PMR
avoidance behaviors, anxiety
PMR, MUSCLE RELAXATION
The content and procedure of the PMR training is aimed as equal as possible to the content and procedure of the VRET. The control group is given a psychoeducational manual in preparation for the PMR training sessions at the end of the first assessment in the CAVE (T0, Pre). They are instructed to read the manual at home and to complete small written exercises included in the manual. Contents of the PMR manual resemble contents of the VRET manual (e.g. function and components of fear, vicious circle of fear, information about MPA in discrimination to stage fright) adjusted to the different therapy method (e.g. treatment of MPA due to PMR). The use of PMR to reduce MPA is explained in the manual in terms of an anxiety management training. Psychoeducational contents specific to the VRET such as individual safety and avoidance behaviors, learning and unlearning anxiety are excluded from the PMR manual and replaced by PMR specific contents (e.g. the relaxation response, classical conditioning). Same as for the VRET the participants of the PMR training are given a questionnaire to assess important factors relating to the training progress and potential changes of MPA due to the relaxation training before and after every training session. Furthermore, blood pressure and heart frequency are being measured in every training session, directly before and after the PMR.The content of the PMR manual is discussed with the patients in the first training session (PMR 1) and the patients have the opportunity to ask questions. They are introduced into the right execution of the PMR by explaining and practicing the correct way of straining and tensing the muscles together with the participant (PMR 1). Sessions two to four (PMR 2–4) are started with discussing the practice experience at home since the last session, reinforcing therapy compliant behavior and supporting the patient in case of difficulties with the therapeutic method. After that the musician is instructed to take a comfortable sitting position (e.g. take off shoes and glasses, unfasten waist belt, close eyes) and the PMR instruction is read out loud to the participant (PMR 1–4). The instruction used is a version by Bernstein and Borkovec according to the concept of progressive muscle relaxation in 16 steps by Jacobsen ([