Progressive Muscle Relaxation and Guided Imagery

Progressive Muscle Relaxation and Guided Imagery

PEP Topic 
Sleep-Wake Disturbances

Progressive muscle relaxation (PMR) is a technique of alternately tensing and relaxing muscles groups in sequence throughout the body. When going through muscle groups, individuals can start with the head and neck and progress to the feet, or vice versa. Similarly, individuals may do one side of the body at a time or both sides at the same time. Listening to a prerecorded script may be used to guide individuals through the process. The addition of guided imagery to PMR involves the use of mental visualization and imagination to enhance relaxation and alter specific experiences and may or may not include direct suggestion. Individuals may use recorded scripts to guide the creation of mental images.  Guided imagery can integrate techniques founded in multiple psychological theory and hypnotherapy. PMR with guided imagery has been examined for effectiveness in patients with cancer for chemotherapy-induced nausea and vomiting, anxiety, fatigue, sleep-wake disturbance, and pain.

Effectiveness Not Established

Research Evidence Summaries

Cohen, M., & Fried, G. (2007). Comparing relaxation training and cognitive-behavioral group therapy for women with breast cancer. Research on Social Work Practice, 17, 313–323.

doi: 10.1177/1049731506293741

Study Purpose:

To compare the effectiveness of a cognitive-behavioral therapy (CBT) group intervention versus a relaxation and guided imagery (RGI) group training intervention.

Intervention Characteristics/Basic Study Process:

The intervention groups received nine 90-minute weekly sessions, and the control group received standard care. The outcomes measured were psychological distress, sleep, fatigue, and health locus of control.

Sample Characteristics:

  • The study was comprised of 170 patients with stage I or II breast cancer.
  • Patients were between two and 12 months since surgery and were receiving treatment (chemotherapy or radiotherapy).


Oncology center in northern Israel

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

This was a randomized, controlled trial.

Measurement Instruments/Methods:

  • Brief Symptom Inventory (BSI)
  • Fatigue Symptom Inventory (FSI)
  • Perceived Stress Scale-10-item (PSS-10)
  • Mini Sleep Questionnaire (MSQ)
  • Multidimensional Health Locus of Control (MHLC)
  • Global Severity Index (GSI)
  • Adherence questionnaire with a Likert scale


GSI and perceived stress decreased in both intervention groups but not in the control group. Means of fatigue symptoms and sleep difficulties decreased in both intervention groups but only significantly in the RGI group. External health locus of control decreased more in the CBT group. No differences were observed among groups in internal locus of control. Participants in the RGI group reported significantly higher self-practice adherence at home than did those in the CBT group.



  • Fifty-six of the 170 patients were excluded from the analysis due to missing more than two meetings or not completing questionnaires.
  • The study required a therapist trained in CBT and RGI.
  • The method of recruiting participants may have affected the generalizability of the results.
  • The follow-up should have been for longer periods and with more assessment points.

Nursing Implications:

A study design with four groups—CBT, RGI, combined CBT and RGI, and control—could shed light on whether combining CBT and RGI is more advantageous than delivering either intervention individually.