trials, tensing for about 8 seconds and relaxing for about 30 seconds of ... iety Inventory score (Spielberger, 1983) dropped with 26.1% (vs. +1.1%) in.
The use of progressive muscle relaxation within psychomotor therapy for patients with schizophrenia. Davy Vancampfort, Marc De Hert, Amber De Herdt, Michel Probst
Theoretical background for the use of progressive muscle relaxation within the treatment of schizophrenia. There is compelling epidemiological evidence that psychological distress and associated anxiety are important environmental risk factors for the onset of psychotic episodes, especially in the case of cumulative exposure (van Winkel, Stefanis & Myin-Germeys, 2008). People with schizophrenia experience difficulties in coping with psychological distress and anxiety, and possess a relatively limited repertoire of coping strategies (Achim et al., 2011). It is therefore not surprising that better functional outcomes might be achieved when psychological distress and anxiety are recognised and treated (van Os & Kapur, 2009). This underlines the need for multi-modal care including psychosocial therapies as adjuncts to antipsychotic medications (Vázquez Pérez, Godoy-Izquierdo & Godoy, 2012). Research on psychosocial approaches to treatment of schizophrenia has yielded incremental evidence of efficacy for cognitive behavioral therapy, social skills training, and psycho-education (Kern et al., 2009). Additional research is needed to examine other therapeutic modalities that might help to improve the functional status of patients with schizophrenia. Recently, there has been a growing interest in relaxation techniques in the multidisciplinary treatment of patients with schizophrenia (Probst et al., 2010; Vancampfort et al., 2011a; Vancampfort et al., 2012a, b). Relaxation techniques are a simple clinical rehabilitation method that can be administered after brief training. Probably the most common relaxation techniques are variants of progressive muscle relaxation, but other methods include yoga and mindfulness based stress reduction (Probst et al., 2010). Progressive muscle relaxation can be defined as a successive tensing and relaxing major muscle groups. The method originally developed by Jacobson (Jacobson, 1939) required dozens of sessions where the participant was taught to relax 30 different muscle groups. Bernstein and Borkovec (Bernstein & Borkovec, 1973) later shortened this technique and found it to be equally effective (Bernstein & Carlson, 1993).
Key messages: • People with schizophrenia experience difficulties in coping with psychological distress and anxiety, and possess a relatively limited repertoire of coping strategies. • Relaxation techniques are a simple clinical rehabilitation method that can be administered after brief training.
Scientific evidence for
the use of progressive muscle relaxation with-
in the treatment of schizophrenia.
Within the scope of this book we present a systematic overview of all available progressive muscle relaxation studies. We searched PsycINFO, PubMed, CINAHL and PEDro from their inception until June 1st, 2012. Key words were “progressive muscle relaxation” AND “schizophrenia” in the title, abstract or index term fields. The reference lists of all located articles were scanned for further relevant literature. Additionally, the bibliographies of relevant book chapters were hand-searched for further articles. Only studies examining patients with a DSM-IV diagnosis of schizophrenia were included. The initial electronic database search resulted in a total of 13 hits (PsycINFO=2, PubMed=5, CINAHL=3 and PEDro=3). Two studies (Chen et al.,2009; Vancampfort et al., 2011b) were of relevance and could be included. These 2 studies are presented in table 1. Both studies were randomized controlled studies comparing progressive muscle relaxation with quiet resting in a room for a same amount of time as the experimental intervention. To ensure program standardization, the PMR in the study of Chen et al. (Chen et al., 2009) was recorded on an audiotape employing an adapted Jacobson’s progressive muscle relaxation protocol which included progressive relaxation of groups of muscles and deep breathing for 25 minutes. The tape contained instructions for systematic tensing and relaxation of specific muscle groups, starting with the groups of muscles in the upper body and progressing down to the lower part of the body. In the progressive muscle relaxation in the study of Vancampfort et al. (Vancampfort et al., 2011b) the therapy consisted of successive tensing and relaxing at least 5 major muscle groups,
beginning with the upper body and proceeding to the lower parts. In this trials, tensing for about 8 seconds and relaxing for about 30 seconds of each muscle group was practiced twice prior to proceeding to a subsequent muscle group. Both included studies found significant reductions in state anxiety in patients following progressive muscle training compared to those sitting quiet for a same amount of time. In the study of Chen et al. (Chen et al., 2009) the total Beck Anxiety Inventory score (Beck et al., 1988) dropped with 57.3% in acute inpatients (vs.-13.3% in the control subjects) while in study of Vancampfort et al. (Vancampfort et al., 2011b) the total State Anxiety Inventory score (Spielberger, 1983) dropped with 26.1% (vs. +1.1%) in acute inpatients. The latter study found also significant reductions in psychological distress (-35.3% vs. 0%) and improvements in subjective well-being on the Subjective Experiences in Exercise Scale (McAuley & Courneya, 1994) (+28.7% vs. -1.2% respectively) after a single session of progressive muscle relaxation compared with the resting control condition. Overall, the present overview suggests that progressive muscle relaxation can reduce state anxiety and psychological distress and improve subjective well-being. No studies investigated the evidence for progressive muscle relaxation as an add-on therapy method for general psychopathology and positive and negative symptoms in these patients. All studies were short-term, and the maintenance effect of the this kind of psychomotor therapy is unclear. There were no data available to enable conclusions about progressive muscle relaxation in comparison with other treatment modalities. While progressive muscle relaxation appears to be a promising psychomotor therapy intervention for state anxiety and psychological distress, many questions remain unanswered. We need to know for which patients with schizophrenia progressive muscle relaxation is most suitable, including the severity and stage of the disorder. If this kind of psychomotor therapy would be used as a first line, stepped care for reducing psychological stress and anxiety, we need to know the dose-response and at what point other treatments should be included. More research is necessary on a broader range of outcomes besides psychological distress and anxiety symptoms. In particular, we need to know the effect of progressive muscle relaxation on positive or negative symptoms and on longterm outcomes, including relapse rates. It also needs to be demonstrated if the beneficial effects of progressive muscle relaxation can be translated into behavioural outcomes, for example through increasing rates of abstinence from nicotine or illegal drugs. The use of these substances is a common practice among individuals with schizophrenia (Green et al., 2007).
BAI , finger temperature
BAI scores decreased from 16.4±4.4 to 7 (vs. Relevant from 15.0±3.9 to 13); significant group dif- outcomes ferences after 11 days (Z=-4.1, p < 0.0001) (vs. controls) and one week post (Z=-2.0, p=0.0446); increase in finger temperature after last session +0.4°C (vs. +0.2°C) (Mann Whitney U =29.5, p < 0.05
SAI , SEES
SAI scores decreased from 45.2±10.3 to 33.4±8.6 (vs. from 45.2±11.8 to 45.7±11.0), SEES psychological distress from 11.6±5.0 to7.5±3.6 (vs. from 12.2±5.5 to 12.2±5.4) (pgroup-differences
