (REPEAT)

‘Now relax the muscles of your hips, and lower back … If you feel tension, let it go ... Let your muscles relax … Feel
your spine supported ... Feel the muscles relax … Deeper and deeper ... More and more relaxed … Growing heavier
and heavier ...Your hips are relaxed … Your legs are relaxed … Your feet are heavy … Tension is draining away
from your body… (REPEAT)

‘Relax your stomach and chest muscles ... As you breathe out, let go of your tension ... Feel your stomach muscles
relax … Feel the tightness leave your chest ... As you breathe evenly and calmly, your chest and stomach should gently

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 rise and fall ... Allow your breathing to become rhythmic and relaxed … (REPEAT)

‘Now think about your hands and arms ... Gently drop your arms by your sides and imagine the tension draining
away from your arms … Leaving your upper arms ... Leaving your forearms … Draining away from your hands
...Your arms feel heavy and floppy … Your arms feel limp and relaxed … (REPEAT)

‘Think about the muscles in your shoulders ... Now relax ... Let your head drop forward … Let your shoulders drop
... Let them drop even further … Feel the tension easing away from your neck and shoulders … Feel your muscles
relaxing more and more deeply … Your neck is limp and your shoulders feel heavy ... (REPEAT)

‘Think about your face muscles ... Focus on the muscles running across your forehead … Relax your forehead and
drop your jaw … Feel the strain easing ... Feel the tension draining away from your face … Your forehead feels
smooth and relaxed … Your jaw is heavy and loose … Imagine the tension leaving your face ... Leaving your neck ...
Draining away from your shoulders … Your head, neck, and shoulders feel heavy and relaxed … (REPEAT)

‘Think of your whole body now ... Your entire body feels heavy and relaxed … Let go of any tension ... Imagine the
tension flowing out of your body ... Listen to the sound of your calm, even breathing … Your arms, legs and head feel
pleasantly heavy ... Too heavy to move … You may feel as though you are floating … Let it happen ... It is part of
being relaxed … When images drift into your mind, don’t fight them ... Just acknowledge them and let them pass ...
You are a bystander: interested but not involved … Enjoy the feelings of relaxation for a few more moments … If you
like, picture something that gives you pleasure and a sense of calm ...
‘In a moment, I will count backwards from four to one . . . When I reach one, open your eyes and lie still for a
little while before you begin to move around again …You will feel pleasantly relaxed and refreshed … Four:
beginning to feel more alert … Three: getting ready to start moving again ... Two: aware of your surroundings ... One:
eyes open, feeling relaxed and alert.’

Relaxation Exercise: Simple relaxation routine

Once deep relaxation has been mastered, or for those who might not need or want to engage in the longer
exercise, you can introduce an even shorter exercise, which can be practised whenever it is needed. The
following routine is based on Benson’s “Relaxation Routine” which incorporates a mental image or mental
device into the relaxation exercise. This can be a pleasant, calming scene, such as a deserted beach, a
particularly relaxing picture or object, a soothing sound or word, like the sound of the sea or the word ‘serene’.
The important thing is that a person finds something that is calming for them.

From time to time, distracting thoughts will come to mind – this is quite usual. Don’t dwell on this; simply
encourage your clients to return to thinking about the soothing image or sound. Once you have started the
exercise, and got into the rhythm of it, carry on for a minute or so (it’s up to you and your patient to decide
how much time you need to achieve a sense of relaxation).

Instructions:

‘To start the exercise, sit in a comfortable position. First, focus on your breathing. Take a slow, deep breath in …

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 Feel the muscle beneath your rib cage move ... Now let it out – slowly ... Aim for a smooth pattern of breathing.

‘Close your eyes, and, while you continue to breathe slowly, imagine your body becoming more heavy … Scan your body
for tension ... Start at your feet and move up through your body to your shoulders and head ... If you find any tension,
try to relax that part of your body … Now, while your body is feeling as heavy and comfortable as possible, become
aware of your breathing again … Breathe in through your nose, and fill your lungs fully ... Now, breathe out again
and bring to mind your tranquil image or sound ... Breathe easily and naturally as you do this … Again, breathe in
through your nose, filling your lungs, right down to your diaphragm … and out, thinking of your soothing picture or
sound . . . When you are ready to breathe in again, repeat the cycle … Keep repeating this cycle until you feel relaxed
and calm and refreshed …

‘When you have finished this exercise, sit quietly for a few moments, and enjoy the feeling of relaxation. Don’t move
around too quickly if you have been quite relaxed – take it gently.’

All these exercises are a means to an end: the end point is your client being able to recognise
unproductive tension and respond by calming relaxing themselves. Everyone will fare differently and
progress will have its ups and downs, so you should prepare your client for this and help them to
experience set-backs as normal and as learning opportunities.

A cautionary word about safety-seeking behaviours

As you will be aware, some CBT strategies can be used as “safety-seeking behaviors” (SBs) or behaviours
that give reassurance without instilling fundamental confidence (see Salkovskis, 1991). There are no
absolute SBs as it is a person’s interpretation that distinguishes an SB from genuine coping. If someone
uses a technique, such as relaxation, and concludes that they only managed to get through because they
used the strategy, then they are using it as an SB. Relaxation is not helping them develop the confidence
that they can cope. On the other hand, a person might use relaxation and conclude that they made a good
decision, that their choice was helpful. In this instance they develop confidence that they can cope and
gain a longer-term sense of mastery over their problem – thus, relaxation is being used as a coping
strategy. You need to check that your patient is developing the latter attitude.

You can often encourage this by helping them to see that they have choices and are making decisions.
This will engender more of a sense of autonomy and mastery. You can also encourage people to
gradually reduce their use of relaxation exercises as their confidence in coping increases.

References:

Benson, H. (1975). The relaxation response. New York: Morrow

Jacobson, E. (1970). Modern treatments of tense patients. Springfield, IL: Thomas.

Salkovskis, P.M. (1991) The Importance of Behaviour in the Maintenance of Anxiety and Panic: A Cognitive Account
Behavioural Psychotherapy. 19, 6-1

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