Table 3.
Progressive Muscle Relaxation with Other Interventions
| No | Author (Year)/ Country | Other Intervention | Duration (Minutes/ Length) | Frequency Per Week | Participants | Study Design | Research Instrument | Components/ Content of Intervention | Outcome Measures (with Effect Size where Available) | Key Finding | Quality of the Article | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EXP | Pre-test | Post- test | F-Up | |||||||||||
| 1 | Alphonsa et al73 (2018) India | Relaxation Therapy (RT) - Music, physical exercise and laughter therapy | 60m/ 4 weeks | Twice a day for 7 days/ week | 20 elderlies (PMR + RT: 10, CG: 10) S: N/A DO: 0% | QED | / | / | / (4 months) | DASS-21 | Use Jacobson’s PMR exercise + RT (background music, followed by physical exercise and laughter therapy). | Stress, Anxiety, Depression | There is a decrease (↓) in stress, anxiety and depression scores at post-test and F-up compared to the pretest (in IG). | High |
| 2 | Corbett et al74 (2019) Ireland | Stress Control (SC) | 15m PMR & SC at home/ 6 weeks + 1 session at the hall | N/A | 35 adults (PMR + SC: 35→22→20) S: At home and a hall DO: 37.1% | QED | / | / | / (3 months) | DASS-21 | Use Jacobson’s PMR exercise + SC program by White.75 | Stress (d=0.72), Anxiety (d=0.41), Depression (d=0.27) | There is a decrease (↓) in stress, and anxiety but not (=) depression score at post-test and F-Up compared to pretest (in IG). | High |
| 3 | Merakou et al76 (2019) Greece | Counselling Services (CS) | 12m PMR at home+ 4 45m PMR session + 8 CS/ 8 weeks | PMR twice a day for 7 days + CS once/ week | 50 unemployed individuals (PMR + CS: 30, CG: 20) S: At home DO: 0% | QED | / | / | DASS-21 | Use the Jacobson’s PMR exercise + CS (provided by the mental health professionals of the PEPSAEE). | Stress (d=1.13), Anxiety (d=1.03), Depression (d=0.74) | There is a decrease (↓) in stress, anxiety and depression score 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). | High | |
| 4 | Ortega et al77 (2021) Spain | Cognitive Behavioural Therapy (CBT) | 120m session/ 5 weeks | Once / week | 44 nursing students (PMR + CBT: 15, CG: 29) S: N/A DO: 0% | QED | / | / | / (3 months) | KEZKAK questionnaire, STAI | Use the Jacobson’s PMR exercise + CBT (emotional control, empathy, assertiveness, self-esteem, problem solving and time management) | Stress, Anxiety | There is a significant decrease (↓) in stress and state anxiety score in IG compared to CG at post-test and at F-Up. | High |
| 5 | Singer et al78 (1988) United States | Stress management skills (SMS) | At home + 120m session at meeting room/ 10 weeks | Once a day for 7 days + once at meeting room/ week | 36 caregivers (PMR + SMS: N/A, CG: N/A) S: meeting room DO: N/A | QED | / | / | STAI, BDI | Use the Jacobson’s PMR exercise by Bernstein, Borkovec35 + SMS (self-monitoring of stressful events and physiological reactions to them + modification of cognitions associated with distress) | Anxiety (d=0.59), Depression (d=0.53) | There is a significant decrease (↓) in anxiety and depression score in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). 3. CG depression increase (↑) slightly at post-test | High | |
| 6 | Sundram et al79 (2016) Malaysia | Deep Breathing (DB) | 15m at quiet room/ session (5x every 2 months) | N/A | 761 male automotive workers (PMR + DB: 468→148, CG: 293→221) S: Quiet room DO: 51.5% | QED | / | / | / (5x every 2 months) | DASS-21 | Use the Jacobson’s PMR exercise by Jacobson18 + DB. | Stress, anxiety, depression (Total: d=0.60) | There is a significant decrease (↓) in stress score but not (=) anxiety and depression in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). | High |
| 7 | Gallego et al80 (2020) Spain | Music Therapy (MT) | 60m at classroom/1 session | 1 session only | 112 nursing students (PMR + MT: 56, CG: 56) S: Classroom DO: 0% | RCT | / | / | Heart rate | Use Jacobson’s PMR exercise + MT (use a CD player with volume established at 50–60 decibels). | Stress | There is a significant decrease (↓) in heart rate (indicating a reduction of stress) in 1. IG compared to CG at post-test. 2. post-test compared to pretest (in IG). | Moderate | |
| 8 | Korkut et al66 (2021) Turkey | Nature sound (NS) | 15m + 15m at laboratory/ one session | Twice in one session only. | 89 nursing students (PMR + NS: 45→42, CG: 44) S: laboratory DO: 3.4% | RCT | / | / | STAI | Use the Jacobson’s PMR exercise + the NS (rain, birds, wind, forest, ocean, waterfall, and stream) | Anxiety (d=1.14) | There is a decrease (↓) in anxiety score at post-test compared to pretest in IG. | Moderate | |
| 9 | Masih et al81 (2019) United States | Mindfulness Meditation (MM) | 20m PMR & MM at home + 30m session at laboratory/ 8 weeks | 7 days practice + 1 session/ week | 36 adults (PMR + MM: 19→17, CG: 17) S: At home and Laboratory DO: 5.6% | RCT | / | / | PSS, Trait-anxiety scale of STAI | Use the Jacobson’s PMR exercise by Bernstein, Borkovec35 + MM by Kabat‐Zinn.82 | Stress (d=0.40), Anxiety (d= 0.15) | There is a decrease (↓) in stress but not (=) trait anxiety score at post-test compared to pretest (in IG). | Moderate | |
| 10 | Ozgundondu & Metin83 (2019) Turkey | Music Therapy (MT) | 20m at classroom/ 8 weeks | Once/ week | 63 nurses (PMR + MT: 32→28, CG: 31→28) S: Classroom DO: 0% | RCT | / | / | / (1 month) | PSS | Use the Jacobson’s PMR exercise + MT (relaxing music developed by Daniel Kobialka) | Stress (d=2.06) | There is a significant decrease (↓) in stress score in IG compared to CG at post-test and at F-Up. | Moderate |
| 11 | Robb68 (2000) United States | Music Therapy (MT) | 15m at laboratory/ 1 session | 1 session only | 15 university students (PMR + MT: 15) S: Laboratory DO: 0% | RCT | / | / | State-anxiety scale of STAI Form Y-1 | Use the Jacobson’s PMR exercise + MT (use Daniel Kobialka’s Going Home Medley).84 | Anxiety (d=2.10) | There is a significant decrease (↓) in anxiety score in post-test compared to pretest. | Moderate | |
| 12 | Tsiouli et al85 (2014) Greece | Deep Breathing (DB) | 37m at home/ 8 weeks | Twice a day for 7 days/ week | 80 caregivers (PMR + DB: 40→19, CG: 40→25) S: at home DO: 45.0% | RCT | / | / | PSS | Use the Jacobson’s PMR exercise + DB. | Stress (d=1.87) | There is a significant decrease (↓) in stress score at post-test compared to pretest in IG. | Moderate | |
| 13 | Tsitsi et al86 (2017) Cyprus & Greece | Guided Imagery (GI) | 25m at home and 25m at private room/ 3 weeks | Once a day for 7 days at home + once at private room/ week | 54 caregivers (PMR + GI: 29, CG: 25) S: at home and private room DO: 0% | RCT | / | / | HAM-A | Use the Jacobson’s PMR exercise + GI (envisioning of a comfortable and restful place on the beach) by da Silva.87 | Anxiety (d=0.37) | There is a decrease (↓) in anxiety score at post-test compared to pretest (in IG). | Moderate | |
| 14 | Valarmathi & Vijayalakshmi88 (2016) India | Deep Breathing (DB) | 30m at home/ 4 weeks | Twice a day for 7 days/ weeks | 54 caregivers (PMR + DB: 60) S: at home DO: 0% | QED | / | / | N/A | Use the Jacobson’s PMR exercise (20m) + DB (10m). | Stress (d=2.24) | There is a significant decrease (↓) in stress score at post-test compared to pretest. | Moderate | |
| 15 | Wang et al89 (2021) China | Health education (HE) | 90m of HE, PMR demonstration and PMR practice in 24 sessions + 30m at home/ 48 weeks | Twice a day for 7/ week | 110 caregivers of patients (EMR: 55, CG: 55) S: rehabilitation centre and at home DO: N/A | RCT | / | / | / (3,6,12months) | HADS | Use the Jacobson’s PMR exercise by Kieffer90 + health education on the acute stroke patients. | Anxiety, depression | There is a significant decrease (↓) in anxiety and depression score in IG compared to CG at 6 and 12 months. | Moderate |
Abbreviations: PMR, Progressive Muscle Relaxation; EXP, Experiment; F-Up, Follow up; S, Setting; DO, Dropouts; RCT, Randomized control trial; QED, Quasi-experimental design; IG, Intervention group; CG, Control group; d, Cohen’s d; EMR, Education & Muscle Relaxation; HE, Health Education; HADS, Hospital Anxiety and Depression Scale; NS, Nature sound; DASS-21, Depression; anxiety; stress scale-21; CBT, Cognitive Behavioral Therapy; MT, Music Therapy; CS, Counseling services; PEPSAEE, Pan-Hellenic Association for Psychosocial Rehabilitation and Professional Reintegration; MM, Mindfulness Meditation; PSS, Perceived Stress Scale; STAI, State-trait anxiety inventory; SC, Stress Control; RT, Relaxation Therapy; GI, Guided Imagery; HAM-A, Hamilton’s Anxiety Scale; DB, Deep Breathing; BDI, Beck Depression Inventory; SMS Stress management skills.