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From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission 
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).distress tolerance Handout 6b   (Distress Tolerance Worksheet 4a)
paired m uscle r elaxation, Step by Step
If you have decided to practice paired muscle relaxation, it can be very helpful to practice 
relaxing each of your muscles first.
When you are starting, practice in a quiet place to reduce distractions, and make sure that you 
have enough time. As you improve with practice, you will want to practice in many different kinds of 
places, so that you can relax effectively when you most need to.
remember that effectiveness improves with practice. If judgments arise, observe them, let 
them go, and return to your practice. If you become anxious, try focusing on breathing in  to the 
count of 5 and out  to the count of 7 (or the counts you have already determined for paced breathing), 
breathing all the while into your belly until you can return to relaxation exercises.now that you are ready to begin . . .
1. Get your body into a comfortable position in which you can relax. Loosen tight clothing. Lie or 
sit down, with all body parts uncrossed and no body part supporting any others.
2. For each area of the body listed below, gather tension by tightening muscles. Focus on the sensation of tightness in and around that area. Hold the tension as you inhale for 5–6 seconds, then release and breathe out.
3. As you release, say in your mind very slowly the word “Relax.”