Amanda Wilde (Host): This is Community Connect presented by Tampa General Hospital. I'm Amanda Wilde. Joining me is Dr. Hannah Fitterman-Harris. She's a Clinical Health Psychologist at Tampa General Medical Group. We're addressing how to use progressive muscle relaxation for insomnia.

Dr. Fitterman-Harris, welcome to the podcast.

Hannah Fitterman-Harris, PhD: Thank you so much. It's great to be here.

Host: So you're a Clinical Psychologist. What is your role at TGH?

Hannah Fitterman-Harris, PhD: So as a Clinical Health Psychologist here, I focus specifically on sleep psychology. So I work with patients to improve their ability to fall asleep or fall back asleep more quickly, to stay asleep and to prevent them from waking up earlier than they'd like to.

Host: And what can a sleep psychologist do to help people sleep?

Hannah Fitterman-Harris, PhD: So we offer something called cognitive behavioral therapy for insomnia, or CBTI for short. And this is actually the gold standard treatment for insomnia, above and beyond medication based treatment. So we work with patients to help them engage in behaviors both during the day and at night that promote quality sleep.

And then we also focus on patient's thoughts and emotions around sleep. So a lot of times people with insomnia develop negative thoughts about their sleep. Things like, I'll never get a good night's sleep again, or sleeping should be easy, why is this so hard for me? And they may feel anxious, worried, or frustrated about their sleep.

Host: And why is cognitive behavioral therapy for insomnia, how have you seen it be effective?

Hannah Fitterman-Harris, PhD: Well, the behavioral components really work to provide consistency to people's schedule, especially their sleep schedule, which we know is really important for sleep. And then it can also, those behavioral components help reset the body's internal clock so people feel sleepy when they want to feel sleepy, and they feel alert and awake during their waking hours.

And then those thought based aspects of CBTI really work to ease the intensity of emotions like anxiety, stress, and frustration. Because if you've ever tried to fall asleep when you're anxious or irritated, you may have realized it is very difficult to do so when you're feeling those strong emotions.

Host: Right, and I imagine many people suffer from this condition.

Hannah Fitterman-Harris, PhD: It is pretty common, unfortunately.

Host: Well, what is progressive muscle relaxation?

Hannah Fitterman-Harris, PhD: Progressive muscle relaxation or PMR for short, it's a type of relaxation technique that involves tensing and relaxing different muscle groups throughout the body, so it helps re-familiarize people with what it actually feels like to be relaxed, which unfortunately is a sensation that's really easy to lose track of, whether it's because life demands, that we're always on the go, or sometimes folks experience something like chronic pain and it's, it's hard to feel that sense of relaxation.

Host: Obviously that sounds like a good thing for any situation, but how can progressive muscle relaxation help sleep, specifically?

Hannah Fitterman-Harris, PhD: Progressive muscle relaxation doesn't make people fall asleep, but it helps the person relax enough to allow what I call the opportunity for sleep. So helping folks get to a relaxed state of body and mind that we really need in order to be able to fall asleep.

Host: So you're going to take us through this exercise today, which is going to be very interesting.

Hannah Fitterman-Harris, PhD: Yes. So I have an exercise to do with you. It's adapted from a version in a book called Relaxation and Stress Reduction Workbook, and that's by Davis, Eshelman and McKay. Um, but I will walk you through this. This will take about 15 minutes.

Host: Okay.

Hannah Fitterman-Harris, PhD: So we can go ahead and get started.

Host: Okay. I'm ready and anyone listening can do this along with us.

Hannah Fitterman-Harris, PhD: Absolutely. Begin by getting into as comfortable a position as you can. Make sure that your weight is supported completely and that your arms and legs are uncrossed, your hands resting in your lap or by your side. If you're sitting, placing your feet flat on the floor. And if you feel comfortable, closing your eyes and keeping them closed.

I will ask you to tense and hold and then relax many of the muscle groups throughout the body. Let your mind focus on the different sensations you have when you tense, hold, and then relax each muscle group. If you feel pain at any point, don't tense that muscle group. Instead, focus just on relaxing the muscles.

Begin to relax as you take a few slow deep breaths. Notice how your abdomen rises and falls with each breath. Continue to breathe slowly and regularly while you think about relaxation. With every breath you take, imagine inhaling relaxation and exhaling tension.

Inhale, relaxation, and calm.

Exhale, tension and stress.

Now as you let the rest of your body relax, wrinkle your forehead as tight as you can, as if you're very surprised, wrinkle it more. Feel the tension across your forehead. Now, relax. Notice as your forehead becomes smooth.

Squeeze your eyes closed, tight. Wrinkle your nose and purse your lips together and relax your facial muscles, allowing your eyes to remain gently closed.

Notice the difference between when your muscles are tense and when they are relaxed.

Now, open your mouth wide and notice the tension in your jaw. Relax your jaw. Keeping a space between your top and bottom teeth. Feel the relaxation throughout your face, in your forehead, your eyes, nose, lips, and jaw. Release more and more with each exhalation.

Now turn your attention to your neck. Gently allow your head to fall towards the right shoulder, feeling the tension in the left side of your neck. Now allow your head to tilt toward the left shoulder. Hold it there. Feel the tension in the right side of your neck.

Next, let your head lower towards your chest, feeling the pull on the back of your neck. And finally, let your head gently fall back looking up towards the ceiling, feeling the tension in the front of your neck, and now relax, allowing your head to return to a comfortable, upright position. Feel the warmth that has replaced the tension.

Keeping the rest of your body as relaxed as possible. Shrug your shoulders up toward your ears. Tensing without straining. All at once, release that tension, dropping your shoulders back down. Imagine a wave of relaxation spreading through your neck and your shoulders. Feel completely at ease.

Turning your attention to your arms and your hands, bend your elbows and tense your biceps. Notice the tension and the tightness. Then let your hands drop down and relax. Noting the difference between the tension that was there and the relaxation that has replaced it.

Clench your fists and bend them back at the wrist. Focus on the tension in your fists and your forearms. Let your muscles go limp. Feel the looseness in your hands and your forearms. Notice how they feel heavier now. Enjoy that feeling. Now breathe in, filling your lungs completely and hold that breath. Experience the tension in your chest, and now exhale all at once and feel the tension in your chest wash away.

Continue relaxing, letting your breath become smooth and rhythmic. Notice the tension releasing from your muscles with each exhalation.

Next, tighten the muscles in your stomach and hold. Feel the tension and relax. Notice the contrast between the tension and relaxation. Now, breathe deeply into your stomach and hold that breath. Exhale all at once, letting your breath carry away your stress and tension. Relax.

Next, round your back, noticing that tension across your shoulders and your upper back and release, allowing your spine to straighten out, breathing in relaxation, breathing out tension and stress.

Now arch your back without straining and focus on the tension in your lower back. Now, relax. Let the tension fade away. Feel your body growing heavier.

Next, tighten your hips, your bottom, and your thighs. And let your muscles soften. Imagine the tension melting away. Now straighten out your legs and tense them, pointing your toes downward. Experience the tension and relax. Straighten and tense your legs again, but this time flex your feet up toward your face. Relax and feel the tension drain from your muscles. Breathe in relaxation. And breathe out tension and stress.

Now, clench your feet by curling your toes and tensing the muscles in the soles of your feet. Hold it there. And let your muscles go limp. Notice the difference between the tension and the relaxation. Feel that your body has undergone a change. Notice the warmth of relaxation washing over you.

Imagine any remaining tension melting away like butter as you move up through your body. Relax your toes. Relax the tops and the arches of your feet. Relax your heels. Relax your legs, starting first with your ankles, then relaxing your calves and your shins. Relax your knees, relax your thighs, your bottom, and your hips. Let the relaxation spread to your stomach, to your lower back, to your chest and your upper back. Feel the relaxation moving through your shoulders, down your arms, into your elbows, through your forearms, your wrists, your hands, and your fingers.

Feel your body becoming heavier. Notice the feeling of looseness and relaxation in your neck, your jaw, your lips and your nose, your eyes, your eyebrows, and your forehead. Enjoy this feeling as you continue to breathe slowly and deeply. Your entire body from the top of your head to the tips of your toes is comfortable, loose and relaxed, calm and refreshed.

Take a few more deep breaths. And know that you can come back to this place of relaxation whenever you want to. When you're ready, take another deep breath and slowly become aware of your surroundings. Move your feet, your legs. Hands and arms. Stretch out if you would like. Rotate your head and open your eyes slowly, feeling refreshed and relaxed.

Host: Such a relaxing, calming exercise. I'm sure there are many applications for it, just to let go of tension and sort of untwist and realign and get reacquainted with your body. Tightening and loosening the muscles consciously in this way really makes you slow down and allows you to scan the body, and I think it's just a matter of taking this time to prepare your body for sleep. And when you relax, you can fall asleep more easily. Right?

Hannah Fitterman-Harris, PhD: Absolutely, and you're right that there are a lot of different applications for this. This is great to, like I said, give that opportunity for sleep, but also just if you're feeling anxious or rushed or just need a moment to have your body and your muscles feel a little bit better; this is a really great exercise.

Host: It really is. It kind of wakes up while it relaxes parts of your body, but just doing that tension and release, you can feel the blood flowing in those areas and just really brings you back to yourself.

Hannah Fitterman-Harris, PhD: Absolutely

Host: Well, Dr. Fitterman-Harris, thank you so much for this guided muscle relaxation to get us to better sleep.

Hannah Fitterman-Harris, PhD: Absolutely. Happy to be here. Thank you again.

Host: That was Clinical Health Psychologist Dr. Hannah Fitterman-Harris. For more information, please visit tgmg.org/psychology. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect presented by TGH on your favorite podcast platform. I'm Amanda Wilde, and this is Community Connect, presented by TGH. Thanks for listening.