D I S S E R TAT I O N I N B R I E F

Progressive Muscle Relaxation, Breathing Exercises,

and ABC Relaxation Theory
Ä

Mia Matsumoto and Jonathan C. Smith

Roosevelt University Stress Institute

This study compared the psychological effects of Progressive Muscle Relax-

ation (PMR) and breathing exercises. Forty-two students were divided ran-
domly into two groups and taught PMR or breathing exercises. Both groups
practiced for five weeks and were given the Smith Relaxation States Inven-
tory before and after each session. As hypothesized, PMR practitioners
displayed greater increments in relaxation states (R-States) Physical Relax-
ation and Disengagement, while breathing practitioners displayed higher
levels of R-State Strength and Awareness. Slight differences emerged at
Weeks 1 and 2; major differences emerged at Weeks 4 and 5. A delayed
and potentially reinforcing aftereffect emerged for PMR only after five
weeks of training—increased levels of Mental Quiet and Joy. Clinical and
theoretical implications are discussed. © 2001 John Wiley & Sons, Inc. J
Clin Psychol 57: 1551–1557, 2001.

Keywords: ABC relaxation; breathing exercises; Jacobson; meditation;

progressive muscle relaxation; relaxation response; yoga

Progressive Muscle Relaxation (PMR; Jacobson, 1929) and breathing exercises are used
widely in clinical and health psychology (Smith, 1999a). Although considerable research
has examined the efficacy of PMR, relatively little has focused on breathing as a specific
approach (Bernstein, Borkovec, & Hazlett-Stevens, 2000; Lehrer & Woolfolk, 1993). No
research has compared both approaches. Different perspectives of relaxation have differ-
ent predictions for the effects of both techniques. Benson (1975) has hypothesized that all
relaxation techniques evoke a nonspecific relaxation response of reduced sympathetic
arousal. Davidson and Schwartz’s (1976) cognitive/somatic specificity hypothesis pos-
tulates two major categories of arousal and relaxation, cognitive and somatic. Both hypoth-

This study was completed by the first author as a Master’s thesis in partial completion of the requirements for
the master’s degree in Clinical Psychology at Roosevelt University.
Correspondence concerning this article should be addressed to: Jonathan C. Smith, Director, Roosevelt Uni-
versity Stress Institute, 430 S. Michigan Ave., Chicago, IL 60605.

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 57(12), 1551–1557 (2001)

© 2001 John Wiley & Sons, Inc.
1552 Journal of Clinical Psychology, December 2001

eses predict that PMR and breathing are somatic techniques that should be equally effective
in reducing somatic arousal and physical symptoms; indeed, most clinicians who use
these techniques assume technique equivalency (Smith, 1999a). However, Smith’s (Smith,
1999a, 1999b) Attentional Behavioral Cognitive (ABC) relaxation theory proposes that
the effects of PMR and breathing exercises should be quite different.
ABC relaxation theory is a comprehensive, empirically based psychological theory
of relaxation. In developing his perspective, Smith started with an exhaustive catalog of
400 words used to describe experiences people have while practicing or engaging in
activities generally accepted as relaxation (progressive muscle relaxation, autogenic train-
ing, yoga, breathing exercises, imagery, creative visualization, tai chi, self-hypnosis, med-
itation, contemplation, and prayer). Through a series of eight separate factor analytic
studies involving a combined sample of 2616 participants, Smith and his colleagues
(Smith, 2001) identified what are currently 15 (or “14 1 1”) relaxation state (R-State)
categories: Sleepiness, Disengagement, Physical Relaxation, Mental Quiet, Rested/
Refreshed, At Ease/Peace, Positive Detachment (manifested as Childlike Innocence),
Energized, Joy, Thankfulness and Love, Mystery, Awe and Wonder, Prayerfulness, and
Timeless/Boundless/Infinite. The fifteenth R-State, Aware, is a metastate that can exist
either alone or in combination with other states.
According to ABC relaxation theory, all approaches to relaxation involve sustaining
passive simple focus—for PMR, the focus is tensing up and letting go; for breathing, it is
the flow of breath, and so on. However, techniques differ dramatically as to which R-States
they evoke. To date, over 30 studies involving over 9000 participants provide substantial
support for this perspective (Smith, 2001) and has revealed major differences among
relaxation techniques; notably, practitioners of progressive muscle relaxation consis-
tently recall feeling Disengagement and Physical Relaxation, whereas breathing and yoga-
stretching practitioners recall Strength and Awareness (now termed Energized). However,
such retrospective research has serious limitations. Do relaxers accurately recall within-
session experiences? Do recollections accurately reflect pre-post session changes?
The present study attempts to compare directly the R-States evoked by PMR and
breathing. We hypothesized that five weeks of PMR will increase significantly R-States
Physical Relaxation and Disengagement, whereas five weeks of breathing exercises will
increase R-State Strength and Awareness.

Method

Participants

Participants consisted of 42 undergraduate college students (14 males, 28 females, aver-

age age 5 19.55, sd 5 0.57; PMR age 5 19.79, sd 5 .61; breathing age 5 19.35, sd 5 .43).
Five males and 16 females were assigned to breathing relaxation and 9 males and 12
females to PMR. All participants completed training and filled out questionnaires. All
completed the entire five-week program, and all applicable APA guidelines were followed.

Instruments

All participants took the Smith Relaxation States Inventory (SRSI; Smith, 2001), an early
version consisting of 25 self-report items that tap ten R-States (Sleepiness, Disengage-
ment, Physical Relaxation, Mental Quiet, At Ease/Peace, Strength and Awareness, Joy,
Love and Thankfulness, Prayerfulness, and Timeless/Boundless/Infinite) and three stress
 Progressive Muscle Relaxation and Breathing Exercises 1553

states (somatic stress, worry, negative emotion); this version does not tap R-States Rested/
Refreshed Relaxation, Positive Detachment (Childlike Innocence), Mystery, or Awe and
Wonder. A state format was deployed in which participants indicated how they currently
felt at the present moment using 6-point Likert scale (1 5 not at all, 6 5 the most ever).
Chronbach’s a reliabilities range from .60 to .88 (Smith, 2001).

Procedure
Participants were assigned randomly to two groups, progressive muscle relaxation and
deep breathing. Instructions for both were read (by MM) directly from standardized
scripts offered by Smith (1999b). The presenter was not blind to the hypotheses, a major
limitation of this study. Each exercise sequence was approximately 30 min in length and
roughly equivalent in complexity. Specifically, Smith’s scripts attempt to provide “pure”
versions of techniques reflecting only one attentional strategy. Thus, PMR incorporates
only tensing up and letting go (without accompanying breathing, stretching, or imagery
instructions often included in popular versions of PMR). Breathing exercises incorporate
only attention to the flow of breath. The entire script of eleven PMR exercises and twelve
breathing exercises were included.
Each group met with the experimenter (MM) for five consecutive weekly sessions
and practiced the assigned 30-min exercise as she read instructions. Participants did not
practice at home. For Weeks 1 and 5, questionnaires were administered three times through-
out the session: immediately prior to practice (pretest), immediately following practice
(posttest), and three min after the posttest (aftertest). During the 3-min pause, partici-
pants were instructed to think casually about the forthcoming day and week’s activities).
For Weeks 2, 3, and 4, the SRSI was given immediately before and after relaxation.

Results
Over five weeks, a sequence of 12 tests were given (5 weekly pretests; 5 weekly post-
tests; and 2 aftertests, one for Week 1 and one for Week 5). Repeated measures analyses
of variance (ANCOVAs) were conducted on the sequence of 11 tests given after Week 1
pretest (yielding a total of 4 pretests, 5 posttests, 2 aftertests); covariates included test 1
(Week 1 pretest) scores (for each variable under consideration), gender, and age. Five
highly significant Group X-Week interactions emerged for which there were significant
pairwise comparisons ( p 5 .05): PMR participants scored higher on Disengagement
[F(10,16) 5 16.03, p 5 .0005], Physical Relaxation [F(10,16) 5 17.72, p 5 .0005],
Mental Quiet [F(10,17) 5 8.85, p 5 .0005], and Joy [F(10,17) 5 9.79, p 5 .0005].
Breathing participants scored higher on Strength and Awareness [F(10,16) 5 10.29, p 5
.0005]. No other analyses reached statistical significance ( p . .05). See Table 1 for
means and standard deviations and Table 2 for summary of all repeated measures
ANCOVAS.
Pairwise comparisons were conducted for each test time (pretest, posttest, and after-
test for each of five weeks) for R-States Disengagement, Physical Relaxation, Mental
Quiet, Strength and Awareness, and Joy. At Week 1 aftertest, PMR practitioners scored
modestly higher ( p # .05) on Physical Relaxation [F(1,40) 5 11.94, p 5 .001] and at
Week 2 on Physical Relaxation and Disengagement [F(1,40) 5 6.23, p 5 .02]. At Week
1, breathing practitioners scored modestly higher on Strength and Awareness [F(1,40) 5
7.25, p 5 .01].
Pronounced differences on Disengagement and Physical Relaxation did not emerge
until the very end of training at Weeks 4 and 5 [F(1,40) 5 14.48, p 5 .0005]. At Week 5
1554 Journal of Clinical Psychology, December 2001

Table 1
Means and Standard Deviations for Progressive Muscle Relaxation and
Breathing Participants on All Variables

R-State Pretest Group Week 1 Week 2 Week 3 Week 4 Week 5

Sleepiness PMR 5.48 (2.94)* 5.48 (2.84) 5.00 (2.61) 5.86 (2.87) 5.33 (2.50)
Breathing 4.86 (2.54) 3.57 (1.29) 4.90 (2.02) 4.24 (1.34) 3.52 (1.91)
Disengagement PMR 4.76 (1.76) 5.35 (1.65) 5.14 (1.80) 5.96 (1.56) 5.52 (1.63)
Breathing 4.33 (2.06) 3.67 (1.77) 4.33 (2.03) 4.38 (2.01) 4.29 (2.37)
Physical Relaxation PMR 4.76 (1.97) 5.33 (1.65) 5.24 (2.05) 5.71 (1.79) 6.00 (1.58)
Breathing 4.90 (1.89) 3.52 (0.87) 4.14 (1.74) 4.19 (1.57) 4.71 (1.82)
Mental Quiet PMR 4.57 (1.47) 4.71 (1.76) 5.10 (1.79) 5.24 (2.02) 6.14 (1.93)
Breathing 4.33 (1.39) 3.62 (1.63) 3.62 (1.47) 4.19 (5.24) 6.24 (1.64)
At Ease/Peace PMR 6.76 (1.45) 6.81 (1.69) 6.57 (1.50) 6.48 (1.69) 6.52 (1.99)
Breathing 5.81 (1.25) 5.38 (1.32) 5.38 (1.96) 6.14 (1.68) 5.90 (2.51)
Strength and Awareness PMR 6.14 (1.80) 6.10 (1.76) 6.19 (1.69) 6.24 (2.10) 6.38 (2.01)
Breathing 5.30 (1.45) 5.52 (1.36) 5.81 (1.83) 6.14 (2.03) 6.05 (2.09)
Joy PMR 6.19 (1.94) 6.33 (1.91) 6.79 (2.02) 6.29 (2.61) 6.52 (1.99)
Breathing 5.38 (1.43) 5.71 (0.78) 5.19 (1.75) 5.24 (2.07) 5.90 (2.50)
Love and Thankfulness PMR 6.52 (2.09) 6.67 (0.48) 7.19 (2.29) 6.67 (2.61) 6.38 (2.01)
Breathing 6.24 (1.92) 6.48 (0.51) 5.81 (1.69) 5.90 (1.58) 6.04 (2.08)
Prayerfulness PMR 2.19 (1.12) 2.43 (1.29) 2.81 (1.44) 2.76 (1.51) 2.57 (1.36)
Breathing 1.67 (1.02) 1.57 (0.98) 1.76 (1.00) 1.71 (1.01) 1.96 (1.06)
Timeless PMR 2.14 (0.96) 2.45 (1.23) 2.24 (1.22) 2.67 (1.20) 2.33 (1.07)
Breathing 2.05 (1.28) 1.85 (0.88) 1.81 (0.81) 1.76 (0.70) 1.81 (1.16)
Physical Stress PMR 6.19 (3.14) 5.48 (1.75) 5.67 (2.76) 4.62 (2.01) 4.33 (1.71)
Breathing 7.14 (2.41) 6.33 (1.53) 6.10 (1.79) 4.95 (1.40) 4.95 (0.92)
Worry PMR 2.24 (1.37) 1.95 (0.92) 1.76 (0.89) 2.05 (1.24) 2.00 (1.00)
Breathing 3.00 (1.00) 3.14 (0.96) 2.38 (1.02) 1.90 (0.89) 2.47 (.87)
Negative Emotion PMR 5.76 (2.81) 4.86 (1.49) 4.33 (1.24) 4.47 (1.17) 4.33 (1.71)
Breathing 6.43 (1.78) 5.95 (1.20) 4.48 (1.21) 4.76 (1.09) 4.95 (.92)

R-State Posttest

Sleepiness PMR 6.33 (2.92) 5.52 (2.62) 6.62 (3.17) 6.76 (3.36) 5.86 (2.22)
Breathing 4.19 (1.83) 4.48 (1.36) 5.00 (2.70) 4.76 (2.78) 4.24 (1.22)
Disengagement PMR 6.62 (2.42) 7.19 (1.29) 7.33 (2.37) 8.00 (1.84) 7.90 (1.61)
Breathing 5.33 (1.85) 5.81 (2.18) 6.33 (2.01) 6.24 (2.59) 5.57 (1.94)
Physical Relaxation PMR 8.62 (1.72) 8.81 (2.14) 9.38 (1.72) 9.86 (1.53) 10.24 (1.64)
Breathing 7.33 (2.63) 7.19 (2.09) 7.62 (2.58) 7.29 (2.41) 7.81 (2.42)
Mental Quiet PMR 6.57 (1.83) 6.53 (2.06) 6.62 (2.67) 6.33 (2.24) 6.62 (2.18)
Breathing 6.62 (1.77) 6.05 (2.64) 5.67 (2.67) 6.24 (2.64) 5.81 (2.23)
At Ease/Peace PMR 7.62 (1.80) 7.62 (1.99) 7.62 (2.16) 7.76 (2.00) 7.71 (1.93)
Breathing 7.76 (1.61) 7.48 (1.89) 7.33 (2.11) 7.57 (1.78) 7.71 (1.68)
Strength and Awareness PMR 6.57 (1.75) 7.38 (2.46) 7.00 (2.28) 6.71 (2.08) 6.95 (2.18)
Breathing 7.90 (1.45) 8.19 (1.89) 7.57 (2.18) 8.14 (2.06) 8.38 (2.20)
Joy PMR 6.62 (1.75) 7.10 (2.43) 7.19 (2.23) 6.81 (2.68) 7.62 (2.29)
Breathing 5.81 (1.69) 6.24 (1.84) 6.14 (1.65) 6.48 (1.75) 6.52 (1.50)
Love and Thankfulness PMR 5.95 (2.48) 6.81 (2.44) 7.38 (2.16) 7.29 (2.15) 7.05 (2.56)
Breathing 6.86 (1.68) 7.00 (1.86) 6.90 (1.84) 6.62 (1.86) 6.90 (1.97)
Prayerfulness PMR 2.52 (1.36) 2.81 (1.40) 2.95 (1.63) 2.90 (1.58) 3.00 (1.52)
Breathing 2.10 (1.22) 2.19 (1.25) 2.38 (1.50) 2.19 (1.50) 2.19 (1.36)
Timeless PMR 2.57 (1.25) 2.95 (1.10) 2.86 (1.49) 3.00 (1.48) 3.19 (1.44)
Breathing 2.38 (0.97) 2.57 (1.36) 2.33 (0.91) 2.57 (1.08) 2.57 (0.98)
Physical Stress PMR 4.05 (0.97) 3.71 (1.23) 3.81 (1.60) 3.38 (0.80) 3.48 (0.87)
Breathing 3.67 (1.39) 3.33 (0.66) 3.81 (1.99) 3.14 (0.36) 3.29 (0.64)
Worry PMR 1.43 (0.60) 1.33 (0.58) 1.38 (0.59) 1.33 (0.58) 1.33 (0.58)
Breathing 1.67 (0.91) 1.38 (0.50) 1.38 (0.74) 1.38 (0.92) 1.29 (0.46)
Negative Emotion PMR 4.05 (1.16) 3.67 (0.86) 3.34 (0.51) 3.43 (0.75) 3.38 (0.67)
Breathing 4.19 (1.33) 3.81 (0.75) 3.48 (0.81) 3.48 (0.75) 3.90 (1.00)
(continued )
 Progressive Muscle Relaxation and Breathing Exercises 1555

Table 1
(Continued)

R-State Aftertest Group Week 1 Week 5

Sleepiness PMR 5.76 (3.13) 5.43 (2.40)

Breathing 4.52 (1.63) 3.86 (1.11)
Disengagement PMR 6.00 (1.76) 7.52 (1.97)
Breathing 5.00 (1.87) 4.52 (1.81)
Physical Relaxation PMR 8.52 (1.50) 9.86 (1.80)
Breathing 6.30 (2.52) 6.57 (2.20)
Mental Quiet PMR 5.29 (1.82) 6.33 (2.06)
Breathing 4.33 (1.71) 3.95 (1.20)
At Ease/Peace PMR 6.81 (1.97) 7.43 (1.89)
Breathing 6.14 (1.65) 6.62 (1.56)
Strength and Awareness PMR 6.57 (2.01) 7.10 (2.30)
Breathing 6.95 (1.60) 7.71 (2.23)
Joy PMR 6.14 (2.43) 7.29 (1.89)
Breathing 5.33 (1.56) 5.71 (1.79)
Love and Thankfulness PMR 5.90 (2.61) 7.05 (2.65)
Breathing 6.33 (1.53) 6.71 (1.79)
Prayerfulness PMR 2.43 (1.29) 2.86 (1.49)
Breathing 2.19 (1.36) 1.95 (1.16)
Timelessness PMR 2.29 (1.23) 2.86 (1.20)
Breathing 2.05 (0.80) 2.10 (0.70)
Physical Stress PMR 3.95 (1.07) 3.61 (0.97)
Breathing 4.48 (1.83) 4.10 (1.30)
Worry PMR 1.71 (1.06) 1.52 (0.60)
Breathing 2.05 (0.97) 1.86 (0.73)
Negative Emotion PMR 4.24 (1.45) 3.71 (0.72)
Breathing 4.43 (1.17) 4.00 (1.10)

*Only Fs for significant repeated measures analyses of covariance reported (see Table 2).

posttest, breathing participants again scored higher on Strength and Awareness [F(1,40) 5
4.47, p 5 .05]. Interestingly, at Week 5 aftertest, PMR scored higher on Joy [F(1,40) 5
6.15, p 5 .05] and Mental Quiet [F(1,40) 5 20.96, p 5 .0005].
Analysis of pretest scores reveals one interesting difference—early in training, at
Week 2, PMR practitioners scored higher on both Disengagement and Physical Relax-
ation at pretest [F(1,40) 5 10.37, p 5 .003]. No other pairwise comparisons reached
statistical significance ( p $ .05).

Discussion
As predicted by the relaxation response (Benson, 1975) and somatic/specificity hypoth-
eses (Davidson & Schwartz, 1976), five weeks of breathing relaxation and PMR gener-
ally do not have differential effects on cognitive or physical stress. However, if we broaden
our perspective to the full range of relaxation states proposed by ABC relaxation theory
(Smith, 1999a), important differences emerge. As hypothesized, PMR appears to evoke
Physical Relaxation and Disengagement, whereas breathing evokes feelings of Strength
and Awareness. In addition, PMR appears to evoke Mental Quiet and Joy as a delayed
aftereffect (at Week 5, after a break at the end of the study). Major differences emerge at
1556 Journal of Clinical Psychology, December 2001

Table 2
F Values and Levels of Significance for All Repeated Measures Analyses of Covariance
(ANCOVAS) for Relaxation States

Relaxation State F p Group Scoring Higher

Sleepiness .93 (10, 17*) .53

Disengagement 16.03 (10, 16) .0005 PMR at Weeks 2, 4, and 5 posttest
Physical Relaxation 17.72 (10, 16) .0005 PMR at Weeks 1, 3, 4, and 5 posttest
Mental Quiet 8.85 (10, 17) .0005 PMR at Week 5 aftertest
Mental Relaxation 5.61 (10, 17) .001†
Strength and Awareness 10.29 (10, 16) .0005 Breathing at Weeks 1 and 5 posttest
Joy 9.79 (10, 17) .0005 PMR at Week 5 aftertest
Love and Thankfulness 23.62 (10, 16) .0005†
Prayerfulness 1.75 (10, 17) .15
Timelessness 1.93 (10, 15) .12
Somatic Stress 32.65 (10, 17) .0005†
Worry 31.10 (10, 17) .0005†
Negative Emotion 18.65 (10, 17) .0005†

*df 5 11, 29; †No significant post-hoc pairwise comparisons between groups; PMR 5 Progressive Muscle Relaxation

Weeks 4 and 5. If replicated, this suggests that relaxation researchers should attempt to
assess at least two, and preferably five weeks of training (Smith, 1999b).
Smith (1999b) and others often have commented that PMR may be less intrinsically
reinforcing than other approaches to relaxation. This may well contribute to high levels
of attrition among practitioners. The present study offers potential insight into the pattern
of reinforcers associated with PMR. Modest levels of Disengagement and Physical Relax-
ation may emerge early in training, and indeed may be anticipated immediately before
training (at pretest) during the second week of training. However, the highest levels of
these two R-States may not appear until Weeks 4 and 5. We found that two strongly
reinforcing R-States, Joy and Mental Quiet, emerge for PMR (and not breathing)—but
only after five weeks of training, and then only after a 3-min break at the end of practice
(during which practitioners thought about the day’s activities). Trainers who wish to
sensitize practitioners to the benefits of PMR may consider alerting clients to the benefits
of Disengagement and Physical Relaxation early in training. Practitioners may need to be
reassured that deeper benefits may take up to four or five weeks, and may appear as an
aftereffect. Smith’s (1999b) suggestion that relaxation researchers and trainers assess
relaxation aftereffects may well have some merit.
The overall differential impact of PMR and breathing exercises may have clinical
implications. Research consistently shows that disturbed individuals already report high
levels of Disengagement (Smith, 2001); however, they do not report high levels of Phys-
ical Relaxation. This pattern is characteristic of many forms of psychopathology, includ-
ing anxiety, depression, hostility, interpersonal sensitivity, phobic anxiety, and paranoid
ideation. Perhaps a relaxation technique that evokes Disengagement may be accepted
readily and applied by individuals who already disengage. Conversely, disturbed individ-
uals have low levels of Strength and Awareness; perhaps they would benefit more from
breathing exercises. Research is needed to test these opposing hypotheses.
Overall, the results of this study illustrate the value of considering the ABC approach
to relaxation. Clearly, relaxation is more than a global cognitive or somatic response of
lowered arousal.
 Progressive Muscle Relaxation and Breathing Exercises 1557

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