Exploring the use of Progressive Muscle Relaxation in Behavioral

Therapy towards reducing stress among Secondary School

Students in Setapak
Hanis Nabilah Khairunnisa M Ahmad Kamal1*, Aishah Hanim Abd Karim2
1
Kulliyyah of Education, International Islamic University Malaysia, Kuala Lumpur, Malaysia
2
Kulliyyah of Education, International Islamic University Malaysia, Kuala Lumpur, Malaysia

*Corresponding Author: hanisnabilahkhairunnisa@gmail.com

________________________________________________________________________________________

1. Introduction

Teenage years are marked by significant physical, psychosocial, and psychological changes
which can cause stress (Senad,2017). Stress is a serious issue among secondary school
students but most parents overlook this thing and normalize stress among teenagers. It is
undeniable there are advantages to having stress, such as it can motivate oneself to move
forward and make a change. However, when the stress has reached its peak, it could impact
one’s mental health. Most teenagers would think of the shortest ways to relieve their
unbearable stress, and most would choose to hurt themselves. 11.1% of teenagers disclosed
self-destructive habits, 6.4% had suicidal thoughts, and 1.4% reported having a suicide
attempt (Zanus et al., 2021). Hence, Progressive Muscle Relaxation (PMR) can be introduced
to teenagers as a better brief therapeutic technique for their daily lives.

Casman and Nurhaeni (2018) found that “Progressive muscle relaxation is a good technic to
reduction stress in children, also increased good mood and attention of children” (p.15). It has
been proven that PMR can reduce stress among the teenagers and be very practical for them
to practice the technique. It is critical to conduct research on this topic because stress among
secondary school students has increased, particularly since the Movement Control Order
(MCO) due to COVID-19 has been identified as one of the leading causes of stress among
teenagers today. Moreover, stress can have an impact on a teenager's life not only
psychologically but also physically and psychosocially. As a result, studies on the use of
Progressive Muscle Relaxation (PMR) in Behavioral Therapy towards reducing stress among
secondary school students should be conducted to provide a quick therapeutic way for
teenagers to cope with stress. However, lack of studies have been conducted among
secondary school students in Setapak. Therefore, the researchers intended to explore the use
of Progressive Muscle Relaxation (PMR) in Behavioral Therapy towards reducing stress
among secondary school students in Setapak.

1.1 RESEARCH OBJECTIVE:

The research objective of the present study are :
1. To improve my questioning counseling skills in probing client’s issues.
2. To discover the effectiveness of progressive muscle relaxation in reducing stress
among among secondary school students in Setapak.

1.2 RESEARCH QUESTION:

The research question of the present study are :

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 1. How effective is progressive muscle relaxation in reducing stress among secondary
school students in Setapak?
2. How can I improve my questioning counseling skills in probing clients’ issues?
2. Literature Review
2.1 Definition Of Behavioral Therapy
Behavioral therapy is a systematic methodology that meticulously assesses what the person
does and then pursues to increase the likelihood of positive experiences (Herkov, 2017). The
behavior therapist would identify the client’s unhealthy behavior and assist them in changing
the negative behavior. Also, behavioral therapy is one technique to treat many types of
mental illness. Wilson (2011, as cited in Corey, 2017) found that “Anxiety disorders,
depression, posttraumatic stress disorder, substance abuse, eating, and weight disorders,
sexual problems, pain management, and hypertension have all been successfully treated using
this approach.” Behavior therapy approaches have been recognized as the recommended
treatment for many psychological issues (Corey, 2017). This approach has developed it has
been identified as contemporary behavior therapy, which consists of four areas of
development: classical conditioning, operant conditioning, social-cognitive theory, and
cognitive behavior therapy (CBT). Each type has a difference in the application of techniques
and the base of the approaches. However, they have the same goals: to guide the clients to
shift their unhealthy behavior and thoughts. Corey (2017) added “A strength of the behavioral
approaches is the development of specific therapeutic procedures that must be shown to be
effective through objective mean.” There are several therapeutic techniques in this approach:
operant conditioning, progressive muscle relaxation, systematic desensitization, Vivo
exposure, and flooding. Each technique can be utilized based on which types of behavior
therapy the therapist applied. 

2.2 Definition Of Progressive Muscle Relaxation (PMR)

In the 1920s, Progressive Muscle Relaxation was introduced by Edmund Jacobson and based
on Behavioral Therapy. Carillo et al. (2021) defined "Progressive muscle relaxation as a
whole-body relaxation technique in which participants alternately tense and relax muscle
groups and regions of the body." In this therapy, the clients have to follow the set of
instructions by the therapist on contracting and relaxing their muscles. During the treatment,
Corey (2017) stated, "At the same time, clients learn to mentally "let go," perhaps by
focusing on pleasant thoughts or images." PMR is an easy and straightforward therapy for
clients to practice at home. It is required for the clients to practice this technique daily to
achieve the best results. By practicing PMR, the youths can identify the difference between
tight and relaxed muscles and use the knowledge to cope with stomach pain (Weydert,2018).
Progressive Muscle Relaxation can be viewed as a good practice in reducing anxiety since it
displays muscle tension when a person is dealing with anxiety or stress.

2.3 Definition Of Stress

In 1936, Hans Selye coined the term "stress," which he defined as "the non-specific response
of the body to any demand for change." (Kapure & Singh, 2021). Hans Selye has been
introduced as the "father of stress," He was the founder of stress. Based on Fink (2017), "The
first and most generic definition of stress is that proposed by Hans Selye: Stress is the non-
specific response of the body to any demand." Stress is a significant mental health issue
among adolescents nowadays. Everyone faces different stressful situation and have different
responses to stress-activating event. According to Bhargava and Trivedi (2018), "Stress is a
condition  or  feeling experienced  when  a person  perceives  that  demands exceed the

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personal and social resources the individual can mobilize." Although some stress can
motivate somebody to move forward, once it crosses the limit, stress can be dangerous for
mental and body health. 

2.4 Types Of Stress

There are three types of stress: eustress, distress and acute stress . These types of stress have
different impacts on each individual. Each individual would also come out with different
reactions to each stress they are facing. There are some statements saying that stress is a
negative emotion, but it is not entirely true since there are types of stress that can give a
benefit. 

● Eustress (Good Stress)

Christian and Obiageli (2019) defined “Good stress, also known as eustress or
positive stress is a positive cognitive response that an individual possess towards a
stressor.” Eustress should be a motivation for somebody to move forward or to
improve their lives. Eustress benefits include enhanced creativity, productivity, and
self-esteem and health benefits such as immune system stimulation for optimal
operation and increased secretion of adrenaline and epinephrine, which can help
improve brain function (Christian & Obiageli, 2019). Hence, this type of stress is
good stress which can motivate somebody to move forward. However, this type of
stress can shift into negative stress when a person felt exhausted with the pressure that
they are dealing with.
● Distress (Bad Stress)
This type of stress is the opposite of eustress. The term stress nowadays used are
mostly referred to distress. Distress is negative stress when it has exceeded one's
capability to cope with the pressure. Distress is a broad term that refers to undesirable
feelings or emotions which imply one's functional capacity; in other statements, it is a
psychological uneasiness that impedes one's regular life (Sivasubramanian, 2016).
Also, Petty et al. (2016) defined distress as "An internal state of negative stress, which
is unwelcome, uncomfortable, or exceeds the capacity of the individual experiencing
it to cope." It showed that distress could have a lousy impact on one's mental health as
the person cannot cope with the stress that they are facing. 

Stress can be classified according to its duration, such as how quickly and long it lasts.
The body reacts differently depending on whether the stressor is new, short-term, or long-
term. The categories are as follows:

● Acute Stress
The person experiencing this type of stress may have been exposed to a traumatic
event in their life. According to Barnhill (2020), “Acute stress disorder is an intense,
unpleasant, and dysfunctional reaction beginning shortly after an overwhelming
traumatic event and lasting less than a month.” This type of stress might be similar to
Post Traumatic Stress Disorder, but they are not the same since people who are
experiencing PTSD would still feel overwhelmed by the trauma for more than a
month.Acute stress can also happen to somebody, which they may have experienced
consciously or unconsciously. For example, witnessing terrifying accidents or
incidents involving a person’s close friends and family can unconsciously trigger this
type of stress. Meanwhile, if they experience violence or severe injury from accidents,
it would be direct exposure. Intrusive memories, poor mood, detachment, resistance,

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 or hyperarousal in the first month after the incident would be the characteristics of
Acute Stress Disorder (ASD) (Litz et al., 2017).

2.5 Stress Among Teenagers In Global Perspective.        

As a complex developmental stage with many challenges, teenage is a problematic
developmental stage with many challenges transition from childhood with immaturity to
adulthood with maturity (Latiffah Abdul Latiff et al., 2017). Most teenagers suffer from
psychosocial issues: stress, anxiety, and depression. Globally, one in seven 10-19-year-olds
experiences a mental disorder, accounting for 13% of this age group's global burden of
disease. (Han,2021) The percentage of mental illness among adolescents has shown that
youths are too exposed to stress nowadays. Also, Han (2021) claimed that "Depression is
estimated to occur among 1.1% of adolescents aged 10-14 years, and 2.8% of 15-19-year-
olds." The percentage has indicated that stress would be the primary issue among adolescents.

There is a finding that the leading cause of stress is academic tests, personal relationships,
relationship issues, life transitions, career choices, hopelessness, inability to rest, rising use of
tobacco, alcohol, drugs, and angry outbursts (Bansode, 2021). The factors that lead to stress
among adolescents might be small, but being prolonged with the same issue and identical
pressure will lead to another significant mental health issue which is depression. Although
stress can positively and negatively impact adolescents, if it is prolonged stress, it can be
linked to depression. Khan and Khan (2017) stated, "Studies have found a link between
chronic stress and anxiety disorders and major depressive disorder." Hence, parents should
pay stress among adolescents attention more as it is not a minor issue and could lead to more
significant impacts on the youngsters. In global, most youths suffer from many conflicts
during their teenage development as they have to face an important transition in their growth
development. According to Bouchrika (2020), "Seven out of ten teens in the U.S. (between
13 and 17 years old) have named anxiety or depression as a major problem among their peers
in the community." The statistics have shown that stress among United States teenagers is
severe. Thompson (2022) added, "From 2009 to 2021, the share of American high-school
students who say they feel "persistent feelings of sadness or hopelessness" rose from 26
percent to 44 percent, according to a new CDC study." The percentage of sadness and
hopelessness among adolescents has reached the highest level of teenage mental health
issues.

Meanwhile, in Malaysia, there is a study conducted, and the findings are the risk of severe
depression, anxiety, and stress among Malaysian middle school students ranges from 9% to
11% (Latiff et al., 2017). Institute for Public Health (2011, as cited in Anuar Abu Hassan et
al., 2020) found that "In Malaysia, National Health Morbidity Survey (NHMS) IV shows that
there has been an upward trend in the prevalence of mental illness among children and
adolescents aged 15 years and below from 13% in 1996 to 20% in 2011".Although the stress
percentage is not high in the United States, there is a tendency for the rate to increase if this
issue is ignored. 

2.6 Islamic Perspective On Stress.

Islam is a way of life and a complete religion which it is not only stressed on spiritual aspect
but also emotional and physical. Small amount of stress would give a good motivation for a
person to move forward, but if the amount of stress increase, it can give bad impacts on the
person’s emotions and mental health. According to Majid et al. (2021), "From the Islamic
point of view based on the Quranic verses, the "stressor" is supposed to be a test from Allah."

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In Islam, it is believed that remembering Allah can give calmness to the person. Allah has
stated it in Al-Quran, "Those who have faith and whose hearts find peace in the remembrance
of God." (Quran 13:28). Allah has promised peace and calmness for those who remember
him, and Muslims should believe in Allah's words.

The trials from Allah showed the mercy of Him on His believers. Allah has
mentioned in Al-Quran, from Surah Al- Ankabut:

"Do the people think that they will be left to say, "We believe" and they will not be
tried?(2) But We have certainly tried those before them, and Allah will surely make
evident those who are truthful, and He will surely make evident the liars.(3)"(29: 2-3)

This verse shows that it is part of fitrah for a good believer to be tested by Allah. It is
based on the individuals themselves on how to react with Allah's test. Also, mental
health issues are part of Allah's tests.  Hence, as a Muslim, that person should be
patient and seeks for the best intervention to reduce his stress. In every trials, Allah
has promised there will be ease. Based on Al- Quran, in Surah Al-Insyirah:

"For indeed, with hardship [will be] ease.(5)Indeed, with hardship [will be] ease.
(6)"(94: 5-6)

Based on a book Ihya’ Ulum al-Din written by Al-Ghazali, he mentioned that all human
actions are based on their hearts and souls. Azizah Abdul Majid and Tengku Sarina Aini
Tengku Kasim (2020) mentioned that, “The heart serves to feel, to know and to recognise,
and the heart is also the recipient of God's commands and prohibitions.”  Heart is the place in
which a human feels tension, feelings and stress. Hence, Al-Ghazali has mentioned that the
spiritual aspect should be cleansed and cared for as it is crucial for internal human wellbeing.
(Yahya et al., 2020). Al-Ghazali said that the cause of the emotional disorder is an unhappy
soul. He emphasized that one can attain happiness through soul treatment by pleasing God
(Allah). Therefore, Islam has gave many ways for the Muslims to reduce their stress and one
of them is Dhikr. Dhikr is a repetition of holy names in remembering Allah's supremacy, and
it could bring calmness for those who are suffering anxiety and stress. Iskandar, Hatta, Azhar
(2020) found that Dhikrullah can be used as a therapy because it alters brain waves, causing
the nervous system to function with a lower stress level, resulting in the entire body being
relaxed.

3. Methodology

3.1 Research Design

In this research, I will conduct qualitative action research. Since my goal is to discover the
effectiveness of PMR in reducing the students’ stress, qualitative action research would be
the most suitable research design. Abdullayeva et al. (2019) define action research as “A
process that integrates practical pursuit, theory and practice, and community-school-based
participants to identify practical solutions about a concern.” In my research, the concern that I
had is the high level of stress among secondary school students nowadays. Most students
would suffer from academic, family, and friendship problems which would cause their issues.
I realized that most teenagers today would try to find a quick way to cope with their stress by
cutting or harming themselves.

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Since there is not much exposure to good ways to release their tension, I think Progressive
Muscle Relaxation (PMR) would be practical for them to utilize as one of the coping ways to
reduce their stress. One of applications of action research is solution development and testing
(Mertler, 2020). Thus, I can find out the effectiveness if PMR in reducing stress through
action research. Besides, action research is about finding other solutions for any school
setting issue, but it is also about improving the researcher’s practice. Clark et al. (2020)
mentioned, “Action research is an approach to educational research that is commonly used by
educational practitioners and professionals to examine, and ultimately improve, their
pedagogy and practice.” Therefore, action research is the best method to help me achieve my
goals in this study. The following section will describe the participants and setting for this
research.

3.2 Participants and Setting

The targeted participant is from age 13 to 17 years old. The participant must be voluntarily
wanting to have sessions to conduct this research. The participant should have issue that
related to high stress level which will be screened on the first session using DASS-21. The
participant chosen for this research is a self-referred client which she is voluntarily wants to
participate in this study. The participant for this study will be only one secondary school
student. The participant chosen for this study a Malay, female and 14 years old or from Form
2. The participant is also struggling with academic issue that cause her to have high stress
level.
The setting for this study is a secondary school in Setapak. This school is a high school that
consists of only one gender, which is female students. This school has Form 1 until Form 5,
and each batch has six classrooms. Each class has approximately 19-23 students, which is
ideal for learning. The total of teachers in this school is 64 teachers, and the total number of
students is approximately 650 female students. Most of the students at this school were from
Malaysia with lower and middle Social Economic Status (SES). There were also 36% Malay
students and 34% of Indian students, and 30% Chinese students. The school session would
start at 7.20 a.m. until 2.30 p.m. If on Tuesday, a curricular day, the school session expands
until 3.30 p.m. In addition, the setting of the interview session with the participant would be
in the counseling room, which is placed at the first level of the school administrators’ block.
The counseling room is specialized for individual counseling sessions, and the place is the
most suitable setting for the participant to have privacy during the interview session. Next,
for the observation setting, I choose to observe the participant in her classroom remark any
changes in her behavior.

3.3 Research Ethics

Every research has its own ethics. In this study, I will used informed consent in order to abide
the research ethics. The informed consent that I used is develop by Dr Haniza Rais which is
one of lecturers from the Department of Educational and Psychology in Counseling. This
informed consent is one of agreement between the participant and the researcher on keeping
the confidentiality during and after the session. It is important for the researcher to explain
the content of informed consent in order to ensure the participant has fully understand the
limitations and confidentiality during the session.

3.4 Data Collection Procedures (ADJUST)

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Session 1
On the first session, I will collect the data by having an in-person interview with the
participant. The face-to-face interview session also will be fully recorded for transcribing
purposes. The school principal has already permitted to conduct this research at school. I will
hand out the informed consent to the participant and highlight several crucial information to
the participant, especially on confidentiality issues. To ensure the participant fully
understands both informed consent (Refer to Appendix I & II), I will ask the client if there is
anything that is not clear before proceeding with the interview session. After the participant
has filled in the informed consent, I will start by building rapport with the participant. I will
ask general questions to probe the client’s stress issue. Next, I will give her Depression
Anxiety Stress Scales 21 (DASS-21) (Refer to Appendix VI). This inventory consists of 21
self-report instruments on four Likert scales, which start from '0 = Did not apply to me at all
to '3 = Applied to me very much. The inventory scores will be divided into three items which
are Depression, Anxiety, and Stress. The total scores of each item will determine the level of
severity of Depression, Anxiety, and Stress. The reliability of the DASS-21 was
demonstrated by Cronbach's alpha values of 0.81, 0.89, and 0.78 for the depressive, anxiety,
and stress subscales, respectively which showed that DASS-21 has excellent reliability
(Coker et al., 2018). The score interpretation for DASS-21 is divided into five levels: Normal,
Mild, Moderate, Severe, and Extremely Severe. Each group has different scores for each
item. The use of DASS-21 to the participant is to know the status of depression, anxiety, and
stress. From the scores, I will start to explain to the client on the interpretation of the DASS
score. Next, I will continue the session with the interview questions:

Interview Questions :
● In your opinion, can you describe the factors that cause you to be stressed?

Table 3.1 Interview Question in Session 1

After collecting information on the factors of stress, I will ask the participant if she has
anything to be shared before end the session. I will ask the client to have another session for
intervention part.

Session 2
On the second session, I will continue with interview question in order to know the
participant’s common stress coping method.

Interview Questions :
● Would you mind to share your common ways to cope with the stress?

Table 3.2 Interview Question in Session 2

After the interview question, I will expose to the client other ways to cope with the stress. I
will explain Progressive Muscle Relaxation (PMR), and while demonstrating, I will do PMR
with the participant. Before the interview session ends, I will give a PMR script and ask the
participant to practice it at home once per day. I intend to observe the participant’s behavior
and body language throughout all sessions to find out the ‘before and after’ practicing PMR. I
also will provide a mini journal for the participant to track the frequencies of PMR practice
and her feelings before and after PMR.

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Session 3
On the last session, I will ask the client to bring the mini journal. Next, I proceed with the
interview questions in order to identify the effectiveness of PMR on participant’s stress
issues. I also will give the last interview questions to analyze my questioning counseling
skills :

Interview Questions :
● After practicing PMR daily, from scale 1-10 what will be the rate for your stress?
Why?
● In your opinion, do you think practicing PMR is easy and effective to you?
● In your point of view, do you think the questions that I have given to you is
effective in probing your issue?
● From scale 1-10 what will be the rate for my questioning skills? Why?

Table 3.3 Interview Question in Session 3

I intend to observe the participant’s body language during the session to find out the ‘after’
practicing PMR. After I have observed, I will ask the participant to send the journal to me for
document analysis to identify the effectiveness of PMR on reducing the participant’s stress.

3.5 Data Analysis

The taped interviews will be transcribed for data analysis. Thematic analysis will be used to
analyze the data that has been collected. According to Maguire and Delahunt (2017),
“Thematic analysis is the process of identifying patterns or themes within qualitative data.”
Firstly, I will re-read the verbatim and jot down important information during the interview
session. Secondly, I have to generate initial codes, which I will highlight on the participant’s
essential terms. After I have coded the data, the same code I will collate together will be the
potential theme for the analysis. Thirdly, I will jot down the code into the long list of
different codes and sort which codes will be the central theme and sub-theme. Fourth, I might
create a mind map to relate the other codes with the initial code. Fourthly, I will review the
pieces. This step consists of two levels. For level 1, I will re-read the data that I have
extracted that must fit into each theme and forms a coherent pattern. Next, in level 2, I have
to consider each theme is related to the data corpus. I might have to create a thematic map to
visualize the relations on each theme to consider whether the themes reflect my data as a
whole. Fifthly, I will define and name each theme that can help the reader immediately
understand the theme discussed. Lastly, in the sixth step to complete the thematic analysis, I
will make a final analysis and make a report write-up. These steps will be utilized for data
analysis.

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Findings of the Study

Cycle 1
The findings gained from the interview session, the verbatim of each participant were made
and analyzed. The raw data that gained were properly converted into coding and then were
put into several meaningful themes. The themes can be seen in this study is based on two
research questions which are: (i) How effective is progressive muscle relaxation in
reducing stress among secondary school students in Setapak? and (ii)How can I improve
my questioning counseling skills in probing clients’ issues? This study only consist of one
cycle as the findings can be found through first cycle. In this cycle, there are four stages and
each stages have its findings.

Background of the Participant

The participant is a self-referred client which she is voluntarily wants to participate in this
study. The participant for this study will be only one secondary school student. The
participant is a Malay, female and 14 years old or from Form 2. She had no siblings as she is
the only child. The participant is an adopted child, and she never met her biological parents.
The participant never entered kindergarten, but she admitted she was home-schooled by her
adopted parents. Then, the adopted parents sent her to the elementary school. Still, her
academic grades were not good, and she almost failed in every subject except for Bahasa
Melayu and the English language. Currently, the participant is in the third class of six classes.
Now, she is struggling to adapt to the competitive environment among her new friends. Most
of them have flying colours since elementary school. She came for counselling session as she
claimed that she was stressed because of her academic result. Also, she wanted to seek for
new coping ways to control and release her stress.

The Plan
At this stage, I have planned to have three sessions with the participant. Each session I have
included one observation in aspect of participant’s behaviour or body language. The purpose
is to identify the difference of participant’s performance before the intervention and after the
intervention. The plan can be referred at Table 4.1.

Table 4.1 : The Planning

Session Plan Stage Involved
1 ● Interview session Planning and
● DASS-21 (pre-test) Observation
2 ● Interview session Action and
● Intervention : Progressive Observation
Muscle Relaxation (PMR)
3 ● Interview session Reflection and
● DASS-21 (post-test) Observation

On the session one, I have given informed consent before starting any interview sessions to
ensure the participant aware of the ethics throughout the sessions. The participant also has
given a short briefing on the study that I have intended to do while in the counselling session.
Next, I proceed the session with conducting interview session to probe on participant’s issue.
Participant disclosed the reason she wanted to have counseling session because she had an
issue with her academic. I gave open ended question to probe the factors that lead to
participant’s stress. After I identified several factors, I explained to the participant on

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Depression Anxiety Stress Scale (DASS-21) that I have planned to know the participant’s
level of stress. After the participant has acknowledge the purpose of the assessment, I asked
the participant to answer all questions in the Depression Anxiety Stress Scale (DASS-21).
The result for DASS-21 can be referred at Table 4.2. Throughout the first session, I have
observed the participant’s body language and behavior.

Table 4.2 DASS-21 Result Pre-PMR

Items Score Status

Depression (D) 14 Severe

Anxiety (A) 12 Very Severe

Stress (S) 19 Very Severe

Based on Table 4.2, it is found that the participant’s stress and anxiety level is very severe
which indicate that the participant’s stress level is really high. After analysing the DASS-21
result for session 1, I explained to the participant on her stress level to ensure the participant
understood the interpretation. According to the first session, I have found three themes during
the interview session. Therefore, for the first question the findings were discussed under one
theme which is (1) factors of stress :

Theme 1: Factors of Stress

During the interview sessions, the participant mentioned several factors that led to her stress
issue. This theme identified three subthemes: poor academic performance, teacher treatment,
and friendship issues.

Poor academic performance. The participant mentioned that she had poor academic
performance, specifically in Mathematics. Although she has tried to study and practice more
to understand the subject, she still got low marks in quizzes and examinations. The poor
academic performance has caused the participant to stress out:

“Aaa, saya sebenarnya ada masalah akademik. Umm… macam saya tak dapat score
matematik.”

“Pastu and kalau macam time exam hari tu. Saya dapat markah low.”

Teacher’s treatment. The participant also has mentioned that the teacher’s treatment or
attitude is one of reasons that cause her not doing really well in Mathematics. Teacher’s role
in educating the students are important since if the teaching and learning session is not
impactful and no warmth, the students would feel pressure and did not enjoy the learning
session. =

“Umm, pastu yang buat saya jadi makin stress sebab cikgu yang ajar saya… ajar
matematik tu. Dia bukan cikgu yang agak peramah dengan murid.”

“And apa dia cakap dia just kata “Korang banyak careless” and tu jer.”

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Friendship conflicts. Based on the participant, she reported that she had friendship issue. It is
very crucial to have supportive circle during learning process, since the supports can be one
of motivation for the students. The participant stated that most her friend which is also her
classmate is not really supportive and …….. issue with her closest friend.

“Haaa, lepas tu macam kawan pulak…kawan bila saya tanya kawan saya. Dia…
macam… paham tak macam ajar ala kadar je.”

“Maybe kawan la kot, sebab umm kat dalam kelas saya ada… dulu saya ada rapat aaa
yang duduk… maksud saya kat dalam kelas tu saya ada kawan yang rapat.”

“… start daripada ubah meja tu, dia jadi rapat dengan orang yang duduk tu. Aaa
macam dia less spend time dengan saya macam…”

The factors that has been mentioned by the participant has indicate that having low grades
and frustrating with the teacher’s attitude can give a huge impact on participant’s stress issue.

The Action
In this phase, I proceeded with the intervention part, but before that, I asked an interview
question regarding the standard methods she used to cope with her stress. The purpose is to
identify whether she had practiced a healthy or unhealthy coping strategy. I found that the
participant has practiced harmless coping, but she wanted to find other effective coping
methods to reduce her stress. Hence, I introduced the Progressive Muscle Relaxation (PMR)
technique to the participant. I also briefly explain to the participant ways to practice PMR and
the impacts of PMR on reducing stress and anxiety. 

Next, I showed the participant a Youtube video that demonstrates PMR since I think it will be
more helpful to the participant. I asked the participant to follow my instruction and used the
PMR script (Refer to Appendix VIII) to start the relaxation technique. I also demonstrated to
the participant, and she followed my steps while listening to therapeutic soothing sounds. I
keep reminding the participant to realize the difference between her tense and relaxed
muscles. It is essential to remind the participant to think of something that is good and
consistently breathe to ensure this technique's maximum effects. After we did PMR, I
observed the participant's body language and behavior. Besides, after applying PMR, I asked
the participant whether she felt any relaxing effect. As a result, the participant mentioned she
had a brief, relaxed effect after doing PMR.

Before I ended the second session, I gave a mini journal, a script of PMR, and a Youtube link
(on PMR demonstration) for the participant to practice for four days. I asked the participant
to fill in the daily journal and track her frequency of doing PMR (Refer to Appendix VII). I
also asked the participant to record her stress level pre-PMR and post-PMR. The purpose is to
identify the participant's stress level difference before and after PMR. The participant has
been instructed to bring the mini journal during the last session.

The Observation
Throughout three sessions that have been conducted, I found that the participant response in
aspects of body language and behavior is different in each session. I observed the participant
in the same setting in the individual counseling room during the counseling session. The
observation is based on the participant’s body language and behavior :

3
Phase 1 (Session 1)– is carried in the individual counseling room.

Table 4.3 Session 1

In the first session, I observed the participant while having a counseling session, and the
participant could not express well one issue that she had. The participant often stuttered
during the first session and did not communicate well. The participant also seemed hesitant to
open up but gradually expressed her issue after building rapport.Besides, the participant also
showed a frowned face and seemed unhappy due to her academic stress issue. The
participant’s body language showed that she was in a defensive posture in which she would
cross her hands while probing her case. As a whole, in the first phase of observation, the
participant was anxious and trying to adapt to the counseling and interview session.

Phase 2 (Session 2) – is carried in the individual counseling room.

Table 4.4 Session 2

4
The participant’s behavior improved in the second session, and she seemed more comfortable
starting the session. The participant also could follow the instruction during the intervention
well. However, the participant seemed not engaged during the interview session in the
previous session. Nevertheless, after the intervention, the participant seemed more relaxed,
and she could make eye contact with me throughout the session. However, although she
appeared calm, she started to fidget after several minutes of the intervention.
Phase 3 (Session 3) – is carried in the individual counseling room.
Table 4.5 Session 3

In the last session, the participant practiced PMR daily, and the continuous practice has
resulted in significant changes in the participant’s behavior and body language. The
participant is talkative and very engaging, which showed an excellent improvement. The
participant also showed comfortable gestures in which she could laugh and revealed her
mood had improved. She also showed a warm smile that indicated that she was happier than
in previous sessions. After practicing PMR daily, the participant’s motivated behavior
reflected that she had become less stressed and more relaxed.

The Reflection
After I had done the intervention and observation, I continued the last session with the
participant by probing the effects of PMR in reducing the participant’s stress. Next, I gave the
DASS-21 to identify the participant’s stress level post-PMR. The result can be referred at
Table 4.6 below:
Table 4.6 DASS-21 Result Post-PMR
Items Score Status

Depression (D) 6 Mild

Anxiety (A) 10 Mild

Stress (S) 10 Average

5
The DASS-21 result above indicates a significant difference in participants’ stress levels after
practicing PMR. Previously, the participant’s score for Stress was 19. However, after four
days of practicing PMR daily, the participant’s stress score dropped to 10. Besides, according
to the participant’s mini journal, she also applied PMR twice a day when her stress level was
high which can be referred at Picture 1 :

Picture 1 My Mini Stress Reduction Journal

The participant’s name and class were concealed for confidentiality concerns. Based on the
journal that has been completed by the participant for four days, practicing PMR every day is
proven to reduce the participant’s stress level. The journal also indicated that the PMR
worked more effectively if the participant applied it frequently. After analyzing the mini
journal, I asked for participants’ feedback on my questioning skills. In this session, two
themes have been identified, which are (1) Impacts of Progressive Muscle Relaxation and
(2) Improvements in questioning skills.

Theme 1: Impacts of Progressive Muscle Relaxation

In the interview session, the participant has given positive feedback on practicing Progressive
Muscle Relaxation (PMR). In addition, this theme identified three subthemes: reduce stress,
relaxation, and motivation.

Reduce Stress.After practicing PMR daily, the participant showed significant effects,
especially in reducing her stress. The participant’s behavior and mood have changed a lot
after three counseling sessions while practicing PMR. The participant mentioned that after
applying PMR when she stresses, she could feel that her stress had toned down. She also gave
a high rate for PMR in reducing her stress which is 7. From this feedback, PMR proves that it
could lower pressure among teenagers :

“Hmmm…rasa release tension.”

6
 “Tak stress. Bukan tak stress macam mana ea.. macam kurang stress”
“Hmmm…saya kasi tujuh kot. Tujuh.”
Relaxation. Reduction in stress could bring a relaxing effect. The participant has claimed that
she felt more relaxed by practicing PMR. She also has mentioned that she felt calmer and it is
one of the participant’s goals when attending the counseling session :

“Hmmm (nodding). Relax. Rasa…rasa lega la. Tadi tak berapa lega.”
“Hmmm… boleh dikatakan yang dia tenang… buat saya tenang sikit.”
Motivation. Experiencing improvement in stress and relaxation can give a huge positive
impact to the participant. PMR also has proved that it can elevate the participant’s motivation
since she also felt energetic :

“Haah, lepas tu… lepas buat PMR ni macam… macam more… apa ea... macam
more energetic and rasa motivated a bit.”

Theme 2: Improvements in Questioning Skills

Since I also intended to improve my questioning skills, I asked the feedback from the
participant to acknowledge if there is any improvements that she would suggest. Also, I
would like to know the participant’s view on my questioning skills. There are two subthemes
that were identified under this theme : (1)Proper method of questioning and (2)Effective
questions.

Proper method of questioning. The way of approaching a client in counselling should be

professional and warm. It is crucial for the counselor to ensure the client to feel comfortable
with the questions in order to probe more on client’s issue. According to the participant, she
felt comfortable with the questions that I have asked to explore her issue :

“… lepas tu cikgu… cikgu pun tak de la nak paksa memaksa pun. Maksudnya
macam… okay je.”
“Haah (nodding). Dia macam… saya pun… okay dengan apa cikgu soalkan. Saya
pun tak de masalah. Hmm… lepas tu cikgu… cikgu pun tak de la nak paksa memaksa
pun. Maksudnya macam… okay je.”
Effective questions. Warm questioning method in counselling is not enough if the questions
are not effective. Effective questions are important to ensure the participant feel they are
being heard and the counselor being attentive. If the questions are not related with the issues,
most likely it will make the counseling session cannot meet the goals. The participant
responded to my questioning skills :

“Saya rasa soalan-soalan cikgu ni beri efektif..(giggles)”

“Daripada segi…soalan yang cikgu berikan tu membantu nak lebih faham masalah
saya.. and cara cikgu explain balik apa saya cakap..”
“Hmmm…8.5.”

7
The participant also gave a rate of 8.5 on my questioning skill which indicates that my
questioning skill is excellent in her point of view. Overall, from the participant’s feedback, it
can be concluded that my questioning skills have improved in the aspect of the questioning
method and giving practical questions. The counselors must keep enhancing questioning
skills as it is an essential part of counseling sessions.

Discussion
One of the objectives of this study is to explore the effectiveness of Progressive Muscle
Relaxation (PMR) among teenagers with stress issues. Teacher's treatment and friendship
conflicts are identified as the main stressors. There is a significant correlation between
educators' attitudes and students' educational achievement (Ekperi et al., 2019). Friendship
conflicts also can have huge effects on students' stress. Kaufman and Sandilos (2016) noted
that adolescents with a constructive circle of friends obtain better academic levels than those
with unsupportive friends. This study also found that the participant has practiced unharmful
coping methods but is still ineffective in reducing the participant's stress.

After exposure to PMR and daily practice, the participant has shown improvements in mood
and stress. The participant's DASS-21 result has revealed a significant difference in all three
items (D-Depression, A-Anxiety, and S-Stress) pre-PMR and post-PMR. Thus, this study can
identify that PMR effectively reduces stress levels. Although there are not a lot of findings on
PMR in reducing academic stress in the school sector, many studies have proven PMR can
effectively reduce stress among students. Previous research by Gangadharan and Madani
(2018) found that "The study concludes that, progressive muscle relaxation technique is very
effective in reducing depression, anxiety and stress among nursing students" (p.1). In
addition, Wilczyńska et al. (2019) reported that Jacobson's progressive relaxation techniques
and tissue manipulation effectively reduce the harmful impacts of distress. Also, this study
found one of the impacts of practicing PMR is relaxation. Research supported by Hidayati
and Makwa (2020) found that anxiety-induced reactions were reported to be lessened, and
individuals reported feeling more at ease after practicing PMR. Therefore, there is no doubt
that PMR can reduce the stress and anxiety among the adolescents.

Limitations of the Study

Every research has its limitations and challenges. Several obstacles throughout the session are
time constraints, too many relief classes, participants’ health issues, and issues with other
academic teachers. Firstly, the time constraints are the most significant limitation that I
encountered. Since there are too many programs during the duration of the research, most of
the time, I have to re-arrange the counseling session with the participant multiple times.
Moreover, the participant is active in co-curriculum activities, which caused most counseling
sessions to be interrupted since the teachers would try to look out for her. Secondly, I also
had many class reliefs, which is more than two classes in a day. Each class duration is 50
minutes. Hence, the time collided with the participant, such as when the participant is free, I
have to attend class to replace the absence of teachers. Thirdly, the participant also had health
issues, and sometimes she could not participate in counseling sessions because she had
hospital appointments. Hence, it is essential to know the participant’s health condition before

8
setting a date for the next counseling session. Last but not least, several academic teachers
complained about taking the learning session time to meet the participant. Since the
participant also had to ride the van to go home, thus, she could not stay back at school to have
a counseling session. Therefore, due to teachers’ complaints, I had to make the session short
but effective to probe the participant’s issues. Although there were many limitations during
this research, the participant cooperated well throughout each session.

Recommendations for Future Research

Based on the finding of the study, the following recommendations are made. Firstly, it is
recommended for future researchers to collect more participants of a different gender.
Besides, since the finding is based on only one female student, the result is not thorough.
There must be a difference between males and females in consequence of PMR in reducing
stress. Secondly, the duration of the study should be much longer to know the long-term
effects of PMR in facilitating students' focus. Tracking the students through journals for at
least a month should provide a better insight into the effectiveness of PMR in stress
reduction. Thirdly, it is suggested to include participants of different ages. The result will be
much better if provided to students from each Form, such as Form 1- Form 5. It is because
different ages would indicate different perceptiveness in PMR. Conducting this research with
varying participants' ages will give a detailed result and a new exploration to identify whether
PMR would be efficient for all students of different ages. Lastly, this research would be much
better if future researchers not only focus on the stress issue. Future researchers can examine
the effects of PMR on aspects of anxiety or motivation.

Conclusion and Implications

In conclusion, secondary school students can implement the Progressive Muscle Relaxation
technique to reduce stress levels. Despite only exposing the common breathing technique to
the secondary school students to help them with anxiety and stress. PMR should be given
more attention and be exposed to all secondary school students. PMR is not only can be easy
to be applied but also effective in reducing the stress level. It is also therapeutic and can help
secondary school students who have a high-stress level to focus on relaxing their muscles to
feel the immediate effect of PMR. However, having more participants with stress issues
might produce better results for this research. Although there are lots of limitations, such as
time constraints, this research showed that PMR should be getting more attention from
counseling field practitioners.

This study implies that I hope this research can benefit the school counselors in exploring
other relaxation methods. PMR is one unpopular technique in the counseling field. Although
PMR is one of the relaxation techniques that have many steps and need the practitioner to
study first, it still can have a massive impact on reducing stress. Next, PMR also can be
practiced by all ages. Hence, this research can benefit not only the counselors but also the
school community or administrators. The school administrators may also benefit from this
research as they can introduce PMR to all teachers. Since there are no age limitations on

9
practicing PMR, this technique can be applied to the school teachers. Some school teachers
would face workload, financial, or marriage stress. Thus, PMR can be used as a brief 'escape'
to lower the pressure. Lastly, PMR can also impact the secondary school students to practice
it at home. Secondary school students can practice PMR at home or in class, but practicing it
in a quiet and therapeutic room is advisable. In conclusion, this research implies that it can
benefit counselors, school administrators, and secondary school students.

10
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Appendices

Appendix I Informed Consent Form

Appendix II Interview Protocol

Appendix III Observation Protocol

Appendix IV Partial Transcription

Appendix V Generating Themes

Appendix VI DASS-21

Appendix VII My Mini Stress Reduction Tracker

Appendix VIII Progressive Muscle Relaxation Script

4
Appendix I Informed consent form

C3: (BI) Informed Consent Form

Informed Consent for Counseling Services and the Limit of Confidentiality in

Counseling
All the information gathered in the counseling session is treated as confidential
EXCEPT for the following circumstances:
1. when clients pose a danger to others or themselves when the counselor believes that a
client under age of 16 is the victim of incest, rape, child abuse or some other crime
2. when the counselor determines that the client needs hospitalization
3. when information is made an issue in a court of action
4. when clients request that their records be released to themselves or a third party
5. When a third person is involved and the client is aware of his/her presence. However,
confidentiality has to be respected by the third person involved.
Some cases may be discussed during the weekly in-service meeting with the supervisor and
other counselors for supervisory purposes.
The counselor shall not be held responsible for the actions taken by the clients outside the
counseling session.
I _______________________________________(name) from Class ________ have read and
understood the statement written above. With my signature, I agree to attend the session/s
with the counselor and will abide to the ethics of counseling and will respect the
confidentiality of the session/s in or out side the session. The session is voluntary.

Clients Signature:
Client's Name:
Date:

Counselor's Signature:
Counselor's Name:
Date:

5
Appendix II Video/Audio Taping Consent Form
C4: (BI) Video/Audio Taping Consent Form

Permission to tape the Counseling Sessions

I__________________________________________ from Class ________ currently seeing a
counselor _________________ at ______________________. I was informed that the
session may be audio or video taped for supervision purposes. I understand that the
supervision is important to ensure the quality of counseling given to me as the client. During
the session, if feel uncomfortable with the recording procedure, I may, at anytime request to
stop the recording. The taped sessions will be kept confidential and the tapes will be
destroyed upon the client's request. With my signature below, I agree that my counseling
session with the counselor to be recorded.

Clients Signature:
Client's Name:
Date:

Counselor's Signature:
Counselor's Name:
Date:

6
Appendix II Interview Protocol
RQ Main questions
How effective is 1. In your opinion, can you
progressive describe the factors that
muscle relaxation cause you to be stressed?
in reducing stress 2. Would you mind to share
among secondary your common ways to cope
school students in with the stress?
Setapak?
3. After practicing PMR daily,
from scale 1-10 what will be
the rate for your stress?
Why?
4. In your opinion, do you
think practicing PMR is
easy and effective to you?
How can I 5. In your point of view, do
improve my you think the questions that
questioning I have given to you is
counseling skills effective in probing your
in probing clients’ issue?
issues?
6. From scale 1-10 what will
be the rate for my
questioning skills? Why?
Probes
● The causes and the
impacts of stress
● If it is positive,
encourage but if it is
negative / the participant
want something
different, try to expose
on other ways to cope
● To know the
effectiveness of PMR in
reducing stress
● To explore the
applicability of PMR
● To probe on my
questioning skills during
the sessions
7
Appendix III Observation Protocol
No Checklist Scale
.
1) Strongly Disagree
2) Disagree
3) Average
4) Agree
5) Strongly Agree

1 The participant is very engaging and communicate really 1 2 3 4 5

well
2 The participant is not avoiding eye contact 1 2 3 4 5
3 The participant shows an open posture 1 2 3 4 5
4 The participant seemed relax and can breath properly 1 2 3 4 5
5 The participant appears happy and give a warm smile 1 2 3 4 5
6 The participant seemed comfortable 1 2 3 4 5
Descriptive Notes Reflective Notes
Physical setting : Reflective comments :questions to
self,observation of nonverbal behavior and
my interpretations

Description of participant

Description of activity

Description of participant’s engagement

Interaction

Participant’s comments:

8
Appendix IV Partial Transcription

9
Appendix V Generating Themes 

Transcription Main Ideas Themes Subthemes

i. “Aaa, saya sebenarnya ada Stress Causes of i. Poor

masalah akademik. Umm… Stress academic
macam saya tak dapat score performance
matematik.” ii. Teacher’s
treatment
ii. “Umm, pastu yang buat saya iii. Friendship
jadi makin stress sebab cikgu Issue
yang ajar saya… ajar
matematik tu. Dia bukan
cikgu yang agak peramah
dengan murid.”

iii. “Haaa, lepas tu macam

kawan pulak…kawan bila
saya tanya kawan saya. Dia…
macam… paham tak macam
ajar ala kadar je.”
i. “Hmmm, sedih la rasa sebab Impacts of i. Demotivated
aaa masa exam tu saya rasa Stress ii. Lost focus in
diri saya masa exam tu dah class
study.”
“…expect macam “okay,
matematik ni InshaAllah
dapat kot B+ ke B- ke at least
macam seventy something
and bila dapat tahu result bile
tengok dekat phone kan,
check. Aaa, tengok dapat 44
macam down la macam…
bagi saya macam tak

10
 sepatutnya berlaku sebab
macam saya study…”
ii. “… actually sebenarnye bila
cikgu tengah ngajar kan, apa
saya paham jer, saya paham
tapi bila saya aaa nak buat
latihan dalam buku, saya jadi
blank macam “Ehh kejap apa
cikgu ajar tadi ?”
i. “Kalau stress dengan bosan la, Coping i. Drawing and
Qis akan ambil sehelai kertas Method writing
tak kisah la kertas apa, Qis ii. Poetry
akan conteng.”
“… biasanya Qis suka buat
cursive handwriting”
ii. “Haah. Umm satu lagi Qis
suka buat poetry.”
i. “Hmmm…rasa release Progressive Effects of i. Reduce
tension.” Muscle PMR stress
“Tak stress. Bukan tak stress Relaxation ii. Relaxing
macam mana ea.. macam (PMR) iii. Energetic
kurang stress” and
“Hmmm…saya kasi tujuh kot. Motivated
Tujuh.”

ii. “Hmmm (nodding). Relax.

Rasa…rasa lega la. Tadi tak
berapa lega.”
“Hmmm… boleh dikatakan
yang dia tenang… buat saya
tenang sikit.”
iii. “Haah, lepas tu… lepas buat
PMR ni macam… macam

11
 more… apa ea... macam more
energetic and rasa motivated
a bit.”
i. “… lepas tu cikgu… cikgu Questioning Improvemen i. Proper
pun tak de la nak paksa Skills t in method of
memaksa pun. Maksudnya Questioning questioning
macam… okay je.” Skills ii. Effective
ii. “Haah (nodding). Dia Questions
macam… saya pun… okay
dengan apa cikgu soalkan.
Saya pun tak de masalah.
Hmm… lepas tu cikgu…
cikgu pun tak de la nak paksa
memaksa pun. Maksudnya
macam… okay je.”
“Saya rasa soalan-soalan
cikgu ni beri efektif..
(giggles)”
“Daripada segi…soalan yang
cikgu berikan tu membantu
nak lebih faham masalah
saya.. and cara cikgu explain
balik apa saya cakap..”
“Hmmm…8.5.”

12
Appendix VI DASS-21

13
14
Appendix VII My Mini Stress Reduction Tracker

DAY 1

Date My stress level (Before) Frequency My stress level (After)

of PMR

Really High Medium Low 1 2 3 Really High Medium Low

High High

Why do I feel this way?

DAY 2

Date My stress level (Before) Frequency My stress level (After)

of PMR

Really High Medium Low 1 2 3 Really High Medium Low

High High

Why do I feel this way?

DAY 3

Date My stress level (Before) Frequency My stress level (After)

of PMR

Really High Medium Low 1 2 3 Really High Medium Low

High High

Why do I feel this way?

DAY 4

Date My stress level (Before) Frequency My stress level (After)

of PMR

Really High Medium Low 1 2 3 Really High Medium Low

High High

Why do I feel this way?

15
Appendix VIII Progressive Muscle Relaxation Script
(Skrip Teknik Progressive Muscle Relaxation)

Pada hari ini kita akan membuat satu teknik relaksasi yang diberi nama. Progressive muscle
relaxation technique. Teknik ini meliputi beberapa komponen otot yang berbeza. Ianya
dimulai dgn kumpulan otot di bahagian kaki dan berakhir di bahagian kepala.
Sebelum kita mulakan sesi ini.

Anda mestilah duduk dalam keadaan yang tegak dan selesa. Anda perlu mendengar
sambil melakukan aksi berdasarkan arahan yang bakal saya berikan.

Sebelum kita mulakan sesi, anda perlu duduk di atas kerusi dengan postur yang tegak dan
tangan di sisi. Tapak kaki dirapatkan ke lantai. Tarik nafas melalui hidung, 1,2,3,4,5.. hembus
perlahan lahan melalui mulut. Relaks .

Kita mulakan sesi dengan kumpulan otot di bahagian kaki. Angkat kaki sedikit dan halakan
jari kaki ke atas. Dalam kiraan , 1-5 , anda ‘release’ kan otot kaki anda. Relaks relaks relaks

Kemudian, kita fokus ke otot betis. Rapatkan kedua-dua betis dan tegangkan. Dalam
kiraan , 1-5 , anda ‘release’ kan otot betis anda. Relaks relaks relaks

Baiklah, seterusnya kita beralih kepada otot tangan. Genggam semua jari-jemari seakan
penumbuk. Regangkan kedua belah tangan ke hadapan, dan genggam penumbuk sekuat
mungkin. Jangan lupa untuk bernafas, dalam kiraan 1-5 , anda ‘release’ kan penumbuk dan
hembuskan nafas melalui mulut. Rasakan perbezaan otot kamu yang sedang tegang dan
relaks.

Seterusnya, kita fokus kepada otot bahu. Rapatkan bahu ke telinga. Rasakan ketegangan di
antara bahu. Kemudian dalam kiraan 1-5, release dan hembus nafas.

Baiklah, sekarang kita akan fokus ke otot muka pula. Rapatkan gigi bahagian atas dan
bawah. Gigit kedua gigi cukup untuk berasa tegang sahaja, jangan terlalu kuat. 1-5,
release.

Kemudian, rapatkan kedua-dua kening seolah anda tengah risaukan sesuatu. Tutup mata
rapat-rapat dan tegangkan. Jangan lupa, teruskan bernafas. Rasakan ketegangan antara
otot kening dan mata. 1-5, release.

Akhir sekali, sekarang anda senyum sehingga menampakkan gigi. Senyum sehingga kamu
dapat rasa otot antara pipi tegang. Dalam kiraan 1-5, release.

Sebelum kita akhiri sesi ini, tutup mata dan duduk di posisi asal. Kosongkan minda, fokus
pada otot-otot. Tarik nafas yang dalam perlahan-lahan, kiraan 1-10, hembus melalui hidung
perlahan lahan. Buka mata perlahan-lahan dan relaks.

16