Progressive muscle relaxation (PMR) was developed in the 1920s by physician Edmund Jacobson, who noticed that his patients' bodies were almost always more tense than they realised. His insight — that you can teach a person to recognise tension and release it in muscle groups one at a time — became the basis for one of the most studied relaxation techniques in modern psychology. For schizophrenia, PMR is a useful tool for the anxiety and somatic tension that travel alongside psychosis, with a few small modifications.
Progressive muscle relaxation is the practice of deliberately tensing and then releasing each muscle group in turn, training the body to notice and discharge accumulated tension.
What the evidence says
PMR has decades of evidence for reducing anxiety and improving sleep, and is included in many cognitive-behavioural protocols. In schizophrenia specifically, several small randomised trials and a 2020 meta-analysis indexed in PubMed suggest that PMR can reduce anxiety and improve quality of life when added to standard care, though evidence on its direct effect on psychotic symptoms is more modest. NICE guidance for schizophrenia (CG178) recommends a range of psychosocial interventions of which structured relaxation is a reasonable component.
The basic technique (about 12 minutes)
- Sit or lie comfortably. Eyes can be open if closing them is destabilising.
- Take three slow exhales to settle.
- Work through these muscle groups in turn. For each: tense for 5 seconds, then release fully for 15 seconds, noticing the difference.
- Right hand and forearm — make a fist
- Right upper arm — bend the elbow and tense
- Left hand and forearm
- Left upper arm
- Forehead — raise eyebrows
- Eyes and cheeks — squeeze shut
- Mouth and jaw — clench gently
- Neck — chin to chest
- Shoulders — raise toward ears
- Chest and back — inhale and tense
- Stomach — tighten
- Right thigh, calf, foot
- Left thigh, calf, foot
- Sit quietly for one minute. Notice the difference between baseline and now.
A short version (5 minutes)
For days when 12 minutes is too much:
- Both hands
- Shoulders
- Face
- Stomach
- Both legs
Same protocol — 5 seconds of tension, 15 seconds of release.
Modifications for schizophrenia
Keep eyes open if needed
Many guides instruct closed eyes. Closing the eyes can intensify hallucinations or paranoia for some people. Open-eye PMR works just as well — find a fixed point in the room and let the gaze rest there.
Use external attention if interoception is hard
If "notice the sensation in the muscle" pulls you into uncomfortable internal focus, you can simply count the seconds and let the body do the rest. The technique still works.
Avoid heavy guided imagery
Many PMR scripts include long imagery — beaches, forests, light flowing through the body. Skip those passages. The benefit of PMR is the muscular work, not the imagery, and imagery can be destabilising.
Skip the abdomen if necessary
People with somatic delusions (beliefs about the body) sometimes find tensing the abdomen unsettling. It is fine to skip a single muscle group.
When to use it
- Daily, on calm days. Once a day for two weeks builds the skill.
- Before bed. One of the most useful evening routines for people with schizophrenia, who often struggle with insomnia. See sleep hygiene.
- After a stressful day. Especially useful when shoulders, jaw, and forehead carry the day's tension.
When to skip it
- During acute psychosis — internal focus is usually counterproductive in the middle of a severe episode.
- Right before an activity that needs alertness — PMR can leave you a little drowsy.
- If physical injuries make tensing painful.
Pairing PMR with other tools
A useful evening routine: 12-minute PMR → slow exhale breathing for two minutes → bedside lamp out. For daytime use, PMR fits well after a grounding sequence has brought distress down from a peak, as a way of releasing the tension that the spike left behind.
You are unable to settle, you are having thoughts of self-harm, or your symptoms are escalating. Call or text 988 (US), or your local emergency line.
Recordings and apps
You don't need to memorise the script. Many free recordings exist; the U.S. Veterans Affairs Whole Health library has reliable PMR audio, as do many CBT self-help sites. Apps that include PMR include several recommended in our digital therapeutics overview.
Working with a therapist
A clinician can record a personalised PMR script for you and help you adapt it. CBTp therapists, occupational therapists, and psychologists all use this technique. The NAMI support hub can help you locate one.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.