Relaxation Therapy

Relaxation Therapy

PEP Topic 
Anxiety
Description 

Relaxation therapies differ in philosophy and method. 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 may involve relaxing the body and 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. Simple relaxation therapy has been examined in anxiety, depression, fatigue, sleep-wake disturbances, and hot flashes.

Effectiveness Not Established

Research Evidence Summaries

Hayama, Y., & Inoue, T. (2012). The effects of deep breathing on 'tension-anxiety' and fatigue in cancer patients undergoing adjuvant chemotherapy. Complementary Therapies in Clinical Practice, 18, 94–98.

doi: 10.1016/j.ctcp.2011.10.001
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Study Purpose:

To investigate the effect of a deep breathing intervention, incorporated within conventional nursing care, on tension-anxiety and fatigue experienced by Japanese women with gynecologic cancer undergoing adjuvant chemotherapy for the first time.

To reduce tension-anxiety and fatigue through deep breathing that incorporated elements of exercise.

Intervention Characteristics/Basic Study Process:

The deep breathing intervention was initiated for patients in the intervention group. Each patient received 15 minutes of guidance from the researcher using a DVD and pamphlets. The intervention was performed with nursing assistance pre- and postchemotherapy, with the latter given on the second, fourth, and sixth days. The control group received treatment with the usual chemotherapy and nursing care.

Sample Characteristics:

  • The study was comprised of 23 women.
  • Mean age was 53.6 years (standard deviation [SD] = 9.4 years) in the intervention group and 61.7 years (SD = 9.8 years) in the control group.
  • All patients were diagnosed with gynecologic cancers, including uterine (54.5%), ovarian, cervical, and peritoneal carcinomatosis. Cancer stage ranged from I (54.5%) to III.
  • Patients were included in the study if they had a recent diagnosis, were postoperative and receiving their first administration of adjuvant chemotherapy, were literate in Japanese, and were willing to participate.
  • Patients were excluded if they were younger than 20 years and had received recent psychological treatment (including medication and psychotherapy) and/or recent asthma treatment.

Setting:

  • Single site
  • Inpatient
  • Osaka, Japan

Phase of Care and Clinical Applications:

  • Patients were undergoing the active treatment phase of care.
  • The study has clinical applicability for late effects and survivorship.

Study Design:

The study used a randomized, controlled trial design.

Measurement Instruments/Methods:

  • Profile of Mood States (POMS)–Short Form (Japanese version):  tension-anxiety and fatigue subscales assessed pre- and posttherapy
  • Cancer Fatigue Scale (CFS), subscales of subjective fatigue:  physical, affective, and cognitive assessed pre- and posttherapy

Results:

There were no statistically significant differences between groups in terms of age, diagnosis, or cancer clinical stage or treatment type (p > 0.05). Prechemotherapy data showed no significant differences between the intervention and control groups in the previously mentioned measurement tools. The postchemotherapy tension-anxiety scores were lower in the intervention group (p = 0.01). Both groups showed significant reductions in tension-anxiety scores (both p = 0.00). The postchemotherapy physical and total fatigue scores of the intervention group were significantly lower than those of the control group (physical, p = 0.04; total, p = 0.04).

Conclusions:

The study demonstrated that the tension-anxiety and fatigue scores of patients undergoing chemotherapy for gynecologic cancers were lowered when the nurses assisted them with deep breathing for a short period in addition to providing conventional nursing care provided pre- and postchemotherapy. The prominent features of the study were that it used a program that combined three deep breathing techniques and was of short duration (10 minutes).

Limitations:

  • The study had a small sample size, with less than 30 patients.
  • The nurse-to-patient ratio for teaching was 1:1.
  • The study was limited to patients with gynecologic cancer and had a limited time period evaluated for fatigue (fatigue can worsen as chemotherapy continues). 
  • The study needs to be reproducible in different facilities and with a larger sample size. 
  • The study lacked an attentional control.

Nursing Implications:

These are very simple exercises that can be taught to patients and be performed even while they are receiving chemotherapy. In addition to usual nursing care, nurses can contribute to reducing patients’ tension-anxiety and fatigue by assisting them in performing deep breathing.

Kim, S., & Kim, H. (2005). Effects of a relaxation breathing exercise on anxiety, depression, and leukocyte in hemopoietic stem cell transplantation patients. Cancer Nursing, 28, 79–83.

doi: 10.1097/00002820-200501000-00012
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Intervention Characteristics/Basic Study Process:

An educated treatment group received the intervention consisting of a 30-minute tape and researcher on relaxation breathing exercise (RBE). The intervention was given every day at 4 pm for six weeks during hospitalization for allogeneic stem cell transplantation.

Sample Characteristics:

  • Of 42 randomized patients, 35 completed the study (18 in RBE group, 17 in control group).
  • Patients were excluded if they were taking medications for anxiety.

Study Design:

A randomized controlled trial design was used.

Measurement Instruments/Methods:

  • Measurements: pre/post-test
  • State-Trait Anxiety Inventory (STAI): Only state anxiety was measured.

Results:

Patients in the RBE group had a mean decrease of 13.3 points in anxiety (p < 0.05).

Conclusions:

RBE could be an effective nursing intervention to reduce anxiety in hospitalized patients undergoing allogeneic stem cell transplantation.

Limitations:

The study had a small sample size.

Systematic Review/Meta-Analysis

Thrane, S. (2013). Effectiveness of integrative modalities for pain and anxiety in children and adolescents with cancer: A systematic review. Journal of Pediatric Oncology Nursing, 30, 320–332.  

doi: 10.1177/1043454213511538
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Purpose:

STUDY PURPOSE: To systematically review the effect of integrative modalities (e.g., hypnosis, acupuncture, massage, virtual reality, folk healing, prayer) on pain and anxiety in children with cancer
 
TYPE OF STUDY:  Systematic review

Search Strategy:

DATABASES USED: PubMed, CINAHL, MedLine, PsycInfo, Web of Science, integrative medicine journals
 
KEYWORDS: pain, anxiety, pediatric, child, oncology, cancer, neoplasm, complementary, integrative, nonconventional, unconventional
 
INCLUSION CRITERIA: Ages 1–18; randomization; use of control group; published in peer-reviewed journals; use of integrative modality except natural products (e.g., herbs, vitamins, supplements); measuring pain and anxiety
 
EXCLUSION CRITERIA: Review article; informational papers

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: 164 articles were retrieved, 25 underwent full-text review using a systematic approach, and 12 met the criteria.
 

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED =  12
  • TOTAL PATIENTS INCLUDED IN REVIEW = 358
  • KEY SAMPLE CHARACTERISTICS:  Mean age of 8.4 years, age ranged from 1–19 years; 55% male participants; 120 participants from Greece; 62% Caucasian; majority had hematologic cancer; many studies were conducted during painful procedures such as lumbar puncture and venipuncture.

Phase of Care and Clinical Applications:

PHASE OF CARE: Mutliple phases of care
APPLICATIONS: Pediatrics 

Results:

Five studies used hypnosis; one study used mind–body therapy; one used distraction and breathing techniques; one used behavioral intervention; one used virtual reality; one used creative-arts therapy; one used massage; and one used music therapy. Sample size for each study was very small, ranging from 8–59. All studies in this review had at least one statistically significant finding except for one study that examined distraction and breathing techniques. Cohen's d calculations show medium (d = 0.70) to extremely large (8.57) effect sizes for overall integrative intervention. Hypnosis was consistently significantly effective for reduction of pain and anxiety with invasive procedures. Distraction and breathing techniques did not demonstrate effectiveness. Virtual reality in one study did not reduce anxiety. Creative arts therapy in one study of 16 children reduced pain during chemotherapy. Massage showed inconsistent results. Music reduced pain and anxiety before and after lumbar puncture. 

Conclusions:

Integrative interventions may be very effective for pain and anxiety in children undergoing cancer treatment. Integrative modalities, however, warrant further study with larger sample sizes to better determine their effectiveness in this population.

Limitations:

  • No description existed of the time window during which data were extracted.
  • Various interventions were combined and analyzed as a unit.
  • Only included randomized controlled trials and thus reduced literature sample size
  • The sample size for each intervention was small.
  • The effect of each intervention is not clear.

Nursing Implications:

This study provided some evidence that complementary modalities can help children undergoing cancer treatment or painful procedures. The usefulness of a particular method should be further examined.


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