Running Head: THE EFFECTS OF 1-WEEK OF PROGRESSIVE

The effects of 1-week of Progressive Muscle Image Training on physical and psychological
symptoms of stress
by
Kelly Werkheiser
Mansfield University B.S. Psychology: Health
for
PSY- 3332 Psychology of Stress Management
Dr. Francis Craig
11 December 2019
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The effects of 1-week of Progressive Muscle Image Training on physical and psychological

symptoms of stress

Stress can be defined in both physical and psychological terms. A study done by

Amirkhan, Landa, and Huff (2018), says that stress comes from minor or major external

demands. Participants were brought in and asked to complete a small survey packet. They then

took home a stress symptoms survey packet to complete one week later. The study concluded

that the indicated signs or symptoms are significantly linked to stress overload. This study based

their definition from Hans Selye who first defined stress in a study done in 1956. Later, In the

Journal of Extension, Selye published a personal message that included his definition of stress.

In the article he says that people need stress to have a productive life, it may cause sickness when

there is too much (1980). This is the same definition of stress that this study used.

Causing Health Related Problems

It is clear from the research that the effects of stress on physical and psychological states

may lead to health problems. In a study by Nygaard, Jensen, and Dyb (2012) they looked at the

stress reactions children with posttraumatic stress had. Participants from tsunami affected

countries were interviewed 10 to 11 months after a tsunami and then 2.5 years after the tsunami.

Results showed that when dealing with traumatized children it is helpful to separate the

symptoms of active avoidance and numbing. They also supported previous literature that says

arousal is a feature of posttraumatic stress disorder, and arousal is highly related to general

mental health problems. Another previous study done about stress related health problems was

done by Lippert and Lee (2015). They looked at data from a study done about stress and coping

in the US homeless population. The data was separated and analyzed by homeless type, which

included new-entry, chronic, and episodic. They found that people who are homeless chronically
THE EFFECTS OF 1-WEEK OF PROGRESSIVE 3

or episodically are more likely to have psychiatric disorders. The reason they found that people

who are new to homelessness do not commonly have a disorder is they have not had as many life

stressors. Another study that investigated mental health problems due to stress was by Zhu,

Chen, Ou, Geng, Jiang (2014). The researchers looked into the relationship between stress and

mental health in civil servants. Participants completed self-administrated questionnaires for a

two-week span. Along with other measures after the two weeks were done. They concluded that

personal, interpersonal, job, and cultural stress were associated with mental health problems, in

civil servants.

Reducing Stress Improves Health

Research has found that reducing of the experience of stress may be important to

improving one’s health. A study was done by Jennings, Henderson, Eria, Abraham, and Gillum

(2018) about the difference in stress coping behaviors in college athletes and non-athletes. All

participants are form a faith-based college, about half athletes and half non-athletes. Participants

completed a survey about positive and negative coping behaviors. Results showed that athletes

coped by exercise while non-athletes coped by listening to music and socializing. Another study

that was done about reducing stress to improve a person’s health was by Gaines and Barry

(2008). This study looked at the effect relaxation breathing had on aggressive male adolescent

behavior. The study was a single-subject design with six different participants. Each participant

earned a daily percentage score throughout the study. Also, each participant received a self-

monitored checklist and schedule. The researchers found that it depended in the person for how

well the breathing worked. Two out of the Six participants behavior significantly increased in a

short amount of time. Another article by Mackenzie, Wiprzycha, Hasher, and Goldstein (2007),

originally looked into if expressive writing reduced stress in caregivers. Participants were split
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into three writing groups where they wrote about a topic from twenty minutes, four times over a

two-week period. They found that with care givers time management was what significantly

reduces stress.

Techniques

Techniques which may be helpful in countering the effects of physical/psychological

aspects of stress are Progressive Muscle Relaxation, Autogenic Training, and guided imagery. In

a study by Parás-Bravo, Salvadores-Fuentes, Alonso-Blanco, Paz-Zulueta, Santibañez-

Margüello, Palacios-Ceña, Boixadrea-Planas, Fernández-de-las-Peñas (2017), they looked at

what a muscle relaxation technique can do for cancer patients’ quality of life. All participants did

progressive muscle relaxation training and had a weekly phone call for one month. They found

that the participants score on the Functional Assessment of Cancer Therapy-General significantly

improved after using PMR and felt their quality of life was better. A systematic review by Kanji

and Ernst (2000), they found that overall the practice of autogenic training does reduce stress and

anxiety. They also noticed that more research needs to be done because of limitations in previous

studies. Another previous study by Apostolo and Kolcaba (2009), investigated the effects of

guided imagery on stress and other factors. Participants listened to a guided imagery recording

and were invited to breath deeply through the process. The researchers found that guided

imagery decreases stress and increases comfort.

New Technique

For this study, the effects of Progressive Muscle Image Training on physical/

psychological aspects of stress were observed.

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The hypotheses tested were:

1. Stress related symptoms will decrease after one week of doing the Progressive Muscle

Image Training technique.

a. After one week of using PM-IT the participants Stress Experience Scale score will

decrease.

b. After one week of using PM-IT the participants quality of sleep will increase.

Methods

Participants

The participant volunteered from the Psychology of Stress Management class at

Mansfield University. There is 1 female participant who is 20-year-old. The participant is a

junior in the psychology program at Mansfield University.

Materials

The script used to direct the Progressive Muscle Image Training session was recorded for

playback. The recording was given to the participant to listen to on their own. The written script

is included as Appendix A. The scale used was the Stress Experience Scale. The scale is included

as Appendix B and a description is below.

Progressive Muscle Image Training Script. This is a relaxation technique meant to

reduce the feeling of stress. The recorded script is a combination of the Progressive Muscle

Relaxation technique and the Autogenic image. (Appendix A)

Stress Experience Scale. This scale is a pre-post-test design that asks the participant to

rate symptoms related to stress on a 1-5 Likert scale from “Not at all” to “All the Time”. Broken
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down into sections that include: muscular, digestive/gastrointestinal, sleep patterns, general

sympathetic arousal, emotional, vital energy, immune, psychomotor, social patterns,

cardiovascular, cognitive, and behavioral. Each section is added up to get a sub scores, then the

sub scores are added for a total score. (Appendix B)

Pillow App Sleep Monitor. Located on an Apple I phone, the app tracks a person’s sleep

patterns throughout the night. Data collected includes: time in bed, time asleep, and sleep quality.

The information used for the study was the percentage of sleep quality.

Procedure

The participant was a student recruited from the class Psychology of Stress Management.

The study was a single subject pre-post design. The participant was in charge of playing and

completing the technique throughout the week. Before the week began the participant completed

the pre-test portion of the Stress Experience Scale about the week prior.

During the week the participant did four sessions of the Progressive Muscle Image

Training technique every other day before going to sleep. Six nights during the seven-day week

the sleep tracking app was used. Before starting a session of using the technique the participant

turned off the lights and made themselves comfortable, in a lying position, on their bed. The

participant would then press play on the recording and follow the instructions. After the

participant finished the session and before they went to bed, the Pillow App Sleep Monitor was

opened, and they followed the instructions. The instructions were to place the phone face down

on the bed next to their pillow. After the week of technique sessions, the participant filled out the

post-test portion of the Stress Experience Scale. All information was then collected by the

researcher.
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Analysis

All analysis was done using the program Microsoft Excel. A pre-post percent change was

used to assess the change in scores from the Stress Experience Scale.

Results

All data was analyzed using quantitative procedures. Pre-test and post-test sub scores

were used to calculate percent change. The pre-test sub scores were as followed: Muscular- 23,

GI- 18, Sleep- 12, Sympathetic Arousal- 12, Emotional- 30, Vital Energy- 13, Immune- 8,

Psychomotor- 19, Social Patterns- 13, Cardiovascular- 7, Cognitive- 25, and Behavioral- 12. The

pre-test created a baseline for the participant. The post-test sub scores were as followed:

Muscular- 15, GI- 13, Sleep- 5, Sympathetic Arousal- 10, Emotional- 15, Vital Energy- 5,

Immune- 6, Psychomotor- 10, Social Patterns- 6, Cardiovascular- 6, Cognitive- 13, and

Behavioral- 10. The participants total pre-test scores were 192, and their total post-test score was

114.

Stress Experience Scale. The percent change of the pre and post test scores were

calculated using the formula (100*Change)/baseline. The percent changes of the subsections are

represented in Graph 1. The sub scores percent change was as followed: Muscular- -34.78, GI- -

27.78, Sleep- -58.33, Sympathetic Arousal- -16.67, Emotional- -50.00, Vital Energy- -61.54,

Immune- -25.00, Psychomotor- -47.37, Social Patterns- -53.85, Cardiovascular- -14.29,

Cognitive- -48.00, and Behavioral- -16.67. The total score percent change was -40.63. The

significance of the percent change supports hypothesis 1 and 1a. The participants stress related

symptoms and score on the Stress Experience Scale decreased after one week.
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Graph 1

Pre-Test Score vs. Percent Change

40

20

-20

-40

-60

-80

Pre % change

Sleep Quality. The participants sleep quality was not significantly affected by the

Progressive Muscle Image Training technique. The percentage of sleep quality is shown in

Graph 2. The non-significance does not support hypothesis 1b. The participants sleep quality

percent did not decrease throughout the week.

Graph 2

SLEEP QUALITY
120%

98%
100%

75% 78% 78%

80%
67% 67%

60%

40%

20%

0%
Nov 18-19 Nov 19-20 Nov 20-21 Nov 21-22 Nov 22-23 Nov 23-24
THE EFFECTS OF 1-WEEK OF PROGRESSIVE 9

Discussion

Analysis was done to examine if the Progressive Muscle Image Training reduced the

symptoms and feelings of stress. Several studies have looked at Progressive Muscle Relaxation

and Autogenic Training but very few have created a combination of the two. The decrease in

stress experiences is connected to the use of the Progressive Muscle Image Training technique.

Through the findings of the study, hypothesis 1 and 1a were supported. Stress symptoms

decreased after the use of the Progressive Muscle Image Training technique. The percent change

of the Stress Experience Scale scores verifies the change over time. The total scores from the

measure also showed a decrease after the one week of using the technique. In previous study’s

after using Progressive Muscle Relaxation, cancer patients felt like thye had better daily function

(Parás-Bravo, Salvadores-Fuentes, Alonso-Blanco, etc., 2017), and after using guided imagery

the participant experienced a decrease in stress and improved comfort (Apostolo & Kolcaba,

2009). The combination of these two techniques also resulted in the same outcome.

Through the findings of the study, hypothesis 1b. was not supported. Sleepy quality did

not increase throughout the week of using Progressive Muscle Image Training. In a study by

Sun, Kang, Wang, and Zeng (2012), self -relaxation did improve an older person sleep quality

and cognitive functions. Unlike the previous research, the quality of sleep did not significantly

improve over the week. The quality of sleep stayed consistent after the first night. There is also

no significant pattern in the sleep quality percentages between the days when the technique was

used or not.

This research contributes to the existing literature by creating a relaxation technique that

combines Progressive Muscle Relaxation, Autogenic Training, and Guided Imagery. This
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technique can be shifted and changed due to a person’s specific needs. Since it combines

multiple techniques more people may be able to use it effectively. The study clarifies that this

technique decreases the physical and psychological symptoms of stress that someone feels.

Limitations and Future Research

Limitations specific to this study was that the sleep tracking should have started the week

before the sessions and continued a week after. This would have allowed for more sleep quality

data to be collected and a trend may have been seen. If this is included in further research the

week before should be tracked for sleep quality to get a baseline of the participants quality of

sleep. Another limitation of the study was the sample size. In future reseach, a single-subject

study should be done but with more participants. This will allow for descriptive statistics to be

run on the participants to account for any differences in groups. Future research could also be

done by looking deeper into other causal experiences of stress, such as someone’s, appetite,

energy, and immune system. This would increase the knowledge of what and how much the

relaxation technique can improve a person’s quality of life.

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References

Amirkhan, J. H., Landa, I., & Huff, S. (2018). Seeking signs of stress overload: Symptoms and

behaviors. International Journal of Stress Management, 25(3), 301–311.

doi:10.1037/str0000066

Apostolo, J. L. A., Kolcaba, K. (2009). The effects of guided imagery on comfort, depression,

anxiety, and stress of psychiatric inpatients with depressive disorders. Archives of

Psychiatric Nursing, 23(6), 403-411. doi: 10.1016/j.apnu.2008.12.003

Gaines, T., & Barry, L. M. (2008). The effect of a self-monitored relaxation breathing exercise

on male adolescent aggressive behavior. Adolescence, 43(170), 291–302.

Jennings, R. A., Henderson, C. S., Erla, M. A., Abraham, S., & Gillum, D. (2018). Stress coping

behaviors of faith–based college non-student athletes vs student-athletes. College Student

Journal, 52(2), 245–257.

Kanji, N., & Ernst, E. (2000). Autogenic training for stress and anxiety: a systematic review.

Complementary Therapies in Medicine, 8, 106-110. doi: 10.1054/ctim.2000.0354

Lippert, A. M., & Lee, B. A. (2015). Stress, coping, and mental health differences among

homeless people. Sociological Inquiry, 85(3), 343–374. doi: 10.1111/soin.12080

Mackenzie, C., Wiprzycka, U., Hasher, L., & Goldstein, D. (2007). Does expressive writing

reduce stress and improve health for family caregivers of older adults? The

Gerontologist, 47(3), 296-306. doi: 10.1093/geront/47.3.296

Nygaard, E., Jensen, T. K., & Dyb, G. (2012). Stability of posttraumatic stress reaction factors

and their relation to general mental health problems in children: A longitudinal

THE EFFECTS OF 1-WEEK OF PROGRESSIVE 12

study. Journal of Clinical Child and Adolescent Psychology, 41(1), 15–26.

doi:10.1080/15374416.2012.632344

Parás-Bravo, P., Salvadores-Fuentes, P., Alonso-Blanco, C., Paz-Zulueta, M., Santibañez-

Margüello, M., Palacios-Ceña, D., Boixadrea-Planas, E., & Fernández-de-las-Peñas, C.

(2017). The impact of muscle relaxation techniques on the quality of life of cancer

patients, as measured by the FACT-G questionnaire. PLoS ONE, 12(10). doi:

10.1371/journl.pone.0184147

Selye, H. (1980). A personal message from Hans Selye. Journal of Extension, 18(3), 1.

Sun, J., Kang, J., Wang, P., & Zeng, H. (2012). Self-relaxation training can improve sleep

quality and cognitive functions in the older: a one year randomized controlled trial.

Journal of Clinical Nursing, 22, 1270-1280. doi: 10.1111/jocn.12096.

Zhu, C., Chen, L., Ou, L., Geng, Q., & Jiang, W. (2014). Relationships of mental health

problems with stress among civil servants in guangzhou, china. Community Mental

Health Journal, 50(8), 991-996. doi: 10.1007/s10597-014-9726-7

THE EFFECTS OF 1-WEEK OF PROGRESSIVE 13

Appendix A

(Progressive Muscle Image Training Script)

Position yourself lying down

Let go of all tension and relax.

Close your eyes

Take in a long, deep breath and exhale very slowly…

Now breathe easily and freely in and out…

(Legs)

Flex your thighs Relax and notice the difference.

Again, flex your thighs Relax and notice the difference.

Flex your knees and thigh muscles again. Hold the tension.

Relax your knees and thighs…

Point your feet and toes downward, away from your face, so that your calf muscles become tense.

Study that tension. Relax your feet and calves.

Again, point your toes downward Hold the tension

Relax your feet and calves

This time bend your feet toward your face so that you feel tension along your shins. Relax

Again, bend your feet toward your face Feel the tension and relax

Think to yourself

I am calm

I am relaxed

I am quiet

(Chest)

breathe in and fill your lungs Inhale deeply and hold your breath.

Study the tension. Now exhale, and push the air out automatically

Feel the relaxation

Fill your lungs again. Breathe in deeply and hold it.

Now breathe out, and appreciate the relief,

Continue relaxing your chest, and let the relaxation spread to your back, shoulders, neck, and arms…

Now tighten your stomach muscles Notice the tension. And relax

Once more, press and tighten your stomach muscles.

Hold the tension and study it. And relax

Continue breathing normally and easily

Now direct your attention to your lower back.

Arch up your back and feel the tension along your spine. Now relax your lower back

Arch your back and feel the tension again. Keep the rest of your body relaxed.
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Localize the tension throughout your lower back area. Relax once more

Relax your lower back, relax your upper back, spread the relaxation to your stomach, chest, shoulders, arms, and facial area…

Think to yourself

I am calm

I am relaxed

I am quiet

(Face)

Wrinkle up your forehead

And now stop wrinkling your forehead. Relax and smooth it out…

Again, wrinkle your forehead and relax

Now frown and crease your brows and study the tension. Let go of the tension again…

Smooth out the forehead

Crease your brow once more and relax

clench your jaw, by pushing your teeth together. Study the tension throughout the jaw

Relax your jaw now…

Let your lips part slightly. Now press your tongue hard against the roof of your mouth.

Look for the tension. Let your tongue return to a comfortable and relaxed position.

Now purse your lips; press your lips tighter and tighter together Relax your lips…

Again, purse your lips tightly together and relax

Feel the relaxation all over your face, all over your forehead, and scalp, eyes, jaw, lips, tongue, and throat

Now tilt your head back to look at the wall behind you and feel the tension in your neck

Roll your neck to the right, and feel the tension shift… Now roll it to the left.

Straighten your head Reach your chin towards your chest

Let your head return to a comfortable position and study the relaxation….

Shrug your shoulders. And relax Let your Neck and shoulders relax.

Shrug your shoulders again, and move them around Bring your shoulders up, and forward, and back

Feel the tension in your shoulders and in your upper back.

Drop your shoulders once more and relax…

Relax your neck, throat, jaw and other facial areas

Think to yourself

I am calm

I am relaxed

I am quiet

(Legs)

Again, flex your thighs Relax and notice the difference.

Flex your thighs again Relax and notice the difference.

Flex your knees and thigh muscles again. Hold the tension.

Relax your knees and thighs…

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Point your feet and toes downward, away from your face, so that your calf muscles become tense.

Study that tension. Relax your feet and calves.

Again, point your toes downward Hold the tension

Relax your feet and calves

This time bend your feet toward your face so that you feel tension along your shins.

Relax

Again, bend your feet toward your face Feel the tension and relax

Think to yourself

I am calm

I am relaxed

I am quiet

(Arms)

As you relax, clench your right fist. Clench it tighter and tighter, and study the tension

Feel the tension in your right fist, hand, and forearm. Now relax…

Let the fingers of your right hand become loose. Observe the contrast in your feelings.

Once more, clench your right fist tight. Hold it, and notice the tension

Now, let go, relax let your fingers straighten out. Notice the difference once more

Now clench your left fist while the rest of your body relaxes.

Clench your fist tighter and feel the tension. And now relax…

Repeat this one more time, clench the left fist Now relax and feel the difference

Clench both fists tighter and tighter, Study the sensations

…and relax… Straighten out your fingers and feel the relaxation…

Now bend your elbows and tense your biceps. Tense them harder, and study the feeling

straighten out your arms… Let them relax, and feel the difference again

Once more, tense your biceps. By bending your elbows

Hold the tension and observe it carefully. Straighten your arms, and relax…

Now straighten your arms so that you feel the most tension along the back of your arms

Stretch your arms and feel the tension. And now relax…

Straighten your arms once more so that you feel the tension again.

Relax and get your arms back to a comfortable position

Relax your feet, ankles, calves, shins, knees, thighs, buttocks, and hips…

Feel the heaviness of your lower body as you relax further relax your stomach, waist, and lower back.

Make sure no tension has crept into your throat.

Relax your neck and your jaw and all your facial muscles

notice any tension that might have crept into your shoulders and arms.

Think to yourself

I am calm

I am relaxed
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I am quiet

Now think of a relaxing scene

You open a heavy oak door stepping out of the cold into a cabin in the woods. There is snow outside covering the ground and tress. A light flurry
falling from the sky. Everything outside looks completely white. It is cold outside but a comfortable warm temperature inside. There are no other
people around but there are animals occasionally outside and a Huskey inside with you. You are surrounded by warm tones including brown,
orange, and red. There is a Christmas tree in the corner with colored lights twinkling. Outside is very still with no wind so the only sounds are the
crackle of the fire in the fireplace, and jazz Christmas music playing softly in the background. The only movement is the occasional animal
outside and the dog inside walking around calmly. Your body feels very relaxed with no aches or pains. You are comfortable on the couch
covered in cozy blankets but not too hot. Your mind feels at peace and calm with no worries.

This scene relaxes you

Imagine yourself there

See this scene clearly

Hear the crackle of the fire

See the colors

You are quiet

You are at peace

Experience it

Be one with it

You are calm

Your mind is quiet

Silence for 1min

Now prepare to leave your scene

Count backward from five

With each number you will be more alert

With each number you will be closer to opening your eyes

Five

You are leaving your scene

You get up from the couch

Open the heavy door and you are outside

Four

You are back in this room

You are laying down

You know where you are

Three

Prepare to open your eyes

Think of what you will see when you open your eyes

Two

Open your eyes

Focus on one object in the room

Take a deep breath

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One

Focus on objects about the room

Take several deep breaths

When you feel ready stretch your arms and legs

Take several deeper breaths

Now proceed knowing you are relaxed

THE EFFECTS OF 1-WEEK OF PROGRESSIVE 18

Appendix B
Use the following scale to rate change
1=Not at all
STRESS EXPERIENCE SCALE (pre-test and post-test) 2=Just a little
3=Occasionally
4=Frequently
Note the regularity experiencing each in the past week 5=All the Tie

MUSCLUAR IMMUNE
Neck muscles stiff Skin/complexion changes
Back/Shoulder muscles stiff Felt Flu-like/Cold-Like
General muscle tension/soreness Allergies active
Tension headache Got sick easily
Lower back pain SUB-SCORE TOTAL
Muscle aches/soreness
Jaw ache/Jaw tension
Toes & Feet Cramp/Ache PSYCHOMOTOR
SUB-SCORE TOTAL Shaky
Play with hair or hands
DIGESTIVE/GASTROINTESTINAL Bite nails
Butterflies in stomach Can’t sit still/Restless
Upset stomach Grind Teeth
Acid stomach Couldn’t sit still/”hyper”
Gastrointestinal upsets Bit on my lower lip
Change in Appetite SUB-SCORE TOTAL
Nausea
Change in regularity SOCIAL PATTERNS
Diarrhea Need to talk to someone
SUB-SCORE TOTAL Wanted to be left alone
Felt less sociable
SLEEP PATTERNS Felt detached from loved ones
Decreased sleep Quantity Difficulty finding right words to say
Decreased sleep Quality SUB-SCORE TOTAL
Wake up frequently CARDIOVASCULAR
Trouble Falling Asleep Chest pain/discomfort
SUB-SCORE TOTAL Faster heart rate
GENERAL SYMPATHETIC AROUSAL Pounding heartbeat
Dry mouth Need to urinate
Hands sweaty/clammy SUB-SCORE TOTAL
Eyes hurt COGNITIVE
Changes in body temperature Difficulty concentrating
Changes in breathing Confused Thinking
Sweat more Racing Thoughts
Felt Flushed (hot) Made bad decisions/judgement errors
SUB-SCORE TOTAL Difficulty Remembering stuff
EMOTIONAL Over-thinking of problems
Quicker to anger/edgy Exaggerated problems
Moody” Loss of concentration
Impatient Concentration on stressor
Irritable Negative Thinking
Felt time pressured/rushed Felt like I was “screwing up”
Less Motivated Decreased Attention
Grouchy Forgetful
Sad/depressed SUB-SCORE TOTAL
Anxious BEHAVIORAL
Giddy/Silly Poorer work/study behavior
Needy Change in appetite
Worried Cried
Frustrated Yelled/Snapped
SUB-SCORE TOTAL Abused substances (legal or illegal)
VITAL ENERGY Smiled less
Decreased activity level Avoided eye contact
Exhausted feeling Impulsive
Tried constantly Cleaning Behavior
Easily tired out SUB-SCORE TOTAL
Felt like I was “running on fumes”
SUB-SCORE TOTAL TOTAL SCORE