Relaxation for depression

Department of Psychiatry, Orygen Youth Health Research Centre, University of Melbourne , Locked Bag 10, 35 Poplar Road, Parkville, Melbourne, VIC, Australia, 3052.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2008; DOI: 10.1002/14651858.CD007142.pub2
Source: PubMed


Many members of the public have negative attitudes towards antidepressants. Psychological interventions are more acceptable but require considerable therapist training. Acceptable psychological interventions that require less training and skill are needed to ensure increased uptake of intervention. A potential intervention of this sort is relaxation techniques.
To determine whether relaxation techniques reduce depressive symptoms and improve response/remission.
The register of trials kept by the Cochrane Collaboration Depression, Anxiety and Neurosis Group was searched up to February 2008. We also searched the reference lists of included studies.
Studies were included if they were randomised or quasi-randomised controlled trials of relaxation techniques (progressive muscle relaxation, relaxation imagery, autogenic training) in participants diagnosed with depression or having a high level of depression symptoms. Self-rated and clinician-rated depression scores and response/remission were the primary outcomes.
Two reviewers selected the trials, assessed the quality and extracted trial and outcome data, with discrepancies resolved by consultation with a third. Trial authors were approached for missing data where possible and missing data were estimated or imputed in some cases. Continuous measures were summarised using standardised mean differences and dichotomous outcomes by risk ratios.
There were 15 trials with 11 included in the meta-analysis. Five trials showed relaxation reduced self-reported depression compared to wait-list, no treatment, or minimal treatment post intervention (SMD -0.59 (95% CI -0.94 to -0.24)). For clinician-rated depression, two trials showed a non-significant difference in the same direction (SMD -1.35 (95% CI -3.06 to 0.37)).Nine trials showed relaxation produced less effect than psychological (mainly cognitive-behavioural) treatment on self-reported depression (SMD = 0.38 (95% CI 0.14 to 0.62)). Three trials showed no significant difference between relaxation and psychological treatment on clinician-rated depression at post intervention (SMD 0.29 (95% CI -0.18 to 0.75)).Inconsistent effects were found when comparing relaxation training to medication and there were few data available comparing relaxation with complementary and lifestyle treatments.
Relaxation techniques were more effective at reducing self-rated depressive symptoms than no or minimal treatment. However, they were not as effective as psychological treatment. Data on clinician-rated depressive symptoms were less conclusive. Further research is required to investigate the possibility of relaxation being used as a first-line treatment in a stepped care approach to managing depression, especially in younger populations and populations with subthreshold or first episodes of depression.

17 Reads
    • "Medical students were included in this analysis because early interventions can potentially have a lasting impact during the course of a medical career. Although meta-analyses have previously been conducted on the use of various models of intervention for mixed groups of people with anxiety and depression (Hunot et al., 2007; Jorm et al., 2008; Krisanaprakornkit et al., 2006; Regehr et al., 2013), meta-analyses and reviews have not determined whether such interventions are effective for physicians. "
    [Show abstract] [Hide abstract]
    ABSTRACT: A significant proportion of physicians and medical trainees experience stress-related anxiety and burnout resulting in increased absenteeism and disability, decreased patient satisfaction, and increased rates of medical errors. A review and meta-analysis was conducted to examine the effectiveness of interventions aimed at addressing stress, anxiety, and burnout in physicians and medical trainees. Twelve studies involving 1034 participants were included in three meta-analyses. Cognitive, behavioral, and mindfulness interventions were associated with decreased symptoms of anxiety in physicians (standard differences in means [SDM], -1.07; 95% confidence interval [CI], -1.39 to -0.74) and medical students (SDM, -0.55; 95% CI, -0.74 to -0.36). Interventions incorporating psychoeducation, interpersonal communication, and mindfulness meditation were associated with decreased burnout in physicians (SDM, -0.38; 95% CI, -0.49 to -0.26). Results from this review and meta-analysis provide support that cognitive, behavioral, and mindfulness-based approaches are effective in reducing stress in medical students and practicing physicians. There is emerging evidence that these models may also contribute to lower levels of burnout in physicians.
    No preview · Article · Apr 2014 · The Journal of nervous and mental disease
  • Source
    • "Aside from recreational activities that may provide psychological relaxation, formalized relaxation techniques may also be incorporated into people’s lifestyle. A Cochrane Review and meta-analysis by Jorm and colleagues [127] of 11 trials using relaxation techniques (progressive muscle relaxation, relaxation imagery, autogenic training) versus control (wait-list, no or minimal treatment), found that although clinician-rated outcomes were non-significant, self-rated depressive symptoms were reduced, with a moderate effect size reported. Specifically, a meta-analysis of five trials found that relaxation reduced self-reported depression compared to wait-list, no treatment, or minimal treatment post intervention (although these are not optimal control conditions). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of depression appears to have increased over the past three decades. While this may be an artefact of diagnostic practices, it is likely that there are factors about modernity that are contributing to this rise. There is now compelling evidence that a range of lifestyle factors are involved in the pathogenesis of depression. Many of these factors can potentially be modified, yet they receive little consideration in the contemporary treatment of depression, where medication and psychological intervention remain the first line treatments. "Lifestyle Medicine" provides a nexus between public health promotion and clinical treatments, involving the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing. This may also provide opportunities for general health promotion and potential prevention of depression. In this paper we provide a narrative discussion of the major components of Lifestyle Medicine, consisting of the evidence-based adoption of physical activity or exercise, dietary modification, adequate relaxation/sleep and social interaction, use of mindfulness-based meditation techniques, and the reduction of recreational substances such as nicotine, drugs, and alcohol. We also discuss other potential lifestyle factors that have a more nascent evidence base, such as environmental issues (e.g. urbanisation, and exposure to air, water, noise, and chemical pollution), and the increasing human interface with technology. Clinical considerations are also outlined. While data supports that some of these individual elements are modifiers of overall mental health, and in many cases depression, rigorous research needs to address the long-term application of Lifestyle Medicine for depression prevention and management. Critically, studies exploring lifestyle modification involving multiple lifestyle elements are needed. While the judicious use of medication and psychological techniques are still advocated, due to the complexity of human illness/wellbeing, the emerging evidence encourages a more integrative approach for depression, and an acknowledgment that lifestyle modification should be a routine part of treatment and preventative efforts.
    Full-text · Article · Apr 2014 · BMC Psychiatry
    • "Similarly, no additional effect was found when MBSR combined with psychotherapy was compared with psychotherapy alone in an outpatient sample (Weiss et al. 2005). It has specifically been stressed that MBI should be compared with relaxation training in order to separate mindfulness effects from mere relaxation or resting (Jain et al. 2007; Manocha et al. 2011), especially since relaxation training also has been associated with reductions in depressive symptoms, anxiety, and distress (Jorm et al. 2008; Manzoni et al. 2008; Murphy et al. 1995; Reynolds and Coats 1986; Stetter and Kupper 2002). In other words, can specific MBI effects be distinguished from simple relaxation effects? "
    [Show abstract] [Hide abstract]
    ABSTRACT: The majority of mindfulness intervention studies do not include active control groups. To examine potential unique effects of mindfulness practice and to study the mechanism responsible for beneficial mental health effects associated with mindfulness-based interventions, the present study compared mindfulness meditation with an active control group in a randomised controlled trial. A short-term mindfulness-based intervention (n = 46) was compared with both an active control group—relaxation training (n = 40)—and an inactive wait-list group (n = 40) on self-reported mindfulness and decentering, executive attention, psychological well-being, anxiety, depression, and coping style, in an adult working population with no prior meditation experience. Analyses of covariance showed that the mindfulness group scored higher than the wait-list group on self-reported mindfulness and psychological well-being. However, no differences were found on decentering, anxiety, depression, executive attention, or coping style. Moreover, the study failed to distinguish any unique mindfulness effects since there were no differences between mindfulness and relaxation on any of the variables. Simple mediation analyses, using a bootstrap approach, revealed that decentering acted as a mediator between self-reported mindfulness and psychological well-being. The length of the intervention, the similarities between body scan exercises in MBI and relaxation, and the absence of decentering effects may partly explain the lack of distinct MBI effects, suggesting that MBIs aimed at increasing well-being and problem-focused coping whilst reducing psychological symptoms in a working population should be longer than merely 4 weeks and include more than seven sessions.
    No preview · Article · Feb 2014 · Mindfulness
Show more