Progressive Muscle Relaxation and VR: Teaching Clients to Calm the Body Before Exposure

When working with clients struggling with phobias or anxiety disorders, one of the most common barriers to effective exposure therapy is heightened physiological arousal. A pounding heart, shallow breathing, or muscle tension, can quickly push clients toward avoidance before the therapeutic work even begins.

Progressive Muscle Relaxation (PMR) offers a powerful, evidence-based way to help clients regulate these bodily responses. And when combined with Virtual Reality Exposure Therapy (VRET), PMR can be taught and practiced in engaging, structured ways that prepare clients to face their fears with greater confidence.

What is Progressive Muscle Relaxation?

PMR was first developed by Edmund Jacobson in the 1920s, grounded in the principle that reducing physical tension can also reduce psychological stress and anxiety. The method involves systematically tensing and releasing muscle groups throughout the body, training individuals to recognize and let go of unnecessary tension.

Clinical research has consistently shown PMR to be effective in reducing both state and trait anxiety. For example:

• Manzoni et al. (2008) conducted a meta-analysis and found relaxation training (including PMR) led to significant reductions in anxiety across clinical and non-clinical populations.

• Conrad & Roth (2007) noted that PMR not only reduces subjective anxiety but also lowers physiological markers such as heart rate and blood pressure.

  
  

These findings reinforce that PMR is more than a “nice-to-have” technique. It’s a well-validated intervention that supports both mind and body.

Why PMR Matters in Exposure Therapy

Exposure therapy is designed to help clients confront feared stimuli without avoidance, allowing new learning and reduced fear responses over time. Yet many clients struggle to engage fully in exposure when their bodies are overwhelmed by tension and panic symptoms.

This is where PMR becomes a valuable preparatory tool. Teaching clients PMR before exposures offers three benefits:

1. Reduced Physiological Arousal By lowering baseline tension and calming the nervous system, PMR makes clients less reactive during exposures.

2. Increased Sense of Control When clients can actively calm their bodies, they feel more capable of handling challenging scenarios. This builds treatment adherence and confidence.

3. Skill Generalization PMR is portable. Once learned, clients can use it outside therapy, applying it with ease in daily life when stress or fear arise.

   
   

Integrating PMR with VR

Traditionally, clinicians might guide clients through PMR in session, but practice outside of the clinic often relies on written instructions or audio recordings. Virtual Reality adds a new dimension to learning and practicing this technique.

With oVRcome, clinicians have access to VR videos with guided audio coaching that walk clients through the process of PMR. These immersive sessions can be assigned as “homework,” allowing clients to build the skill at their own pace and in their own space. The combination of visual immersion and audio guidance helps sustain attention, making practice more engaging than traditional methods.

Moreover, VR-delivered PMR can be seamlessly incorporated into exposure programs.

For example:

• Clients might begin with a short PMR session before entering a virtual exposure environment.

• Clinicians can assign PMR modules between exposure sessions to reinforce relaxation skills.

• Clients who become overwhelmed mid-session can pause, return to PMR practice, and then re-engage with exposure once they feel calmer.

This flexibility makes PMR not only an adjunctive technique but a cornerstone of successful VRET implementation.

Practical Considerations for Clinicians

• Introduce PMR Early: Teaching PMR in the initial stages of therapy gives clients a concrete tool they can rely on once exposures begin.

• Normalize the Learning Curve: Some clients may initially find it difficult to notice tension and release. Encourage patience and repetition.

• Highlight Autonomy: Emphasize that PMR is a self-management skill. Using VR modules, clients can take ownership of their practice, which enhances long-term outcomes.

Bringing It Together

As clinicians, we know that exposure therapy is highly effective — but only if clients can tolerate the distress that comes with it. Progressive Muscle Relaxation equips clients with a scientifically grounded, body-based method for reducing anxiety. By integrating VR-delivered PMR modules, you can ensure that your clients not only learn this essential technique but also practice it consistently, in ways that feel accessible and engaging.

Helping clients calm their bodies before exposure isn’t about avoiding fear. It’s about giving them the tools to face it with greater resilience. With PMR and VR, you can enhance your therapeutic toolkit and empower clients to step into exposures with confidence.

References

• Conrad, A., & Roth, W. T. (2007). Muscle relaxation therapy for anxiety disorders: It works but how? Journal of Anxiety Disorders, 21(3), 243–264.

• Manzoni, G. M., Pagnini, F., Castelnuovo, G., & Molinari, E. (2008). Relaxation training for anxiety: A ten-years systematic review with meta-analysis. BMC Psychiatry, 8(1), 41.