A handful of companies on the Fortune 500 list are over 100 years old, which is rare. What organizational characteristics do you think might explain 100-year longevity? (2.5 points)
1. How might the top management of an organization use SWOT analysis or scenario planning to set goals and strategy? Explain and give examples from your experience.
1. Describe the virtual network structure. What are the advantages and disadvantages of using this structure compared to performing all activities in-house within an organization?
When would an organization consider using a matrix structure? How does the global matrix differ from the domestic matrix structure described in Chapter 3?
Guided Imagery and Progressive Muscle Relaxation in Group Psychotherapy
Hannah K. Greenbaum
Department of Psychology, The George Washington University
PSYC 3170: Clinical Psychology
Dr. Tia M. Benedetto
October 1, 2019
Guided Imagery and Progressive Muscle Relaxation in Group Psychotherapy
A majority of Americans experience stress in their daily lives (American Psychological
Association, 2017). Thus, an important goal of psychological research is to evaluate techniques
that promote stress reduction and relaxation. Two techniques that have been associated with
reduced stress and increased relaxation in psychotherapy contexts are guided imagery and
progressive muscle relaxation (McGuigan & Lehrer, 2007). Guided imagery aids individuals in
connecting their internal and external experiences, allowing them, for example, to feel calmer
externally because they practice thinking about calming imagery. Progressive muscle relaxation
involves diaphragmatic breathing and the tensing and releasing of 16 major muscle groups;
together, these behaviors lead individuals to a more relaxed state (Jacobson, 1938; Trakhtenberg,
2008). Guided imagery and progressive muscle relaxation are both cognitive-behavioral
techniques (Yalom & Leszcz, 2005) in which individuals focus on the relationship among
thoughts, emotions, and behaviors (White, 2000).
Group psychotherapy effectively promotes positive treatment outcomes in patients in a
cost-effective way. Its efficacy is, in part, attributable to variables unique to the group experience
of therapy as compared with individual psychotherapy (Bottomley, 1996; Yalom & Leszcz,
2005). That is, the group format helps participants feel accepted and better understand their
common struggles; at the same time, interactions with group members provide social support and
models of positive behavior (Yalom & Leszcz, 2005). Thus, it is useful to examine how stress
reduction and relaxation can be enhanced in a group context.
The purpose of this literature review is to examine the research base on guided imagery
and progressive muscle relaxation in group psychotherapy contexts. This research student
provides overviews of both guided imagery and progressive muscle relaxation, including
theoretical foundations and historical context. Then this research student examines guided
imagery and progressive muscle relaxation as used on their own as well as in combination as part
of group psychotherapy (see Baider et al., 1994, for more). Throughout the review, the highlight
themes in the research. Finally, the end by pointing out limitations in the existing literature and
exploring potential directions for future research.
Features of Guided Imagery
Guided imagery involves a person visualizing a mental image and engaging each sense
(e.g., sight, smell, touch) in the process. Guided imagery was first examined in a psychological
context in the 1960s when the behavior theorist Joseph Wolpe helped pioneer the use of
relaxation techniques such as aversive imagery, exposure, and imaginal flooding in behavior
therapy (Achterberg, 1985; Utay & Miller, 2006). Patients learn to relax their bodies in the
presence of stimuli that previously distressed them, to the point where further exposure to the
stimuli no longer provokes a negative response (Achterberg, 1985).
Contemporary research supports the efficacy of guided imagery interventions for treating
medical, psychiatric, and psychological disorders (Utay & Miller, 2006). Guided imagery is
typically used to pursue treatment goals, such as improved relaxation, sports achievement, and
pain reduction. Guided imagery techniques are often paired with breathing techniques and other
forms of relaxation, such as mindfulness (see Freebird Meditations, 2012). The evidence is
sufficient to call guided imagery an effective, evidence-based treatment for a variety of stress-
related psychological concerns (Utay & Miller, 2006).
Guided Imagery in Group Psychotherapy
Guided imagery exercises improve treatment outcomes and prognosis in group
psychotherapy contexts (Skovholt & Thoen, 1987). Lange (1982) underscored two such benefits
by showing (a) the role of the group psychotherapy leader in facilitating reflection on the guided
imagery experience, including difficulties and stuck points, and (b) the benefits achieved by
social comparison of guided imagery experiences between group members. Teaching techniques
and reflecting on the group process are unique components of guided imagery received in a
group context (Yalom & Leszcz, 2005).
Empirical research focused on guided imagery interventions supports the efficacy of the
technique with a variety of populations within hospital settings, with positive outcomes for
individuals diagnosed with depression, anxiety, and eating disorders (Utay & Miller, 2006).
Guided imagery and relaxation techniques have even been found to “reduce distress and allow
the immune system to function more effectively” (Trakhtenberg, 2008, p. 850). For example,
Holden-Lund (1988) examined the effects of a guided imagery intervention on surgical stress
and wound healing in a group of 24 patients. Patients listened to guided imagery recordings and
reported reduced state anxiety, lower cortisol levels following surgery, and less irritation in
wound healing compared with a control group. Holden-Lund concluded that guided imagery
recordings contributed to improved surgical recovery. It would be interesting to see how the
results might differ if guided imagery was practiced continually in a group context.
Guided imagery has also been shown to reduce stress, length of hospital stay, and
symptoms related to medical and psychological conditions (Scherwitz et al., 2005). For example,
Ball et al. (2003) conducted guided imagery in a group psychotherapy format with 11 children
(ages 5–18) experiencing recurrent abdominal pain. Children in the treatment group (n = 5)
participated in four weekly group psychotherapy sessions where guided imagery techniques were
implemented. Data collected via pain diaries and parent and child psychological surveys showed
that patients reported a 67% decrease in pain. Despite a small sample size, which contributed to
low statistical power, the researchers concluded that guided imagery in a group psychotherapy
format was effective in reducing pediatric recurrent abdominal pain.
However, in the majority of guided imagery studies, researchers have not evaluated the
technique in the context of traditional group psychotherapy. Rather, in these studies, participants
usually met once in a group to learn guided imagery and then practiced guided imagery
individually on their own (see Menzies et al., 2014, for more). Thus, it is unknown whether
guided imagery would have different effects if implemented on an ongoing basis in group
Progressive Muscle Relaxation
Features of Progressive Muscle Relaxation
Progressive muscle relaxation involves diaphragmatic or deep breathing and the tensing
and releasing of muscles in the body (Jacobson, 1938). Edmund Jacobson developed progressive
muscle relaxation in 1929 (as cited in Peterson et al., 2011) and directed participants to practice
progressive muscle relaxation several times a week for a year. After examining progressive
muscle relaxation as an intervention for stress or anxiety, Joseph Wolpe (1960; as cited in
Peterson et al., 2011) theorized that relaxation was a promising treatment. In 1973, Bernstein and
Borkovec created a manual for helping professionals to teach their clients progressive muscle
relaxation, thereby bringing progressive muscle relaxation into the fold of interventions used in
cognitive behavior therapy. In its current state, progressive muscle relaxation is often paired with
relaxation training and described within a relaxation framework (see Freebird Meditations, 2012,
Research on the use of progressive muscle relaxation for stress reduction has
demonstrated the efficacy of the method (McGuigan & Lehrer, 2007). As clients learn how to
tense and release different muscle groups, the physical relaxation achieved then influences
psychological processes (McCallie et al., 2006). For example, progressive muscle relaxation can
help alleviate tension headaches, insomnia, pain, and irritable bowel syndrome. This research
demonstrates that relaxing the body can also help relax the mind and lead to physical benefits.
Progressive Muscle Relaxation in Group Psychotherapy
Limited, but compelling, research has examined progressive muscle relaxation within-
group psychotherapy. Progressive muscle relaxation has been used in outpatient and inpatient
hospital settings to reduce stress and physical symptoms (Peterson et al., 2011). For example, the
U.S. Department of Veterans Affairs integrates progressive muscle relaxation into therapy skills
groups (Hardy, 2017). The goal is for group members to practice progressive muscle relaxation
throughout their inpatient stay and then continue the practice at home to promote ongoing relief
of symptoms (Yalom & Leszcz, 2005).
Yu (2004) examined the effects of multimodal progressive muscle relaxation on
psychological distress in 121 elderly patients with heart failure. Participants were randomized
into experimental and control groups. The experimental group received biweekly group sessions
on progressive muscle relaxation, as well as tape-directed self-practice and a revision workshop.
The control group received follow-up phone calls as a placebo. Results indicated that the
experimental group exhibited significant improvement in reports of psychological distress
compared with the control group. Although this study incorporated a multimodal form of
progressive muscle relaxation, the experimental group met biweekly in a group format; thus, the
results may be applicable to group psychotherapy.
Progressive muscle relaxation has also been examined as a stress-reduction intervention
with large groups, albeit not therapy groups. Rausch et al. (2006) exposed a group of 387 college
students to 20 min of either meditation, progressive muscle relaxation, or waiting as a control
condition. Students exposed to meditation and progressive muscle relaxation recovered more
quickly from subsequent stressors than did students in the control condition. Rausch et al. (2006)
concluded the following:
A mere 20 min of these group interventions were effective in reducing anxiety to normal
. . . merely 10 min of the interventions allowed [the high-anxiety group] to recover from
the stressor. Thus, brief interventions of meditation and progressive muscle relaxation
may be effective for those with clinical levels of anxiety and stress recovery when
exposed to brief, transitory stressors. (p. 287)
Thus, even small amounts of progressive muscle relaxation can be beneficial for people
Guided Imagery and Progressive Muscle Relaxation in Group Psychotherapy
Combinations of relaxation training techniques, including guided imagery and
progressive muscle relaxation, have been shown to improve psychiatric and medical symptoms
when delivered in a group psychotherapy context (Bottomley, 1996; Cunningham & Tocco,
1989). The research supports the existence of immediate and long-term positive effects of guided
imagery and progressive muscle relaxation delivered in group psychotherapy (Baider et al.,
1994). For example, Cohen and Fried (2007) examined the effect of group psychotherapy on 114
women diagnosed with breast cancer. The researchers randomly assigned participants to three
groups: (a) a control group, (b) a relaxation psychotherapy group that received guided imagery
and progressive muscle relaxation interventions, or (c) a cognitive behavioral therapy group.
Participants reported less psychological distress in both intervention groups compared with the
control group, and participants in the relaxation psychotherapy group reported reduced
symptoms related to sleep and fatigue. The researchers concluded that relaxation training using
guided imagery and progressive muscle relaxation in group psychotherapy is effective for
relieving distress in women diagnosed with breast cancer. These results further support the utility
of guided imagery and progressive muscle relaxation within the group psychotherapy modality.
Limitations of Existing Research
Research on the use of guided imagery and progressive muscle relaxation to achieve
stress reduction and relaxation is compelling but has significant limitations. Psychotherapy
groups that implement guided imagery and progressive muscle relaxation are typically
homogeneous, time-limited, and brief (Yalom & Leszcz, 2005). Relaxation training in group
psychotherapy typically includes only one or two group meetings focused on these techniques
(Yalom & Leszcz, 2005); thereafter, participants are usually expected to practice the techniques
by themselves (see Menzies et al., 2014). Future research should address how these relaxation
techniques can assist people in diverse groups and how the impact of relaxation techniques may
be amplified if treatments are delivered in the group setting over time.
Future research should also examine differences in inpatient versus outpatient
psychotherapy groups as well as structured versus unstructured groups. The majority of research
on the use of guided imagery and progressive muscle relaxation with psychotherapy groups has
used unstructured inpatient groups (e.g., groups in a hospital setting). However, inpatient and
outpatient groups are distinct, as are structured versus unstructured groups, and each format
offers potential advantages and limitations (Yalom & Leszcz, 2005). For example, an advantage
of an unstructured group is that the group leader can reflect the group process and focus on the
“here and now,” which may improve the efficacy of the relaxation techniques (Yalom & Leszcz,
2005). However, research also has supported the efficacy of structured psychotherapy groups for
patients with a variety of medical, psychiatric, and psychological disorders (Hashim & Zainol,
2015; see also Baider et al., 1994; Cohen & Fried, 2007). Empirical research assessing these
interventions is limited, and further research is recommended.
Directions for Future Research
There are additional considerations when interpreting the results of previous studies and
planning for future studies of these techniques. For example, a lack of control groups and small
sample sizes have contributed to low statistical power and limited the generalizability of
findings. Although the current data support the efficacy of psychotherapy groups that integrate
guided imagery and progressive muscle relaxation, further research with control groups and
larger samples would bolster confidence in the efficacy of these interventions. In order to recruit
larger samples and to study participants over time, researchers will need to overcome challenges
of participant selection and attrition. These factors are especially relevant within hospital settings
because high patient turnover rates and changes in medical status may contribute to changes in
treatment plans that affect group participation (L. Plum, personal communication, March 17,
2019). Despite these challenges, continued research examining guided imagery and progressive
muscle relaxation interventions within-group psychotherapy is warranted (Scherwitz et al.,
2005). The results thus far are promising, and further investigation has the potential to make
relaxation techniques that can improve people’s lives more effective and widely available.
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