Teaching Deep Breathing and Jacobson's Progressive Muscle Relaxation (JDMR) to Individuals with Developmental Disabilities: A Detailed Guide

Jacobsen Deep Muscle Relaxation (JDMR), developed by Dr. Edmund Jacobson, is a time-tested therapeutic approach, which involves systematically tensing and relaxing muscle groups to promote relaxation and reduce stress. Widely used in therapeutic and clinical settings, JDMR has shown potential for helping individuals with developmental disabilities (DD). Developmental disabilities encompass a range of lifelong conditions, including intellectual disabilities, autism spectrum disorders, and cerebral palsy, which can affect cognitive, social, and motor skills.

This blog post explores the application of JDMR in this population, emphasizing its benefits and offering practical steps for implementation. We also discuss the importance of preparing individuals through deep breathing exercises, a foundational relaxation technique that enhances the effectiveness of JDMR. By understanding and adapting these practices, caregivers and professionals can empower individuals with DD to achieve improved mental and physical well-being.

I (Dr. Carey) have successfully used this technique with dozens of individuals of varying levels of disability.   For individuals with developmental disabilities—who may have limited language, cognitive flexibility, or abstract reasoning abilities—adapting this technique to accommodate any special needs is essential to ensure understanding and effectiveness.

JDMR was developed by Dr. Edmund Jacobsen in the early 20th century and has been widely used to help individuals achieve a state of relaxation to help cope with stress related and anxiety disorders.  JDMR focuses on the connection between muscular tension and psychological stress. Jacobsen posited that relaxing the body could directly influence mental calmness. The process involves:

1. Tensing specific muscle groups: Holding the tension briefly (usually 5-10 seconds).

2. Releasing the tension: Allowing the muscles to relax completely.

3. Noticing the difference: Encouraging awareness of the contrast between tension and relaxation.

JDMR progresses systematically from one muscle group to another, often starting with the feet and ending with the face. The exercise promotes mindfulness, body awareness, and stress relief.

Why JDMR is Beneficial for Individuals with Developmental Disabilities

People with DD often experience heightened anxiety, muscle tension, and difficulty regulating emotions. JDMR offers a structured, accessible way to address these challenges. Here are some key benefits:

• Reduction in Anxiety and Stress: JDMR helps lower physiological arousal, which is beneficial for managing anxiety and hyperactivity.

• Improved Body Awareness: Many individuals with DD have difficulty identifying physical sensations. JDMR fosters a deeper connection with their bodies.

• Enhanced Motor Coordination: For individuals with motor challenges, JDMR promotes muscle control and relaxation.

• Better Sleep Quality: Relaxation techniques, including JDMR, have been linked to improvements in sleep, a common challenge in this population.

• Empowerment and Independence: Mastering a relaxation skill can build confidence and autonomy.

The Role of Deep Breathing as a Precursor to JDMR

Deep breathing exercises serve as an excellent preparatory activity for JDMR. They help individuals achieve a state of calm, increase oxygen flow, and establish a foundation for relaxation. Teaching deep breathing to individuals with DD requires patience and creativity.

Steps for Deep Breathing with Individuals with DD

1. Explain the Concept: Use simple language to describe breathing deeply. For example, “We’re going to take big breaths like blowing up a balloon.”

2. Model the Practice: Demonstrate slow, exaggerated breaths. Encourage them to watch and mimic your actions.

3. Use Visual Aids:

   • Picture cards with images of inflating and deflating balloons.

   • A pinwheel or bubbles, which require slow, controlled breathing to use effectively.

4. Incorporate Counting:

   • Count aloud to pace the breathing: “Breathe in for 1, 2, 3… and out for 1, 2, 3.”

   • Visual timers or rhythmic clapping can also guide pacing.

5. Make it Engaging:

   • Use interactive tools like apps or calming music.

   • Create imaginative scenarios, like pretending to smell flowers (inhale) and blow out candles (exhale).

6. Adapt the Environment:

   • Choose a quiet, familiar space.

   • Encourage seated or reclined positions for comfort.

7. Start Briefly: Begin with short sessions (1-2 minutes) and gradually extend as the individual becomes comfortable.

8. Praise and Reinforce: Offer encouragement for participation and effort.

Preparation and Environment Setup

Creating a comfortable, distraction-free environment is crucial to foster relaxation and engagement.

• Calming Space: Choose a quiet room with minimal sensory distractions, such as soft lighting and soothing background sounds (e.g., calming music or nature sounds).

• Comfortable Seating: Provide a chair with back support or allow the individual to lie down if preferred.

• Sensory Tools: Include items like weighted blankets, fidget tools, or soft pillows to provide additional comfort if needed.

Introduction to Progressive Deep Muscle Relaxation

Start with a simple explanation of the purpose of JDMR using clear and concrete language.

• Verbal Explanation:

  • “We’re going to practice making your body feel calm and loose. First, we’ll make the muscles tight like a robot, and then soft like a jellyfish.”

  • Avoid abstract terms like "stress" or "tension." Use tangible analogies that are easy to grasp.

• Visual Aids:

  • Use pictures or drawings that show muscles in a tense state (e.g., clenched fists) and then in a relaxed state (e.g., open hands).

Modeling and Demonstration

Demonstrate each step visually, showing how to tense and relax each muscle group.

• Mirror Technique: Sit facing the individual and perform the exercises simultaneously, encouraging them to mimic your actions.

• Physical Prompts: For individuals who need more guidance, provide gentle, non-invasive physical prompts (e.g., placing your hand over theirs to help guide muscle tension and release).

Breaking Down the Process: Step-by-Step Instructions

Simplify the process by focusing on one muscle group at a time and using brief, clear instructions. Begin with larger, easier-to-control muscle groups, such as the hands or arms, before moving to more subtle areas like the face.

Example Sequence:

1. Hands and Arms

• Tensing: “Make your hands into tight fists. Squeeze like you’re holding a lemon really tight.”

• Relaxing: “Now let go. Open your hands slowly like you’re letting the lemon drop.”

2. Shoulders

• Tensing: “Lift your shoulders up to your ears, like you’re trying to touch them. Hold it—tight, tight!”

• Relaxing: “Now, let your shoulders drop. Feel them go down like melting ice.”

3. Face

• Tensing: “Scrunch your face like you just tasted a sour lemon. Make it really small.”

• Relaxing: “Now, let your face get soft, like a relaxed puppet.”

4. Legs and Feet

• Tensing: “Stretch your legs out straight and point your toes, like reaching for something with your feet.”

• Relaxing: “Now, let your feet flop down, like spaghetti noodles.”

Encourage Mindfulness

• Ask individuals to notice the difference between tension and relaxation. For example, “Does it feel heavy or light? Tight or loose?”

Sensory and Visual Enhancements

Incorporate sensory supports and visual cues to reinforce the tensing and relaxing process.

• Tactile Cues: Use soft hand pressure on muscles to help the individual feel the difference between tension and relaxation.

• Visual Relaxation Cards: Show cards with "Tense" (a clenched fist icon) and "Relax" (an open hand icon) to prompt actions.

• Auditory Cues: Use descriptive sounds to accompany actions (e.g., “tight like a spring” for tension and “soft like a cloud” for relaxation).

Encouraging Participation and Reinforcement

Offer positive reinforcement throughout the session to maintain engagement.

• Immediate Praise: Use specific praise like, “Great job squeezing your fists! Now they’re super relaxed.”

• Rewards: Incorporate a simple reward system, such as earning a token or sticker for completing each muscle group exercise.

• Interactive Feedback: Ask simple yes/no questions or use visual choice boards (e.g., “Did that feel tight or soft?”) to check understanding.

Adaptation for Cognitive and Language Limitations

Adapt the language and pace of JDMR based on the individual’s cognitive level.

• Short Sessions: Keep the initial sessions short (5–10 minutes) and gradually increase the duration as the individual becomes more comfortable.

• Repetitive Practice: Use repetition and consistent phrasing to reinforce learning (e.g., “Tight like a robot, soft like jelly”).

• Simplify Concepts: Avoid discussing abstract benefits like “stress reduction.” Focus instead on how the body feels during and after relaxation (“Does your body feel soft now?”).

Overcoming Challenges in Implementation

Implementing JDMR with individuals who have DD may present challenges, such as difficulty understanding instructions or restlessness. Here are solutions:

• Restlessness: Introduce movement breaks or use shorter, more engaging sessions.

• Communication Barriers: Utilize alternative communication methods, such as gestures or picture cards.

• Sensory Sensitivities: Adjust the exercises to accommodate tactile aversions or preferences.

Monitoring Progress and Adjusting Techniques

Observe the individual’s responses and adjust techniques as needed.

• Nonverbal Feedback: Watch for signs of relaxation, such as slower breathing or decreased fidgeting.

• Adjust Based on Feedback: If an individual struggles with a particular muscle group, focus on those they can manage easily and gradually introduce more complex areas.

Maintaining a Consistent Practice Routine

Encourage regular practice to build familiarity and comfort with JDMR.

• Daily Practice: Suggest incorporating JDMR into daily routines, such as before bedtime or after a challenging activity.

• Family Involvement: Teach caregivers how to guide the exercises at home for consistency and reinforcement.

Conclusion

Jacobsen Deep Muscle Relaxation training offers immense potential for enhancing the well-being of individuals with developmental disabilities. By pairing JDMR with deep breathing exercises, caregivers and professionals can provide a structured, empowering approach to relaxation. The adaptability of these techniques ensures they can be tailored to meet the unique needs of this diverse population.

Ultimately, these practices foster not only relaxation but also greater self-awareness, emotional regulation, and confidence. As society strives for inclusivity and support for individuals with developmental disabilities, tools like JDMR become invaluable in promoting holistic health and well-being.