Relaxation Therapy

Relaxation Therapy

PEP Topic 
Depression
Description 

Relaxation therapies differ in philosophy and method. In any case, the goal is to use the power of the mind and body to achieve a sense of relaxation and lowered metabolism. Relaxation therapy interventions may incorporate breathing exercises and involve relaxing the body. These interventions may involve techniques such as diversion or visualization. Relaxation therapy differs from progressive muscle relaxation in that the specific technique of sequential muscle relaxation is not necessarily used. Simple visualization may involve imagining a relaxing setting and differs from guided imagery. In guided imagery, specific types of mental images are elicited to affect specific aspects of the experience. The effectiveness of simple relaxation therapy has been examined in the treatment of anxiety, depression, fatigue, sleep-wake disturbances, and hot flashes.

Likely to Be Effective

Systematic Review/Meta-Analysis

Luebbert, K., Dahme, B., & Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment related symptoms and improving emotional adjustment in acute and non-surgical cancer treatment: A meta-analytical review. Psycho-Oncology, 10, 490–502.

doi: 10.1002/pon.537
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Search Strategy:

Databases searched included MEDLINE, PsycINFO, PSYNDEX, and CANCERLIT.

Literature Evaluated:

Randomized controlled trials (RCTs) conducted 1980–1995

Sample Characteristics:

Authors analyzed 15 studies.

Results:

Authors reported a small but significant effect on treatment-related symptoms, a significant medium effect on depression, and a small effect on anxiety.

Conclusions:

Consistency of positive results showed reductions in treatment-related side effects and improved emotional adjustment.

Research Evidence Summaries

Lutgendorf, S.K., Mullen-Houser, E., Russell, D., Degeest, K., Jacobson, G., Hart, L., . . . Lubaroff, D.M. (2010). Preservation of immune function in cervical cancer patients during chemoradiation using a novel integrative approach. Brain, Behavior, and Immunity, 24, 1231–1240.

doi:10.1016/j.bbi.2010.06.014
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Study Purpose:

To examine the effects of healing touch on natural killer (NK) cell activity, mood, and specific clinical and quality-of-life outcomes among women receiving chemoradiation for locally advanced cervical cancer

Intervention Characteristics/Basic Study Process:

After consent, patients randomized to one of three treatment arms: healing touch, relaxation, and control (usual care). The healing touch and relaxation interventions were administered individually four days per week throughout chemoradiation, on nonchemotherapy days, immediately following radiation. Healing touch participants received on average 15.25 (±6.97) sessions versus 11.75 (±5.20) sessions for relaxation (p = 0.08). Psychosocial surveys were completed for a total of four assessments (including baseline) over six weeks of chemoradiation. Each healing touch or relaxation session lasted 20–30 minutes and was delivered by experienced practitioners.

Sample Characteristics:

  • The sample was composed of 51 participants.
  • The mean age of the healing touch group was 48.1 years (SD = 16.0 years); the range of ages was 25–82 years. The mean age of the relaxation group was 43.1 years (SD = 9.6 years); the range of ages was 24–60 years. The mean age of the usual-care group was 48.0 years (SD = 13.8 years); the range of ages was 26–77 years.
  • Female: 100%, with stages IB1–IVA cervical squamous or adenocarcinoma. All patients were receiving a standard six-week course of chemoradiation.

Setting:

  • Single site
  • Outpatient
  • Iowa, United States

Phase of Care and Clinical Applications:

Active treatment

Study Design:

Prospective, randomized clinical trial with repeated measures

Measurement Instruments/Methods:

  • Center for Epidemiological Studies Depression Scale (CESD). Scores of 16 or higher indicate ‘‘probable cases of depression.”
  • Two subscales from the Profile of Mood States-Short Form (POMS-SF), to differentiate effects on anxiety versus depressed mood.
  • Functional Assessment of Cancer Therapy (FACT) quality-of-life measure.
  • Fatigue Symptom Inventory (FSI).
  • Five-item scale, modified from the Treatment Credibility Scale (TCS), administered at study entry to assess patient expectations before receiving group assignment.
  • Mean of three blood pressure measurements taken at two-minute intervals before and three measurements after the second relaxation or healing touch session, in weeks 1, 3, and 5, to assess extent of relaxation
  • Clinical and demographic information.
  • Immune measures as quantified by NK cell activity.

Results:

  • Healing touch group showed preservation of NK cell activity over time, as compared to NK activity in the other two groups, which had significant declines in NK cell activity over time (weeks 1–6). The usual-care group showed a 68% drop in NK cell activity. The relaxation group showed a 43.7% drop in NK cell activity. The healing touch group showed a 26.6% decrease in NK cell activity.
  • Authors reported a significant decline in depression in the healing touch group over time (p = 0.03), but the other two groups did not show such a decline. By week 6, mean CESD scores of healing touch patients were below 16 (the cutoff for clinical depression), whereas mean scores of the relaxation and usual-care groups were still in the depressed range (p = 0.07).
  • Anxiety significantly decreased in all groups over time.
  • Authors reported no significant effects on quality of life or fatigue in any group.

Conclusions:

Results indicate that, in patients with cervical cancer who are undergoing chemoradiation, healing touch may be effective in preventing some aspects of decreased immunity and reducing depressed mood.

Limitations:

  • The study had a small sample size, with fewer than 100 participants.
  • The study was possibly underpowered and had a risk of bias due to no blinding to the treatment condition. Relaxation was offered as a way to control for expectation of active treatment.
  • Brachytherapy protocol changes over the course of the study may be a confounding factor.

Nursing Implications:

Complementary interventions may be an important adjunct for patients during active treatment, in both improving depressed mood as well as maintaining immunocompetence. However, the intervention must be feasible and acceptable to patients. This very well-reported study took five years to accrue a final sample of 51 patients (fewer than one patient per month), which illustrates the complexity of performing such research.

Sloman, R. (2002). Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Cancer Nursing, 25, 432–435.

doi: 10.1097/00002820-200212000-00005
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Study Purpose:

To determine the efficacy of relaxation and imagery for control of depression and anxiety

Intervention Characteristics/Basic Study Process:

Patients were assigned to one of four treatment conditions:

  • progressive muscle relaxation (PMR) training
  • guided imagery training
  • both PMR and guided imagery training
  • control group

 A trained nurse taught patients the techniques in their homes, left a tape recorder and cassette, and asked subjects to practice the technique(s) twice daily. The nurse visited twice weekly to repeat the sessions.

In the control group, the nurse spent an equal amount of time with subjects, discussing general health and treatment concerns.

Investigators conducted pretesting. Post-testing occurred, for all subjects, three weeks after the initial session.

Sample Characteristics:

The sample was composed of 26 men and 30 women. All participants had advanced cancer and were receiving palliative care.

Setting:

  • Home
  • Sydney, New South Wales, Australia

Measurement Instruments/Methods:

  • Hospital Anxiety and Depression Scale (HADS), to measure anxiety and depression
  • Functional Living Index-Cancer (FLIC), to measure quality of life

Results:

All three treatment groups showed significant reduction in depression, compared to the control group. No one treatment proved to be significantly superior, and none of the three treatments produced a significant reduction in anxiety.

Limitations:

  • The study had a small sample size, with fewer than 56 participants.
  • Authors did not provide a clear description of the PMR and guided imagery techniques, so replication would be difficult.
  • The study occurred in one site, with one nurse conducting the interventions.
  • Post-testing at three weeks showed a short-term benefit; long-term benefits were not addressed.

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