Anxiety management training

1. Introduction

Version followed: Suinn's standard individual/group AMT as set out in Suinn (1990, Anxiety Management Training: A Behavior Therapy) and Suinn & Deffenbacher (1988), with the earlier Suinn & Richardson (1971) and Edie (1972) variants noted where they differ. The 1990 book itself was not readable online (publisher pages refused); its session-level detail below is reconstructed from opened secondary and study sources and is tagged [uncertain] where it rests on the book alone.

Anxiety management training (AMT) is a brief, relaxation-based, self-control therapy developed by Richard Suinn and Frank Richardson at Colorado State University as a faster, more general alternative to systematic desensitisation. It was built for generalised anxiety but its authors describe it as usable wherever anxiety (and later anger and other intense emotions) is central. [source: Suinn & Deffenbacher 1988 abstract; Ehrenreich & Fisak, SAGE Encyclopedia of CBT]

Core idea of change: the bodily and mental signs of anxiety themselves can be conditioned as cues for an incompatible response (relaxation, originally also competence). The client repeatedly arouses anxiety in imagery in session, notices its earliest cues, and switches to relaxation; control is gradually transferred from therapist to client so the skill can be used on any anxiety, including situations never rehearsed. No hierarchy is built: the method is "nonspecific" to the feared object. [source: Edie 1972 (ERIC ED117581) pp. 2–6; Suinn & Richardson 1971 title; SAGE Encyclopedia]

2. Framework

AMT is a short, structured skills programme, delivered individually or in groups, and in early research partly by audiotape. Two shapes are documented [source: SAGE Encyclopedia; Edie 1972; Suinn & Richardson 1971]:

• Standard clinical course: typically about five weekly sessions of roughly an hour, with sessions repeated when a step is not yet mastered, so courses commonly run longer (6–8 is a common clinical span [uncertain: exact count in Suinn 1990 not verified]).
• Research/group course (Edie 1972): five group sessions, twice weekly over about three weeks: a 2-hour relaxation session, three 1.5-hour treatment sessions each containing three arousal-and-control cycles, and a 2-hour closing session. The 1971 original was three sessions with automated elements.

Phases (session numbers approximate; follow mastery, not the calendar) [source: SAGE Encyclopedia; Edie 1972; sequence of later phases per Suinn 1990 as summarised in secondary literature, [uncertain]]:

Format details: anxiety intensities are kept to two levels (moderate and high) rather than a graded hierarchy; scenes are the client's own real past experiences and need not be the presenting problem. [source: SAGE Encyclopedia; Edie 1972 p. 9]

3. Guiding principles

• Skill, not cure. AMT is taught as a coping skill learned through practice. Practical meaning: frame every session as practice and every setback as information for more practice. [source: SAGE Encyclopedia]
• Anxiety is deliberately aroused. Practical meaning: you must actually produce felt anxiety in session; relaxation alone is not AMT. [source: Edie 1972; UAB dissertation p. 1]
• Anxiety cues become discriminative stimuli. Practical meaning: train attention to the client's own earliest signals so those signals trigger relaxation. [source: Edie 1972 pp. 2, 6]
• Incompatible response. Relaxation (originally also competence imagery) is used to inhibit anxiety. Practical meaning: the switch must produce genuine relaxation, not just compliance. [source: Edie 1972; slideserve summary of Suinn & Richardson 1971]
• Nonspecific and generalisable. No hierarchy; any real anxiety memory serves. Practical meaning: choose scenes for vividness, not topic, and expect transfer to untreated situations. [source: SAGE Encyclopedia; slideserve summary]
• Two intensity levels. Practical meaning: work at moderate first, then high; skip graded ladders. [source: SAGE Encyclopedia]
• Fading of therapist control. Practical meaning: each session you say less and the client does more until they run the cycle alone. [source: SAGE Encyclopedia describes self-control aim; fading as a named principle per Suinn 1990, [uncertain]]
• Early detection. Practical meaning: aim for the client to catch anxiety at low levels in daily life, not only at peaks. [source: Edie 1972 p. 8]
• Practice between sessions. Practical meaning: daily relaxation practice and self-monitoring logs are part of the treatment, not extras. [source: Edie 1972 pp. 7–8; Suinn 1990 contents list logs for self-monitoring]
• Check after every exposure. Practical meaning: a short post-session (or post-cycle) interview confirms vividness, anxiety felt and recovery achieved. [source: Edie 1972 p. 8; Suinn 1990 contents list sample post-session interviews]
• Brevity. Practical meaning: plan a short course and repeat steps only as mastery requires. [source: Edie 1972 pp. 4–5; Google Books description]

4. Intervention inventory

Sources for this section: Edie 1972 (ERIC ED117581) for the documented research protocol; UAB dissertation (one-session AMT, citing Suinn & Richardson 1971); SAGE Encyclopedia entry for structure and session 1; Suinn 1990 contents (Google Books) for the existence of relaxation instructions, relaxation-imagery management, logs and post-session interviews. Step detail beyond those is [uncertain] or [synthesis]. All example language is illustrative unless quoted.

4.1 Intake and suitability check

• Purpose / when: Before session 1, confirm anxiety is a central problem and AMT fits; collect raw material for scenes. [source: Edie 1972 p. 6 (20–30 min screening); SAGE Encyclopedia]
• Steps: (1) Map where, when and how anxiety shows up (body, thoughts, behaviour). (2) Screen for conditions where in-session anxiety arousal needs care (see Watch for). (3) Ask for one recent, real, vividly remembered situation of moderate anxiety and one of high anxiety, plus one real calm, pleasant memory. (4) Start a simple daily anxiety log (situation, 0–100 rating, cues noticed). [steps 3–4 partly [synthesis]; logs per Suinn 1990 contents]
• Example language (illustrative): "I'd like to hear about a specific time in the last few months when you felt clearly anxious. Not the worst ever, just one you remember well."
• Watch for: Active psychosis, dissociative episodes, recent trauma with intrusive re-experiencing, medical conditions where strong arousal is unsafe, and panic triggered by relaxation; consult medical colleagues where relevant and adapt or choose another treatment. [synthesis]

4.2 Rationale and consent to in-session arousal

• Purpose / when: Session 1. Frames AMT as skill-learning and obtains informed agreement to deliberately feel anxiety in session. [source: SAGE Encyclopedia]
• Steps: (1) Explain that anxiety has early signals and that a learned relaxation response can be attached to those signals. (2) Describe the course: relaxation first, then practice switching from imagined anxiety to relaxation, with the client gradually taking over. (3) State plainly that imagery will be used to bring on anxiety in session and that this is temporary and controlled. (4) Agree a stop signal and confirm consent. (5) Stress daily practice.
• Example language (illustrative): "Think of this like learning a sport: we practise a move under pressure until it becomes automatic. To practise, we'll need some real anxiety in the room, brought on by imagining a past event, and you'll learn to turn it down."
• Watch for: Hesitation about feeling anxious on purpose; address it before starting arousal (see 5). Signs it is working: client can restate the rationale in their own words.

4.3 Deep muscle (tension–release) relaxation training

• Purpose / when: Session 1 and daily homework; builds the incompatible response. [source: Edie 1972 p. 7 (Jacobson-based, adapted from Wolpe & Lazarus 1966); Suinn 1990 appendix of relaxation instructions]
• Steps: (1) Seat the client comfortably, eyes closed if acceptable. (2) Work through the main muscle groups (hands/forearms, upper arms, face, neck and shoulders, chest/back, stomach, legs/feet): tense each for a few seconds, notice the tension, release, and notice the contrast for longer. (3) Add slow breathing and a summary of whole-body relaxation. (4) Ask for a 0–100 relaxation or anxiety rating before and after. (5) Assign daily practice, initially guided (audio recording of your own instructions is consistent with AMT's tape use [source: Google Books description; synthesis]).
• Example language (illustrative): "Make a fist with your right hand... hold it... notice the tightness... and let go. Let the hand go loose and notice how it feels different now."
• Watch for: Pain or injury in any muscle group (skip tensing there); relaxation-induced anxiety; falling asleep. Working when the client reaches relaxation faster and reports it at home.

4.4 Relaxation scene

• Purpose / when: Session 1 onward. A real, calm memory used to deepen relaxation and to help return to it after arousal. [source: UAB dissertation p. 3 (therapist describes a pleasant scene with relaxation suggestions); Edie 1972 p. 9; Suinn 1990 chapter on managing relaxation imagery]
• Steps: (1) Ask for a specific real moment when the client felt calm and safe. (2) Gather sensory details (where, sights, sounds, temperature, bodily feeling). (3) Write a short script in the client's words. (4) After muscle relaxation, describe the scene and let the client stay in it. (5) Check vividness and calm afterwards.
• Example language (illustrative): "You're back on that porch, the evening air cooling, the sound of the crickets... and you notice the easy, heavy feeling in your shoulders."
• Watch for: Scenes that turn bittersweet or intrusive (choose another); scenes that are imagined ideals rather than lived memories (often less vivid [synthesis]).

4.5 Brief relaxation without tension and the breath control cue

• Purpose / when: From session 2. A quicker relaxation method usable in daily life and to end arousal. [source: Edie 1972 p. 8 (control cue: deep breath, held briefly, released slowly); "relaxation without tension"/recall method in Suinn 1990 [uncertain]]
• Steps: (1) Once tension–release relaxation is reliable, guide relaxation by attention and release alone, skipping the tensing. (2) Teach the control cue: a deep breath, a brief hold, a slow exhale, followed by letting the muscles loosen. (3) Pair the cue repeatedly with the relaxed state in session and at home.
• Example language (illustrative): "Take one deep breath... hold it a moment... and breathe out slowly, letting your shoulders drop as you do."
• Watch for: Over-breathing or breath-holding that increases dizziness; keep the breath gentle. Working when one breath plus release brings a noticeable drop in tension.

4.6 Anxiety scene construction (moderate and high)

• Purpose / when: Before the first arousal session (session 1–2), and again before introducing high intensity. [source: SAGE Encyclopedia (two levels); Edie 1972 p. 9; UAB dissertation p. 16]
• Steps: (1) Pick a real past event. (2) Ask the client to rate how anxious it made them (0–100); one scene clearly moderate, a second clearly high [specific anchor numbers often cited, e.g. around 60 and 90, are [uncertain]]. (3) Collect the setting, what was happening just before the peak, and the client's bodily sensations, thoughts and actions at the time. (4) Write a short script ending at the moment anxiety rises. (5) Avoid scenes of current danger or unprocessed trauma. [step 5 synthesis]
• Example language (illustrative): "Walk me through that meeting moment by moment. Where were you sitting? What did you notice in your body just as your name was called?"
• Watch for: Scenes too weak to produce anxiety (pick another) or overwhelming (step down to moderate). A good scene produces felt anxiety within a minute or two of imagery.

4.7 Anxiety arousal by scene imagery (therapist-directed)

• Purpose / when: Core exposure step from session 2. Produces real anxiety in session so its cues can be linked to relaxation. [source: Edie 1972 pp. 7–9 (AMT II/III); UAB dissertation pp. 1, 3 (therapist describes scene and expected sensations)]
• Steps: (1) Relax the client first (4.3/4.4). (2) Describe the moderate anxiety scene, including the client's own sensations and thoughts. (3) Ask the client to let the anxiety build and to signal when they clearly feel it (a raised finger is a common convention [uncertain]). (4) Hold the scene briefly (Edie used inductions of about two to three minutes). (5) Move to the recovery step (4.9). (6) Repeat for several cycles per session (Edie: three per session).
• Example language (illustrative): "Now switch on the scene... you're in the corridor, your name is called... notice your heart starting to speed up... let the anxiety come... lift your finger when you can really feel it."
• Watch for: No anxiety (scene too weak, poor imagery: see 5); escalating panic (end early with the control cue, use a milder scene). Working when the client reliably feels anxiety and recovers.

4.8 Anxiety arousal by bodily-cue description

• Purpose / when: Alternative or addition to scenes when imagery is weak, or to sharpen awareness of physical cues. [source: Edie 1972 p. 8 (AMT I: therapist describes sensations such as a pounding heart and shallow, irregular breathing); AMT II combined cues and scenes]
• Steps: (1) From intake, list the client's own anxiety sensations. (2) After relaxation, ask the client to attend to these sensations while you describe them building. (3) Continue for two to three minutes or until clear anxiety is signalled. (4) End with the control cue and return to relaxation.
• Example language (illustrative): "Notice your chest... your breathing becoming shallow and quick... a tightness in your stomach, just as it was that day."
• Watch for: Clients with panic disorder or health anxiety may escalate quickly when focused on bodily sensations; go slowly and check in. [synthesis]

4.9 Switching to relaxation (relaxation control)

• Purpose / when: Immediately after each arousal. Builds the response that follows the anxiety cues. [source: Edie 1972 p. 8; UAB dissertation p. 3]
• Steps: (1) On the client's signal, instruct them to end the scene (early sessions) and return to relaxation using the control cue, the relaxation scene or muscle release. (2) Guide them until relaxed again and ask them to signal when relaxed. (3) After the first cycle in each session, briefly check that anxiety was felt and recovery occurred (Edie). (4) Repeat cycles.
• Example language (illustrative): "Now switch off that scene... take a deep breath, hold... and slowly let it out... go back to the porch, feeling the warmth, letting your muscles loosen."
• Watch for: Residual tension: extend recovery before the next cycle. Working when recovery time shortens across cycles.

4.10 Cue awareness training (physical, cognitive, behavioural)

• Purpose / when: From about session 3. Helps the client notice the earliest signs of their own anxiety so the switch can happen early in daily life. [source: SAGE Encyclopedia (recognising physiological and cognitive cues early); Edie 1972 p. 8 (identify anxiety at lower levels)]
• Steps: (1) During each arousal, ask the client to notice exactly how anxiety shows up: body sensations, thoughts, urges or actions. (2) In the post-cycle check, list these cues and identify which came first. (3) Use the earliest cue as the signal to start relaxation. (4) Add cue noticing to the daily log.
• Example language (illustrative): "This time, as the anxiety rises, notice what tells you it's starting: is it your jaw, your stomach, a thought like 'I'll mess this up'?"
• Watch for: Clients who only notice anxiety at peak; keep practising at moderate intensity. Working when cue lists become specific and the client spots anxiety earlier in logs.

4.11 Self-initiated relaxation and fading of therapist control

• Purpose / when: Sessions 3 onward. Transfers control so the client can use the skill alone. [source: SAGE Encyclopedia (self-control aim); fading as structured in Suinn 1990, [uncertain]]
• Steps: (1) Session 3: you start the scene, the client decides when to switch and does the relaxation themselves while you stay quiet. (2) Session 4: introduce the high scene; the client manages recovery. (3) Session 5 and later: the client brings on anxiety and ends it alone, with you giving only start/stop prompts or none. (4) Progressively shorten the relaxation used (from full sequence to control cue alone) and practise with eyes open. [step 4 partly synthesis] (5) Optionally have the client stay in the scene while relaxing instead of switching it off (coping within the scene) [uncertain].
• Example language (illustrative): "This time I'll just say 'begin'. Bring on the scene yourself, notice your first signal, and use whatever relaxation you need. Lift your finger when you're back to calm."
• Watch for: Client waits for your voice; reduce prompts more gradually. Working when the client runs full cycles without help.

4.12 High-intensity scene practice

• Purpose / when: After moderate-scene control is reliable (about session 4). [source: SAGE Encyclopedia (moderate and high levels)]
• Steps: (1) Use the high scene from 4.6. (2) Begin with therapist-guided recovery, then shift to client-initiated recovery. (3) Alternate moderate and high scenes if the client struggles. [step 3 synthesis]
• Example language (illustrative): "Now we'll use the harder one, the night of the phone call. Same skill: catch the first signal and switch."
• Watch for: Overwhelm; go back to moderate and rebuild. Working when recovery from the high scene is reasonably quick.

4.13 Competence (success) imagery

• Purpose / when: Original 1971 protocol and Edie AMT II/III: after the control cue, the client imagines a real moment of success or competence as an alternative incompatible response. Suinn later dropped it, reportedly because many clients lacked success experiences to draw on. [source: Edie 1972 p. 9; slideserve summary of Suinn & Richardson 1971 and Suinn 1990]
• Steps: (1) Collect a real memory where the client felt capable and in control. (2) After the switch, describe this scene briefly. (3) Return to relaxation. Use only if the client has a credible success memory.
• Example language (illustrative): "Now go to the moment you finished that presentation and saw the nods around the table."
• Watch for: Clients who cannot find a real success (relaxation alone is the standard 1990 choice).

4.14 Post-session interview

• Purpose / when: End of every arousal session (and briefly after the first cycle). Checks the process and tailors the next session. [source: Edie 1972 p. 8; Suinn 1990 appendix of sample post-session interviews]
• Steps: Ask about (1) scene vividness, (2) peak anxiety (0–100), (3) cues noticed and which came first, (4) what helped the return to relaxation and how long it took, (5) any problems. Adjust scenes and pace accordingly.
• Example language (illustrative): "How real did the scene feel? What was the first thing you noticed? What helped you come back down?"
• Watch for: Lingering distress at session end; do further relaxation before the client leaves.

4.15 Homework: daily relaxation, self-monitoring logs and in vivo use

• Purpose / when: Throughout. Builds the skill and its use in daily life. [source: Edie 1972 pp. 7–8, 15 (daily relaxation, control cue in everyday situations; clients reported it got more effective with use); Suinn 1990 appendix of self-monitoring logs]
• Steps: (1) Session 1: daily relaxation practice. (2) From session 2–3: log anxiety episodes, cues noticed and whether relaxation was used. (3) From the middle sessions: use the control cue or brief relaxation in mild everyday anxiety first, then in harder situations. (4) Review logs at the start of each session.
• Example language (illustrative): "This week, catch at least one small moment of tension each day, use the breath and release, and note what happened."
• Watch for: Non-practice (see 5). Working when logs show earlier detection and successful use.

4.16 Group delivery

• Purpose / when: AMT was designed and tested for groups (Edie: groups of 10 per condition). [source: Edie 1972 pp. 3, 7; Suinn & Deffenbacher 1988 abstract]
• Steps: (1) Each member identifies their own scenes in a brief individual interview. (2) Lead relaxation for the whole group. (3) During arousal, instruct members to switch on their own scene; use generic bodily-cue descriptions. (4) Members signal with a finger; watch the group and pace to the slowest. (5) Hold a short group debrief and a final session for exchanging ideas.
• Example language (illustrative): "Everyone, switch on your own moderate scene now... let the anxiety build."
• Watch for: Members who do not signal or who stay distressed; check individually.

4.17 Application to anger and other intense emotions

• Purpose / when: AMT's authors applied the same structure to anger and other stress-related problems, and Suinn 1990 covers behavioural medicine, performance and intense emotions. [source: Suinn & Deffenbacher 1988 abstract; Google Books contents]
• Steps: Use the same sequence, substituting real anger (or other emotion) scenes and the client's anger cues; the switch remains relaxation. Detailed adaptation steps were not verified. [uncertain]
• Watch for: Anger clients who see relaxation as weakness; frame it as staying in control. [synthesis]

5. Handling problems

The sources say little about clinical difficulties beyond repeating sessions when steps are not mastered [source: SAGE Encyclopedia] and running scene/cue checks [source: Edie 1972]. Suinn 1990 has a chapter on managing relaxation imagery, which is not drawn on. Everything below is [synthesis] unless tagged otherwise.

• Cannot relax / relaxation-induced anxiety. Keep eyes open, shorten the sequence, emphasise the release phase over tensing, let the client choose the pace, and use the breath control cue as the main tool. If muscle work makes them more anxious, switch to the relaxation scene or breath alone. [synthesis]
• Poor imagery (scene produces no anxiety). Re-collect the scene with more sensory and bodily detail, use the client's own words, have them describe it aloud in the present tense, or use bodily-cue arousal (4.8, documented in Edie 1972). Choose a more recent event. [synthesis; 4.8 source: Edie 1972]
• Overwhelm during arousal. End the scene at once with the control cue and guided relaxation; drop back to the moderate scene; shorten exposure; do not finish a session in high arousal. Check for trauma memories and, if present, refer to trauma-focused treatment rather than using that memory in AMT. [synthesis]
• Stuck at therapist-directed control. Fade more gradually: first stay silent only during recovery, then also during arousal; agree that the client signals and you only say "begin". Repeat the session as needed. [synthesis; repeating sessions per SAGE Encyclopedia]
• Not practising at home. Review barriers, shrink the task (a few minutes daily, or the control cue at set times), link practice to a daily routine, provide a recording, and review the log at the start of each session so practice visibly matters. [synthesis]
• Skill works in session but not in daily life. Start in vivo use with mild everyday anxiety; rehearse in session the specific situations where it failed (as new scenes); ensure the client is acting on early cues, not peaks; practise with eyes open and in different postures. [synthesis; early detection per Edie 1972]
• Resistance to the rationale ("relaxing won't fix my real problems"). Present AMT as a tool that lowers arousal so the client can think and act more effectively; combine with problem-solving where real stressors exist. [synthesis]
• Ruptures (feeling pushed into distress, or that the therapist is mechanical). Name the rupture, acknowledge the discomfort of deliberate arousal, give the client more control over scene choice and intensity, and invite feedback in each post-session interview. [synthesis]
• Panic-prone or health-anxious clients. Bodily-cue focus may escalate symptoms; begin with scenes rather than sensations, and explain that sensations are expected and controllable. Consider a panic-specific treatment if panic dominates. [synthesis]
• Falling asleep in relaxation. Practise sitting upright, shorten scripts, practise at times of day when alert. [synthesis]
• Anger clients. Frame relaxation as control, not weakness; use anger scenes and cues; screen for risk of violence and plan for safety outside sessions. [synthesis]
• Medical considerations. Clients with cardiac or respiratory conditions, or who are pregnant, should get medical clearance before strong arousal and avoid tensing affected areas; take care with breath-holding in the control cue. [synthesis]
• When AMT alone is not enough. For children, AMT's components are used inside broader protocols rather than as stand-alone treatment. [source: SAGE Encyclopedia] For persistent avoidance, obsessive-compulsive symptoms or trauma, add or switch to exposure-based or trauma-focused CBT. [synthesis]
• Suicidal ideation or self-harm emerging. Pause the protocol, carry out a standard risk assessment and safety plan (including lethal-means counselling on safe storage or removal), and resume AMT only when stable. [synthesis]

Sources

Sources:

• Edie, C. A. (1972). AMT study report, ERIC document ED117581: main source for documented procedure (relaxation session, scenes, bodily-cue arousal, control cue, cycles, homework, group format).
• UAB dissertation comparing AMT and induced anxiety: one-session AMT phases.
• Ehrenreich & Fisak, "Anxiety management", SAGE Encyclopedia of Cognitive Behavior Therapy: structure, two intensity levels, session 1 (excerpt only).
• Suinn & Deffenbacher (1988), Anxiety management training, The Counseling Psychologist 16, 31–49 (abstract)
• Suinn (1990), Anxiety Management Training: A Behavior Therapy, Google Books page: description and contents list only.
• Internet Archive catalogue record for Suinn (1990)
• Slide summary: AMT with competence imagery (Goldman & O'Brien): secondary; history of competence imagery.
• Suinn, course syllabus on empirically supported therapies (ABCT): bibliography only.

Further reading (not drawn on): Springer pages for Suinn (1990), including the chapters "AMT—The Basic Technique"; ScienceDirect page for Suinn & Richardson (1971); ResearchGate record of Suinn's AMT chapter.

Books and papers cited:

• Suinn, R. M., & Richardson, F. (1971). Anxiety management training: A nonspecific behavior therapy program for anxiety control. Behavior Therapy, 2, 498–510.
• Suinn, R. M. (1986). Manual: Anxiety management training. Fort Collins, CO: Rocky Mountain Behavioral Sciences Institute. [not seen]
• Suinn, R. M., & Deffenbacher, J. L. (1988). Anxiety management training. The Counseling Psychologist, 16(1), 31–49.
• Suinn, R. M. (1990). Anxiety Management Training: A Behavior Therapy. New York: Plenum.
• Suinn, R. M. (1995). Anxiety management training. In K. Craig & K. Dobson (Eds.), Anxiety and Depression in Adults and Children. Sage. [not seen]
• Wolpe, J., & Lazarus, A. A. (1966). Behavior Therapy Techniques. Pergamon (relaxation instructions adapted in Edie 1972).