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Copyright © 2018, NMJN, p-ISSN 2087-7811, e-ISSN 2406-8799
Nurse Media Journal of Nursing, 8(2), 2018, 71-78
Available Online at http://ejournal.undip.ac.id/index.php/medianers
Effects of Progressive Muscle Relaxation with Music and
Aromatherapy on Decreasing Stress Levels among Teachers
Claudia Fariday Dewi1, Ani Margawati2, Muhammad Mu’in3
1Postgraduate Program in Nursing, Department of Nursing, Diponegoro University, Indonesia
2Department of Nutrition, Diponegoro University, Indonesia
3Department of Nursing, Diponegoro University, Indonesia
Corresponding Author: Claudia Fariday Dewi (claudiasiwe@gmail.com)
ABSTRACT
Background: Stress among teachers has a significant relationship with the
psychosomatic and depressive symptoms. Progressive muscle relaxation with music and
aromatherapy is an intervention which can be implemented to reduce the level of stress
among teachers.
Purpose: This study aimed to investigate the effects of progressive muscle relaxation
with music and aromatherapy on decreasing the level of stress among teachers.
Methods: This study employed a pre-posttest quasi-experimental design with a control
group. The samples were 46 teachers recruited by purposive sampling and were evenly
assigned to the intervention group and the control group. Progressive muscle relaxation
with music and aromatherapy was given to the intervention group for four sessions in
four days; each lasted for 20 minutes. The data were collected using the Teacher Stress
Inventory and analyzed using the t-test to know the effects of the intervention.
Results: The results showed that the mean of stress level among the teachers in the
intervention group decreased from 50.65±3.761 to 32.78±8.426 after the intervention.
Meanwhile, in the control group, the mean of stress level slightly decreased from
49.87±3.348 to 49.17±4.868. The t-test obtained a p-value of 0.000, indicating that there
were significant differences in the stress levels between the intervention and the control
group.
Conclusion: Progressive muscle relaxation with music and aromatherapy reduced the
level of stress among teachers. Based on the findings, it is recommended that community
nurses promote this relaxation therapy to decrease the stress level among school teachers.
Keywords: Aromatherapy; music; progressive muscle relaxation; teacher stress
BACKGROUND
Work stress is one of the health problems that often occurs in teachers. International
Labour Organization in 2016 mentioned that one of the highest prevalence of work stress
occurs in the education sector (International Labour Organization, 2016). Furthermore,
the Health and Safety Executive (2016) reported that in the teaching profession, there are
about 2,530 cases of stress per 100,000 teachers. It means that among 465,112 teachers
of high school and vocational school in Indonesia, there are approximately 11,767 cases
of stress (The Central Statistic Agency, 2015). The high number of cases of teacher stress
indicates that there is a problem in the society’s mental health that should be solved.
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Nurse Media Journal of Nursing, 8(2), 2018,
Teachers indeed have a very important role in improving the quality of education of a
nation (Seth, 2016). However, when teachers experience stress, there will be some
unfavorable effects on the learning process and the quality of the educational institution.
Results of a study conducted in Turkey showed a significant negative relationship
between stress levels of teachers and the health of educational organizations (Sabanci,
2015). Moreover, another study by Mclean and Connor (2016) reported that teachers who
had depressive symptoms caused poor quality of learning in the classroom. Teachers’
emotional fatigue affects the teachers’ perceived support and the teachers’
depersonalization with the development of student motivation (Shen, Mccaughtry,
Martin, Garn, Kulik, & Fahlman, 2015). Teacher work stress can also affect the physical
and mental health of teachers. Results of previous studies indicated that increased work
stress raised psychosomatic problems and depressive symptoms (Chang & Min, 2009;
Madhura, Subramanya, & Balaram, 2014). Teachers who experience work stress will try
to protect themselves by self-withdrawal, absent, decreased performance, loss of
commitment, dissatisfaction at work, and interpersonal conflict (Seferoğlu, Yıldız, &
Yücel, 2014).
Community nurses can help teachers address the problem of stress at work. In this
context, the nurses may provide psychosocial support to the teachers to deal with the issue
of occupational stress in the form of prevention which focuses on individual workers.
One of the efforts which can be made is through nursing complementary interventions
(Snyder & Lindquist, 2006). A common complementary intervention which has been
widely used to deal with the problem of work stress is progressive muscle relaxation
(PMR). A study by Sundram, Dahlui, and Chinna (2016) reported a significant reduction
in the level of stress among male workers after given the PMR. Similarly, progressive
muscle relaxation with music was reported to increase the focus of attention and reduce
mental tension (Robb, 2000). The reduction in stress levels showed the potential of PMR
therapy as a coping strategy at the workplace.
In addition to PMR, other complementary therapies which can reduce stress include
music therapy and aromatherapy. Listening to music prior to a standardized stressor
predominantly affects the autonomic nervous system (in terms of a faster recovery) and
a lesser degree the endocrine and psychological stress response (Thoma, la Marca,
Brönnimann, Finkel, Ehlert, & Nater, 2013). Music affects the body relaxation by
reducing the activity of alpha-amylase and systolic blood pressure (Linnemann, Ditzen,
Strahler, Doerr, & Nater, 2015). Aromatherapy describes the use of essential oils from
various plants which are beneficial to improve the physical and psychological state of an
individual (Mccabe & Jacka, 2001). Previous studies reported that aromatherapy
improved mood (Linnemann et al., 2015) and decreased stress (Toda & Morimoto, 2011).
Unfortunately, there have been limited studies which investigate the effects of
progressive muscle relaxation with music and aromatherapy to cope with work stress.
Thus, it is necessary to conduct a study which explores the effects of such combination
of interventions on teachers’ stress.
PURPOSE
This study aimed to examine the effects of progressive muscle relaxation intervention
with music and aromatherapy on decreasing the level of stress among teachers.
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Nurse Media Journal of Nursing, 8(2), 2018,
METHODS
This study used a pretest-posttest quasi-experimental design with a control group. The
samples were 46 teachers from two vocational high schools in Manggarai regency in East
Nusa Tenggara, Indonesia. The samples were assigned into two groups: the intervention
group that received progressive muscle relaxation with music and aromatherapy (n=23),
and the control group which did not receive such intervention (n=23). The samples were
recruited using purposive sampling. The inclusion criteria included teachers who were
favorable to lavender aromatherapy and relaxation music and experienced a moderate
level of stress. The exclusion criteria were teachers having other stress management
therapy, and experiencing severe and acute heart disease, pain, infection or inflammation
of the musculoskeletal, and hearing loss.
Prior to the study, the researchers conducted an initial screening using the Teacher Stress
Inventory (TSI) to determine the level of stress in teachers subjectively. The TSI
questionnaire was administered to 75 teachers in two vocational high schools. Results
indicated that the respondents who met the inclusion and exclusion criteria were 46.
Objective measurement of stress was also conducted using a cocoro meter to check the
alpha amylase concentration in the saliva as an indicator of stress. If the result is 0-30
KU/L (kilo unit per liter), it means that the respondent is happy and does not have stress.
A result of 30-45 KU/L means the respondent is slightly stressed; 45-60 KU/L means the
respondent experience stress, and 60 KU/L means the respondent has severe stress
(Ariyanto, Wahyuning, & Desrianty, 2015).
The intervention in this study was progressive muscle relaxation intervention with music
and aromatherapy which was administered for four sessions in four consecutive days. The
duration of each session was 20 minutes. Aromatherapy through inhalation works best
using a vaporizer or diffuser. The use of diffuser was preferable in this study as it can
spray different molecules at the same time. A 3% concentration of lavender oil was used.
In total, 20 drops of lavender oil were mixed with 50 ml of water. The diffuser containing
aromatherapy was turned on half an hour before the intervention. In this research, the
researcher also played the music of Pachelbel Canon in D Major. This music had a regular
rhythm, less than 80 beats per minute, lacked extreme tones, smooth and flowing melodic
sounds. During the intervention, the music was also played for 20 minutes. Objective and
subjective measurement were performed before and after the intervention. The collected
data were analyzed using the t-tests.
The study was approved by the research ethics committee of the Faculty of Medicine,
Diponegoro University, and the schools where the study took place. All respondents were
informed of the purpose of the study and consented for their participation in the study.
RESULTS
The characteristics of respondents included age and years of teaching, sex, education, and
marital status. Based on Table 1, the majority of teachers were males, bachelor degree
holders and married. Most of them were employed by the school foundation. The mean
of age in the intervention and control group was 32.43 and 32.83, respectively. The mean
of years of teaching in the intervention and control group was 6.43 and 6.78, respectively.
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Nurse Media Journal of Nursing, 8(2), 2018,
Table 1. Characteristics of respondents (n=46)
Variable
Intervention
Group
Control Group
Total
n
%
n
%
n
%
Sex
Male
14
60.9
13
56.5
27
58.7
Female
9
31.9
10
43.5
19
41.3
Education
Associate degree
1
4.3
1
4.3
2
4.3
Bachelor degree
22
95.7
22
95.7
44
95.7
Status of Marriage
Single
7
30.4
6
26.1
13
28.3
Married
16
69.6
17
73.9
33
71.7
Status of Employment
Honorary
2
8.7
2
8.7
4
8.7
Government employees
1
4.3
2
8.7
3
6.5
Employees of foundation
20
87
19
82.6
39
84.8
Age (M±SD)
Years of teaching (M±SD)
32.43±6.88 32.83±7.63
6.43±5.84 6.78±6.22
Table 2. The mean of stress among teachers in the intervention group and control group
using cocoro meter
Group
Time of
measurement
n
Mean
SD
Min-Max
CI
Intervention
Pre test
23
50.65
3.761
45-59
49.03-52.28
Post test
23
32.78
8.426
21-54
29.14-36.43
Control
Pre test
23
49.87
3.348
45-57
48.42-51.32
Post test
23
49.17
4.868
36-58
47.07-51.28
Table 2 shows that the stress value among teachers before the intervention in the
intervention was 50.65 kU/L, while in the control group was 49.87 kU/L. After the
intervention, the stress value among teachers in the intervention group decreased to 32.78
kU/L, meaning that teachers did not experience stress. Meanwhile, in the control group,
the stress value slightly decreased (49.17 kU/L).
Table 3. Mean difference of teacher stress after the intervention in the intervention group
and control group
Group
n
Mean
SD
Variants
p-value
Intervention
23
32.78
8.426
0.013
0.000
Control
23
49.17
4.868
Based on Table 3, there was a significant difference in the level of stress among teachers
after the progressive muscle relaxation with music and aromatherapy on in the
intervention group and control group (p=0.000). It indicates that the intervention was
effective to decrease teacher stress.
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Nurse Media Journal of Nursing, 8(2), 2018,
DISCUSSION
The results of this study proved that there was a significant effect of progressive muscle
relaxation with music and aromatherapy on decreasing the level of stress among teachers.
This is in line with a previous study which reported that progressive muscle relaxation
could reduce cortisol levels by an average decrease of 0.013 units per 15 days (p=0.039)
(Linnemann, Ditzen, Strahler, Doerr, & Nater, 2015). Music therapy and lavender
aromatherapy give effects on the stress management by decreasing the alpha-amylase
activity (Hur, Song, Lee, & Soo, 2014). Muscle relaxation combined with music can
increase the focus of participant attention and reduce mental tension; music encourages
the body becomes more relaxed and able to motivate participants to follow a relaxation
program (Robb, 2000). Meamwhile, aromatherapy has been proven to be a supportive
therapy which improves mood and sense of comfort (Linnemann et al., 2015).
Another study by Robb (2000) also showed a decrease of the mean of State Anxiety
Inventory (STAI) in the group receiving progressive muscle relaxation intervention with
music by 15.54, whereas in only music and muscle relaxation intervention, the decrease
of STAI is only 9.20 and 11.06. This proves that progressive relaxation techniques with
music are more effective than using progressive relaxation or music techniques only
(Robb, 2000).
Another study examining the combination of relaxation therapy showed that mindfulness
intervention combined with room aromatherapy can decrease the stress by 32.9%. This
study proves that aromatherapy increases awareness during meditation (Redstone, 2015).
Similarly, Davis and Nurse (2005) reported that a combination of aromatherapy
interventions in reducing muscle tension through massage therapy with music suggests a
significant decrease in anxiety.
Progressive muscle relaxation is a relaxation technique aimed at reducing muscle energy
use. Stress was related to the reporting of musculoskeletal pain which involved head pain
(35.2%) and back pain (31.9%) (Østerås, Sigmundsson, & Haga, 2015). Through
progressive muscle relaxation interventions, there is a relaxation of the skeletal muscle
which impacts on the relaxation of visceral muscles so that the body’s consumption of
oxygen, the speed of metabolism, respiratory rate, muscle tension, systolic and diastolic
blood pressure decreased (Bernstein, Borkovec, Hazlett-stevens, & Douglas, 2000).
The process of relaxation in skeletal muscles that impacts on visceral muscle relaxation
becomes more leverage with the help of relaxation music. Music provides a stimulus to
decrease muscle energy. The results of other studies showed that music could reduce the
activity of alpha-amylase and systolic blood pressure (Linnemann, Ditzen, Strahler,
Doerr, & Nater, 2015). Decreased alpha-amylase activity through music is influenced by
the elements contained in the music. The type of music used by researchers in this study
is the type of music Pachelbel’s ‘Canon’ and stress relief that has a slow frequency,
regular rhythm with a tempo less than 80 beats. Elements contained in the music used to
affect the response of relaxation respondents. This is in line with studies that show an
increase in brain-derived neurotrophic factor (BDNF) that functions in controlling
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Nurse Media Journal of Nursing, 8(2), 2018,
anxiety and emotions after being given intervention with a low rhythm and mild tempo
of 50-60 dB (Angelucci, Ricci, Padua, Sabino, & Attilio, 2007).
The additional intervention other than PMR and music used in this study is lavender
aromatherapy. Other studies showed that aromatherapy relaxed breathing muscles and
made breathing rhythms more regular. Moreover, the use of lavender aromatherapy is
effective in improving mood and provide a sense of comfort (Linnemann et al., 2015).
Aromatherapy lavender can lower the level of salivary cortisol that indicates decreased
stress (Toda & Morimoto, 2011).
The PMR intervention with music and aromatherapy performed in this study was
conducted in 4 sessions for four days. The results showed that the effect of the
intervention was seen to be significant between before and after the intervention within
that period. The results of this study were supported by studies that showed a decrease in
blood pressure, electromyography, anxiety, and fatigue after the provision of progressive
muscle relaxation with music for four sessions of exercise (Jose & Almeida, 2013;
Kyung, 2010).
CONCLUSION
The stress of teacher respondents decreased after given PMR with music and
aromatherapy in the intervention group. Whereas in the control group, the level of stress
remained almost similar before and after the intervention. Nurses can implement PMR
with music and aromatherapy in the workplace as one of the occupational health services
and work together with the educational authorities to open opportunities for nurses to
implement relaxation interventions as an effort to prevent occupational stress.
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