Muscular relaxation exercises and deep breathing are two ways to help people to relax and combat symptoms of anxiety. They may also help to ease symptoms of depression. They can be used together with mindfulness techniques which have been shown to help with anxiety and depression.
Why do relaxation exercises?
Some people relax with sport, exercise, listening to music, watching TV or reading a book, etc. However, some people find it helpful to follow specific relaxation exercises. This leaflet gives a summary of two commonly used routines - deep breathing exercises and muscular relaxation exercises - and a brief introduction to mindfulness. These techniques are particularly useful to combat the two common physical symptoms of anxiety - over-breathing and muscular tension. There is some evidence that they may also help to ease symptoms of depression.
These exercises will be more effective the more you practise them. Take a few minutes each day and work through the exercises. As you practise them you are likely to find that your muscles are more relaxed more of the time and that you are breathing more deeply. Once you have learned them, you can then use them in everyday life whenever you feel tense or anxious.
Many people have a tendency to breathe faster than normal when they are anxious. Sometimes this can make you feel a little dizzy, which makes you more anxious and you breathe even faster, which can make you more anxious, etc. If you practise deep breathing when you are relaxed, you should be able to do this when you feel tense or anxious to help you to relax.
Try the following for 2-3 minutes. Practise this every day until it comes naturally to you and you may find that it reduces your background anxiety. You will then be able to do it routinely in any stressful situation:
- Breathe slowly and deeply in through your nose, and out through your mouth in a steady rhythm. Try to make your breath out twice as long as your breath in. To do this, you may find it helpful to count slowly 'one, two' as you breathe in, and 'one, two, three, four' as you breathe out.
- Mainly use your lower chest muscle (your diaphragm) to breathe. Your diaphragm is the big muscle under the lungs. It pulls the lungs downwards which expands the airways to allow air to flow in. When we become anxious we tend to forget to use this muscle and often use the muscles at the top of the chest and our shoulders instead. Each breath is more shallow if you use these upper chest muscles. So, you tend to breathe faster and feel more breathless and anxious if you use your upper chest muscles rather than your diaphragm.
- You can check if you are using your diaphragm by feeling just below your breastbone (sternum) at the top of your tummy (abdomen). If you give a little cough, you can feel the diaphragm push out here. If you hold your hand here you should feel it move in and out as you breathe.
- Try to relax your shoulders and upper chest muscles when you breathe. With each breath out, consciously try to relax those muscles until you are mainly using your diaphragm to breathe.
Planned times for regular positive relaxation
Find a quiet warm place where you won't be disturbed. Choose a time of day when you do not feel pressured to do anything else. Lie down on your back, or sit in a well-supported chair if you find that more comfortable. Once you have learned the exercises, close your eyes while you do them. You are going to work on each of your muscle groups. With each group of muscles, first tense the muscles as much as you can, then relax them fully. Breathe in when you tense the muscles and breathe out when you relax.
To start with, concentrate on your breathing for a few minutes. Breathe slowly and calmly, using the breathing techniques shown above. Each time you breathe out say words to yourself such as 'peace' or 'relax'. Then start the muscle exercises, working around the different muscle groups in your body.
- Hands - clench one hand tightly for a few seconds as you breathe in. You should feel your forearm muscles tense; then relax as you breathe out. Repeat with the other hand.
- Arms - bend an elbow and tense all the muscles in the arm for a few seconds as you breathe in; then relax as you breathe out. Repeat the same with the other arm.
- Shoulders - raise your shoulders as high as you can as you breathe in; then relax as you breathe out.
- Neck - press your head back as hard as is comfortable and roll it slowly from side to side; then relax.
- Face - try to frown and lower your eyebrows as hard as you can for a few seconds; then relax. Then raise your eyebrows (as if you were startled) as hard as you can; then relax. Then clench your jaw for a few seconds; then relax.
- Chest - take a deep breath and hold it for a few seconds; then relax and go back to normal breathing.
- Stomach - tense the stomach muscles as tightly as possible; then relax.
- Buttocks - squeeze the buttocks together as much as possible; then relax.
- Legs - with your legs flat on the floor, bend your feet and toes towards your face as hard as you can; then relax. Then bend them away from your face for a few seconds; then relax.
Then repeat the whole routine 3-4 times. Each time you relax a group of muscles, notice how they feel when relaxed compared to when they are tense. There may be groups of muscles that feel particularly tense, often the shoulders or jaw muscles. Make sure they feel properly relaxed by the time you have finished. If you practise these exercises every day you will find that they reduce your overall level of tension.
Obviously, you cannot do all of the above when out and about. However, the principle of full tension followed by relaxation of a group of muscles can help to ease anxiety in everyday situations. Therefore, in situations when you feel tension or anxiety rising, try either of the following:
- Twist your neck around each way as far as it is comfortable, then relax.
- Fully tense your shoulder and back muscles for several seconds, then relax.
Mindfulness is another technique which is often useful in managing depression and anxiety. It focuses on being present in the current moment, neither worrying about things which might happen in the future nor brooding on things which have happened in the past. Dwelling on your thoughts and worrying about things are common features of depression and anxiety and mindfulness has been shown to be effective at reducing these.
Mindfulness is sometimes taught as part of the treatment for mental health problems, in mindfulness-based cognitive therapy and mindfulness-based stress reduction. However, the basic techniques are easy to learn for yourself and there are a number of websites which can help.
How to practise mindfulness
When you are sitting somewhere quiet and relaxed, perhaps after you have done the exercises above, concentrate for a few minutes on your breathing and on how your body feels. Sounds may be going on around you and you will notice them. However, don't let your mind dwell on them. Thoughts will come into your mind and that is alright. However, try to let them go again and focus again on your breathing. The thoughts which normally worry you may seem less significant and overwhelming. Spend a few minutes each day practising living in the moment. As with the other exercises, you will find that the benefit extends out into other areas of your life.
Further reading & references
- Manzoni GM, Pagnini F, Castelnuovo G, et al; Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC Psychiatry. 2008 Jun 2;8:41.
- Jorm AF, Morgan AJ, Hetrick SE; Relaxation for depression. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD007142.
- Varvogli L, Darviri D; Stress Management Techniques: evidence-based procedures that reduce stress and promote health. Health Science Journal, Vol 5, Issue 2 (2011).
- Chen KW, Berger CC, Manheimer E, et al; Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials. Depress Anxiety. 2012 Jul;29(7):545-62. doi: 10.1002/da.21964. Epub 2012 Jun 14.
- Li AW, Goldsmith CA; The effects of yoga on anxiety and stress. Altern Med Rev. 2012 Mar;17(1):21-35.
- The Free Mindfulness Project
- Mental Health Foundation: Mindfulness
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Tim Kenny
Dr Jan Sambrook
Dr Hannah Gronow