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Objective To evaluate the physiological and psychological changes in cancer survivors who engage in repeated forest therapy in a living environment. Methods This study included stay-based forest therapy for female cancer survivors aged ≥40 years. The program was conducted in two cycles, each spanning 3 weeks and consisting of a 2-night, 3-day stay, followed by daily life integration. The cycles were repeated from July 2, 2022, to August 18, 2022. Participant assessment included standard physical health parameters and a questionnaire on general characteristics, lifestyle habits, stress levels, and health status. Results Thirty-seven female cancer survivors participated in the forest healing program, 56.8% of whom had a history of breast cancer. The median body mass index (BMI) was 23.80 kg/m2 (range, 21.00-25.60). More than half of the patients reported mild-to-moderate fatigue, chronic pain, and mild-to-moderate depression (81%, 65%, and 73%, respectively). After two cycles of forest therapy, no significant differences were observed in terms of fatigue, pain, or BMI levels. However, significant improvements were found in quality of life measures, particularly the psychological quality of life (mean score 12.54 at baseline vs. 13.48 after cycle 2; P=0.007). Positive improvements were also observed in terms of stress (mean score 17.03 vs. 13.76; P=0.002) and depression (mean score 8.35 vs. 6.11; P=0.002) levels. Conclusion Our forest-healing program demonstrated that nature-based therapies improve the mental health and quality of life of female cancer survivors, suggesting the need for further research on nature-based interventions to better support cancer survivors.

Background: Impaired sleep quality is a common problem experienced by nurses working shifts, and if not treated properly, it can impact their work performance and overall health. Spiritual Emotional Freedom Technique (SEFT) therapy has been proven to improve sleep quality. However, its effectiveness has never been studied in nurses who experience sleep disorders due to working shifts. Objective: To investigate the influence of spiritual relaxation therapy on sleep quality among nurses experiencing sleep disturbances due to shift work. Method: This is a Quasi-Experimental study with a pre-test-posttest control group design. A total of 38 nurses who experience sleep disorders due to working shifts were included in this study. The PSQI questionnaire was utilized as the instrument to measure sleep quality. Data analysis involved the Mann-Whitney test. Results: The average sleep quality before the intervention was in the mild category; after the intervention, most were in the good category. The results showed that the sleep quality of nurses who received spiritual relaxation was better than the control group (p

The effects of Rational Emotive Behavioural Therapy (REBT) and Relaxation Therapy (RT) on mathematics anxiety (MA) were examined among Deaf learners (DLs) in Oyo State in Nigeria. The randomized controlled study adopted a purposive sampling procedure to select three schools for the Deaf and Deaf learners (DLs) in Oyo State. A random sampling procedure was employed to select 60 DLs who were assigned to two experimental groups REBT (n = 25; male = 10; female = 15), RT (n = 17; male = 8; female = 9), and a control group (n = 20; male = 11; female = 9). The Mathematics Anxiety Scale (MAS) was used to screen the participants. The data gathered were analysed using the analysis of variance and descriptive charts. The findings revealed the efficacy of the two therapeutic interventions in reducing MA among DLs. The estimated mean difference between the treatment and control groups showed the following: REBT (15.66), RT (11.63), and control group (9.99). This study, therefore, concluded that REBT and RT were effective at drastically reducing Deaf learners’ anxiety regarding mathematics. Appropriate recommendations were made and implications were highlighted for practice, policy, and research, based on the findings

Abstract Background Caring for hemodialysis patients could be a heavy burden on family caregivers, causing them to become fatigued and decrease their quality of life. This study aimed to investigate whether Jacobson’s relaxation can help alleviate the fatigue of family caregivers of hemodialysis patients. Methods This randomized controlled trial was conducted in 2021. Sixty-six family caregivers of hemodialysis patients were recruited by convenience sampling from a referral hospital in Tehran, Iran, and assigned randomly by coin toss to two groups of experimental (n = 32) and control (n = 34). Caregivers in the experimental group performed Jacobson’s relaxation three times a week, each time for 30–45 min, for 30 days. The score and severity of fatigue before, 2 weeks after, and 1 month after the intervention were measured with the Fatigue Severity Scale. Data analysis was performed in the statistics software SPSS using descriptive statistics (frequency, percentage, mean, and standard deviation) and analytic statistics (Independent Samples t-test, Mann–Whitney U test, Chi-Square test, Fisher’s exact test, and RM-ANOVA test). The significance level was less than 0.05. Results The fatigue scores of the experimental and control groups were not significantly different before the intervention (4.42 ± 0.42 vs. 4.38 ± 0.42, P = 0.696). However, the experimental group had significantly lower fatigue scores than the control group 2 weeks after the intervention (4.11 ± 0.63 vs. 4.39 ± 0.42, P = 0.036) and 1 month after the intervention (3.5 ± 0.71 vs. 4.4 ± 0.44, P = 0.001). The results also showed a significant drop in the fatigue score of the experimental group after the intervention (P

Therapeutic communication towards decreasing anxiety levels in preoperative patients. Through a deeper understanding of the role of therapeutic communication in caring for preoperative patients, we can improve the quality of health care and patient well-being. The purpose of the study was to determine the effect of therapeutic communication on anxiety levels in preoperative patients. This research design uses quasi-experiments with the Non-Equivalent Control Group research design which in this design consists of a control group and an experimental groupThe Wilcoxon test shows that the p-value obtained is 0.001, and the Z value is -3.256. A P-value of 0.317, Mann Whitney U-Test statistical test with computerized assistance and obtained a Z value of -3.867 with Asymp Sig of 0.000It can be concluded that the provision of therapeutic communication has an effect on reducing anxiety levels in preoperative patients. Providing therapeutic communication in preoperative patients with an empathetic, informative, and supportive communication approach can have a positive effect on reducing anxiety levels in patients. By listening, providing clear information, providing emotional support, providing questioning opportunities, and teaching relaxation techniques, medical personnel can help patients feel calmer, overcome uncertainty, and feel better prepared for surgical procedures. This can contribute to patient comfort and minimize the negative impact of anxiety on the surgical process and postoperative recovery

Background: Sleep disorder is common in women with mastectomy. Previous studies have shown that relaxation technique improves sleep quality. However, the effects of these interventions on the sleep quality of breast cancer patients who underwent mastectomy surgery is still unclear. This study aimed to determine the effect of the Benson relaxation technique (BRT) on sleep quality in women with breast cancer after mastectomy. Methods: This randomized clinical trial study was performed on 72 eligible patients who were referred to the screening and chemotherapy center of Shahid Modares Hospital of Kashmar City from April to July 2021. The patients were selected through convenient sampling and randomly allocated to intervention (n = 36) and control (n = 36) groups. In the intervention group, in addition to the routine treatments, BRT was performed once in the morning and once in the evening for 2 months, each time for 20 minutes. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the score of sleep quality at the beginning of the study and 2 months later. Data were analyzed using the paired t test and independent t test at 95% CI. Results: The mean score of sleep quality before the intervention in the intervention and control groups was 9.25 ± 2.50 and 8.47 ± 2.13, respectively. After the intervention, the mean score of sleep quality in the intervention and control groups was 6.63 ± 1.92 and 8.41 ± 2.15, respectively, and the difference was significant between the 2 groups (P = 0.001) Conclusion: The Benson relaxation technique improves sleep quality in women with breast cancer after mastectomy. Therefore, it can be considered an adjunct therapy to improve the sleep quality in these people.

Introduction: PreOperative is a stage that begins when there is a decision to perform the surgical intervention and ends when the patient is sent to the operating table. Objective: Know the level of anxiety in preoperative patients. Method: This study uses a descriptive analysis design with a case study approach. Researchers made observations on two study subjects, and the study will be measured using the Hamilton Rating Scale for Anxiety (HARS) questionnaire. Result; Based on the results of measuring the level of anxiety in two samples during the visit, it showed a very significant decrease in the stress level. This is because both clients have been given therapy breath relaxation techniques in combination with dhikr therapy, which can improve alveoli ventilation, maintain gas exchange, prevent pulmonary atelectasis, and reduce physical and emotional stress. Conclusion; The application of breath relaxation techniques in combination with dhikr therapy can lower the level of anxiety in preoperative patients. It is therefore advisable for subsequent studies with more samples and a long time of therapy administration regarding applying breath relaxation techniques in combination with dhikr therapy to the anxiety of preoperative patients.

Background: Informal caregivers of COVID-19 patients, who are in direct contact with patients and the virus, experience many psychological issues and are prone to Illness Anxiety Disorder (IAD). Accordingly, this study aims to determine the effects of virtual training of the Benson Relaxation Technique (BRT) on IAD in the informal caregivers of COVID-19 patients. Methods: This randomized clinical trial study was conducted on 54 informal caregivers of COVID-19 patients who scored X ≥20 on the health anxiety inventory (HAI) by Salkovskis. They were randomly divided into control (n=28) and intervention (n=26) groups. The intervention group received the BRT audio file and pamphlet through messengers, and applied this technique twice a day, each for 20 min, for 3 weeks. However, the control group did not receive any training. Subsequently, after 3 weeks, HAI was completed by both groups again. Data analysis was done using SPSS software, version 22. Results: The mean score of IAD in the informal caregivers of the patients before the intervention in the experimental and the control groups was 24.88±5.89 and 23.27±5.64, respectively. After the intervention, the mean score of the IAD in the informal caregivers of the patients in the intervention and the control groups changed to 17.30±7.15 and 19.78±7.14, respectively. The result of the t-test showed a significant difference between the changes in the IAD scores of the two groups after the implementation of the intervention (P=0.046). Conclusion: The findings show that the virtual training of BRT, as a comprehensive, simple, and inexpensive method, reduces IAD in the informal caregivers of COVID-19 patients. The healthcare systems can take steps to support these people who are exposed to IAD by providing virtual training of BRT to informal caregivers of COVID-19 patients.

ABSTRACT Objectives: to evaluate the effect of guided imagery relaxation through virtual reality on anxiety in women with cervical cancer undergoing radiochemotherapy. Methods: randomized, non-blinded, single-center clinical trial conducted at a cancer reference hospital. 52 women participated, with randomized allocation of 24 in the control group and 28 in the experimental group (12 sessions of guided imagery relaxation through virtual reality, applied three times a week). The outcome was evaluated using the State-Trait Anxiety Inventory and statistical analysis was performed using the Generalized Linear Mixed Model. Results: n the experimental group, women presented significant anxiety traits (p=0.010) before the intervention. Between the 4th and 12th week of follow-up, there was a reduction in anxiety levels, without statistical significance. Conclusions: guided imagery relaxation through virtual reality provided evidence of anxiety reduction in women with cervical cancer undergoing radiochemotherapy and may contribute to clinical practice. Brazilian Clinical Trial Registry: RBR-7ssvytb.

BackgroundAlthough psychological interventions for stress relief, such as cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR), have been developed, they have not been widely used in treating depression. The use of mobile devices can increase the possibility of actual use by integrating interventions and reducing the difficulty and cost burden of treatment application. This study aims to determine whether “inMind,” an integrated mobile application for stress reduction, developed for the general population, decreases stress for patients with mild to moderate major depressive disorder during the pharmacological treatment period.MethodsThis study is a single-blind, multicenter, randomized, controlled crossover trial. The App, developed in Republic of Korea, provides integrated interventions for stress reduction for the general population through three modules based on mindfulness-based stress reduction, cognitive behavior therapy, and relaxation sounds that are known to be effective in stress reduction (“meditation,” “cognitive approach,” and “relaxation sounds,” respectively). Participants (n = 215) recruited via medical practitioner referral will be randomized to an App first group (fAPP) or a wait list crossover group (dAPP). The study will be conducted over 8 weeks; the fAPP group will use the App for the first 4 weeks and the dAPP group for the next 4 weeks. During all study periods, participants will receive their usual pharmacological treatment. The Depression Anxiety Stress Scale-21 is the primary outcome measure. The analysis will employ repeated measurements using a mixed-model approach.DiscussionThe App can potentially be an important addition to depression treatment because of its applicability and the comprehensive nature of the interventions that covers diverse stress-relieving models.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT05312203, identifier 2021GR0585.

Context: COVID-19-affected patients showed increased stress, impaired sleep quality, altered complete blood count, and increased inflammatory and oxidative parameters. Yoga is an add-on nonpharmacological treatment that is established to normalize the abovementioned parameters. Heartfulness meditation is a form of Raja yoga. Aims: The present study aimed to study the effects of 4 weeks of heartfulness meditation on the abovementioned parameters in COVID-19 patients following treatment completion. Settings and Design: The present study was a randomized controlled trial carried out in the Department of Physiology, AIIMS, Mangalagiri, Andhra Pradesh. Subjects and Methods: Out of 50 COVID-19 treatment-completed patients recruited for the study, 25 were randomly assigned to the study group who received 4-week app-based heartfulness meditation. Other 25 patients were assigned to the control group who received app-based relaxation for 4 weeks. Perceived stress score, Pittsburgh Sleep Quality Index questionnaire, baseline cardiovascular parameters, complete blood count, serum cortisol, inflammatory parameters, oxidative stress parameters, and antioxidant parameters were assessed before and after 4 weeks of intervention in both the groups. The outcome assessor was blinded in the present study. Statistical Analysis Used: The mean difference between the two groups was tested using the Student's t-test or Mann–Whitney U-test based on data distribution. Effect of intervention was analyzed using paired Student's t-test for dependent samples test or Wilcoxon signed-rank test based on data distribution. Results: The groups were comparable before intervention for all the variables. After 4 weeks of intervention, we observed a significant decrease in stress, circulating cortisol, inflammatory markers, and oxidative stress biomarker in both the groups. Further, we observed improved sleep quality and antioxidant biomarkers in both the groups. These beneficial alterations following intervention were high in the study group compared to the control group. Conclusions: Our results suggest that app-based heartfulness meditation/relaxation can be used as a nonpharmacological adjuvant to hasten the recovery process in patients who have completed the COVID-19 treatment protocol. Beneficial effects in subjects practicing heartfulness meditation were more than that observed in subjects practicing relaxation.

Background: Anxiety associated with surgical stress can lead to high blood pressure (BP), which may end up with undue last minute cancellation of surgery. Relaxation therapy is now being widely used as a complementary therapy for stress and high BP. We conducted a randomized controlled study to compare the effect of relaxation therapy on pre-induction anxiety and BP in hypertensive patients. Materials and Methods: A randomized controlled study was conducted on hypertensive patients undergoing elective surgery. They were allocated into two groups (relaxation therapy and control) using simple randomization with allocation concealment. The relaxation therapy group received intervention by an audio clip an evening prior and 30 min before the scheduled surgery. Their anxiety score on numerical rating scale (0–10) and BP was recorded before and after each intervention. The control group received standard care only. Pre-induction BP and anxiety score were recorded in both groups. The outcome measures were difference in pre-induction anxiety and BP between relaxation and control groups and difference in pre- and post-relaxation anxiety and BP. Results: Out of 70 patients, 30 received relaxation therapy and 34 received standard pre-operative care. There was a significant reduction in BP and anxiety after relaxation therapy in the intervention group (P < 0.0001). The relaxation therapy group showed significantly lower pre-induction systolic BP (138.93 vs. 156.59, P < 0.0001) and anxiety score (2.5 vs. 5.5, P < 0.0001) than the control group. Requirement of anxiolytic drug was less in the relaxation therapy group. Conclusion: Relaxation therapy significantly reduces pre-induction BP and anxiety.

Background: Fatigue is the most common symptom in patients with breast cancer undergoing chemotherapy. Benson’s relaxation technique is considered effective to reduce fatigue, but its effect in combination with smartphone technology is limited. Objective: This study aimed to analyze and determine the effect of the Benson relaxation application (Bens app) on fatigue in patients with breast cancer undergoing chemotherapy. Methods: A quasi-experimental design with a pretest-posttest comparison group was used. Fifty-six patients were included using consecutive sampling technique, of which 28 were assigned to the experimental group (received Benson relaxation technique using Bens app) and comparison group (obtained Benson relaxation technique using booklet). The Benson relaxation was done two times per day for seven days, and the Brief Fatigue Inventory questionnaire was used to measure the patients’ fatigue levels. Data were analyzed using paired and independent t-tests. Results: The experimental group (p = 0.001) and the comparison group (p = 0.015) showed a significant reduction in fatigue after receiving the Benson relaxation for seven days. However, there was a statistically significant difference in fatigue between the experiment and comparison groups after the intervention (t55 = 2.481, p = 0.016). Conclusion: Benson relaxation could reduce fatigue in patients with breast cancer using the Bens app and booklet. However, the Bens app is considered more effective than a booklet. Therefore, the Bens app can be viewed as an alternative to help patients perform Benson relaxation and integrated into the nurse palliative care program for patients with cancer.

Background: Most hemophilia patients experience pain in their lives. Some complementaryinterventions might affect pain belief. This study aimed to determine the effect of Benson’s relaxationtechnique on pain intensity, pain belief and perception, and pain acceptance in hemophilia patients.Methods: In this clinical trial study, 80 hemophilia patients were divided into an intervention(relaxation technique) and a control (routine care) group based on block randomization. This studywas conducted in the hemophilia center of Shahid Dastgheib hospital affiliated to Shiraz Universityof Medical Sciences from October to December 2018. The intervention group listened to a voicecontaining relaxation technique twice a day for eight weeks. Numeric rating scale, pain belief andperception inventory, and chronic pain acceptance questionnaires were completed at the beginning andeight weeks after the intervention. Data were analyzed by SPSS 21 using independent t-test, Paired-ttest,Chi-square, Mann-Whitney U test, and ANCOVA. P-value Results: After the intervention, the mean scores of pain intensity, pain belief and perception inventory,and pain acceptance in the intervention group were 4.26±2.17, -13.35±1.50, and 67.24±9.49 and inthe control groups were 5.85±2.61, -2±1.70, and 56.57±11.04, respectively. After the intervention, a difference was found between the groups regarding the mean score of pain intensity (P=0.007), pain belief and perception inventory (p

ABSTRACT Objective: To analyze the effects of the technique of virtual reality guided imagery in the vital signs of hematopoietic stem-cell transplantation patients. Method: Quasi-experimental study with 35 participants who received an intervention using virtual reality guided imagery with progressive muscle relaxation, applied three times a week for four weeks in a referral hospital for transplants in the south of Brazil. Data collected included: temperature, arterial pressure, respiratory rate, heart rate, pain, and oxygen saturation, before and after each intervention. The comparisons were analyzed using Wilcoxon’s test. Results: There was a clinical significance between the mean measurements before and after for respiratory rate (p=0.00) in all stages, and for the variables Heart rate, Temperature, and Oxygen saturation from the 1st to the 12th measurements (p=0.05). Conclusion: The intervention was low cost, easy to apply, and showed positive effects, presenting itself as an option for patient-focused care.

Anxiety is a state of mind that university students often manifest in exam situations, which can negatively impact their grades. This study aimed to evaluate the effect of different relaxation techniques, including guided breathing and social support, on test anxiety among nursing students a few minutes before taking the final knowledge assessment test. For this purpose, a factorial study with a post-intervention measurement was carried out with three groups of nursing students. One group used the full yogic breathing relaxation technique (abdominal, thoracic, and clavicular), another used a social support technique, and the last group did not receive any intervention. Of 119 participants, 98.2% showed a moderate-high level of anxiety. Regarding the anxiety scale score, it was found that participants with moderate anxiety levels had higher scores on the knowledge test (Rho = −0.222; p = 0.015). The present study found no differences in anxiety levels between the study groups. Combining these relaxation techniques with others shown to be effective could reinforce their positive effect. Starting to work on this anxiety from the beginning of nursing courses appears to be a good strategy, striving to improve students’ confidence in their abilities.

Objective. To determine the acceptability of using extended reality (XR) relaxation training as a preventive treatment for pediatric migraine. Methods. Youths aged 10–17 years old with migraine were recruited from a specialty headache clinic and completed baseline measures evaluating their vestibular symptoms and attitudes about technology. The patients were then instructed in three XR-based relaxation training conditions (fully immersive virtual reality with and without neurofeedback, and augmented reality with neurofeedback), in counterbalanced order, and completed acceptability and side effect questionnaires after each. The patients also took XR equipment home for one week to use for relaxation practice and again completed the measures about their experience. The acceptability and side effect data were compared against predetermined acceptable thresholds and were evaluated for their association with the participant characteristics. Results. The aggregate acceptability questionnaire scores exceeded our minimum threshold of 3.5/5, with the two fully immersive virtual reality conditions preferred over augmented reality for relaxation training (z = −3.02, p = 0.003, and z = −2.31, p = 0.02). The endorsed side effects were rated by all but one participant as mild, with vertigo being the most common. The acceptability ratings were not reliably associated with age, sex, typical hours per day of technology use, or technology attitudes, but were inversely related to the side effect scores. Conclusions. The preliminary data on acceptability and tolerability of immersive XR technology for relaxation training among youths with migraine supports further intervention development work.

BackgroundBehavioral approaches are central to the preventive treatment of migraine but empirical evidence regarding efficacy and effectiveness is still sparse. This study aimed to evaluate the efficacy of a newly developed migraine-specific, integrative cognitive-behavioral therapy program (miCBT) combining several approaches (trigger and stress management, coping with fear of attacks, relaxation training) by comparing it with a single behavioral approach (relaxation training, RLX) as an active control group and a waiting-list control group (WLC).MethodsIn a three-armed open-label randomized controlled trial, 121 adults with migraine were assigned to either miCBT, RLX or WLC. The outpatient group therapy (miCBT or RLX) consisted of seven sessions each 90 min. Participants who completed the WLC were subsequently randomized to one of the two treatment groups. Primary outcomes were headache days, headache-related disability, emotional distress, and self-efficacy. The baseline was compared to post-treatment, and followed by assessments 4- and 12-months post-treatment to compare miCBT and RLX.ResultsMixed-model analyses (intention-to-treat sample, 106 participants) showed significantly stronger pre-post improvements in self-efficacy (assessed by the Headache Management Self-Efficacy Scale, HMSE-G-SF) in both treatment groups compared to the WLC (mean difference at post; miCBT: 4.67 [0.55–8.78], p = 0.027; RLX: 4.42 [0.38 to 8.46], p = 0.032), whereas no other significant between-group differences were observed. The follow-up analyses revealed significant within-group improvements from baseline to 12-month follow-up in all four primary outcomes for both treatments. However, between-group effects (miCBT vs. RLX) were not significant at follow-up.ConclusionThe miCBT has no better treatment effects compared to RLX in migraine-prophylaxis. Both treatments effectively increase patients' self-efficacy.Trial RegistrationGerman Clinical Trials Register (www.drks.de; DRKS-ID: DRKS00011111).

BackgroundThis study aimed to investigate the effect of relaxation therapy on hypoxia during intravenous propofol anesthesia in patients with pre-operative anxiety.MethodsTwo-hundred and eighty patients were randomly categorized in the experimental group (relaxation therapy group) and control group. The Spielberger State-Trait Anxiety Inventory (S-STAI) was administered 30 to 60 min pre-operatively to assess the patient's current anxiety status and select appropriate patients. Patients in the experimental group received pre-surgical relaxation therapy. Decrease in oxygen saturation during the procedure was recorded for each patient group, and the relevant data were compared between the two groups.ResultsThe basic S-STAI scores of the experimental and control groups were 56.88 ± 2.91 and 57.27 ± 3.56, respectively (p = 0.331). The difference was not statistically significant. The incidence of hypoxia in the experimental group during painless artificial abortion [routine blood oxygen saturation (SpO2) 15 s] decreased from 30 to 12.3%.ConclusionRelaxation therapy may effectively reduce the incidence of hypoxia during painless artificial abortion by using less dose of propofol. It may help patients relieve their anxiety and improve perioperative safety.Trial RegistrationChinese Clinical Trial Registry (ChiCTR2000032109).

Abstract Objectives To evaluate the course of pain intensity and frequency related to temporomandibular disorders (TMDs) 15 years (range 5–21 years) after having received TMD treatment as adolescents due to frequent (at least once a week) TMD pain in two controlled trials. Materials and Methods In the first trial, subjects (n = 122) were randomly allocated to either information only, received in a control condition (Co), or information and an occlusal appliance (OA) versus relaxation therapy (RT). In the second trial, including 64 subjects, nonresponders to OA or RT were subsequently allocated to the alternate treatment (ST). All study participants having completed the trials (n = 167) were invited to a long‐term follow‐up evaluations, with a response rate of 69.5% (n = 116). Patient‐reported outcomes of TMD‐related frequency and intensity were appraised relative to baseline data and short‐term outcomes as observed in the two trials by use of general linear mixed model and generalized estimation equation statistics. Results A significantly higher proportion of participants treated with OA and in the combined RT/Co condition than those in the ST group, reported a frequency level of TMD pain less than once week at post‐treatment and the long‐term follow‐up. Adolescents treated with OA showed significantly lower TMD pain intensity levels post‐treatment than those in the other two treatment conditions. While no difference between the OA and the RT/Co conditions was found in the long‐term follow‐up, participants in these two conditions were significantly more improved than those in the ST group. Conclusion Adolescents treated with an OA clearly showed better outcome with regard to intensity and frequency in a long‐term follow‐up of TMD pain than those treated with RT and ST for nonresponders. These latter individuals need special clinical attention and more effective supplementary treatment methods to be developed.

Background: The dysmenorrhea prevalence is still reported high in the world. Several previous studies discovered that deep breathing relaxation effectively reduced dysmenorrhea. Other studies presented the combination of early mobilization and spiritual relaxation could reduce the level of client pain postoperative appendectomy, however the effectiveness of spiritual relaxation techniques to reduce dysmenorrhea is not yet tested. Objective: to determine the effect of spiritual relaxation to reduce dysmenorrhea. Method: The research design used was Quasi Experiment with the pretest-posttest Control Group Design approach. The populations were female students who experienced menstrual pain (dysmenorrhea) and met the inclusion and exclusion criteria. The variable in this study was dysmenorrhea. The sampling technique was simple ramdom sampling consisted of 44 respondents. The calculation instrument was NRS (Numeric Rating Scale) and data were analyzed through statistical test of Paired T-Test and Independent T-Test. Results: After spiritual relaxation treatment, the intensity of menstrual pain reduced significantly from 6.05 - 1.77, it proved that there was an effect of spiritual relaxation on dysmenorrhea with a significant value (ρ) of 0.000 (p ≤ 0.05). There were significant differences in the intensity of menstrual pain in the intervention and control groups (1.77 ± 1,109 vs 5.63 ± 0.445; p> 0.05). Conclusion: Spiritual relaxation effectively reduces dysmenorrhea

Abstract Background Breastfeeding is of great importance for infant health both short and long term, especially for those born preterm. Apart from the socio-economic and cultural factors which may influence a mother’s decision on breastfeeding, lactation performance is also influenced by maternal physiological and psychological condition, as well as infant behavioural factors. The aim of this project is to investigate physiological, psychological and anthropological aspects of ‘signalling’ between mother and infant during lactation in a stressful situation, following late preterm delivery, using an experimental approach. Method A single blind parallel randomised controlled trial will be conducted in Chinese primiparous mothers who deliver a infant (34 0/7–37 6/7) weeks and plan to exclusively breastfeed. Mothers will be recruited from four local community clinics attached to Beijing Children Hospital. Two home visits will be arranged at one week and eight weeks postpartum. Participants will be randomly assigned to either intervention arm or control (no intervention) before the first home visit. Mothers from the intervention group will be asked to listen to an audio recording with relaxation meditation daily during breastfeeding. Maternal stress and anxiety will be measured at one week and eight week postpartum using Chinese version of Cohen’s Perceived Stress Scale (PSS) and Beck Anxiety Inventory (BAI). Infant weight and length gain (as SD scores) from one to eight week will be measured using anthropometry. Milk volume will be measured using 48-h test-weighing method. Breast milk samples and mother and infant’s stool samples will be collected to measure macronutrient and microbiome content. Anthropometric measurements (weight, length and head circumference) will be performed during all home visits. Discussion Primary outcomes of this study will be the effect of the intervention on maternal psychological state, and infant growth. Other outcomes will include the effect of the intervention on milk production, infant behaviours, and the microbiome composition in breastmilk and maternal and infant’s gut. Results of this study will provide greater understanding about maternal-infant factors which influence the success of breastfeeding, and which may then be useful targets for future interventions. Trial registration ClinicalTrials.gov identifier: NCT03674632. Registered 14 September 2018.

Introduction: Patients admitted to the intensive care unit express the chest tube removal as one of their worst experiences. In spite of scientific advances, no effective action is taken to reduce the pain due to it. Therefore, the aim of this study was to investigate the effect of respiratory relaxation on the severity of pain resulting from the removal of chest tube after coronary artery bypass graft. Methods: This single blind randomized trial was performed in 2016 on 80 patients with open heart surgery with only one mediastinal chest tube. Patients were randomly divided into case and control groups. In the case group, relaxation and relaxation breathing exercises were used for 5 minutes before the tube was exhausted. The severity of pain was measured by visual analog scale before, immediately and 15 minutes after the removal of the chest tube. Data analysis was performed using common tests. Results: The results showed that there was no significant difference between the severity of pain in both groups before the removal of the chest tube (P=0.84). It was also found that there was a significant difference between the severity of pain immediately after the discharge of the tube in the case group (P=0.0001), but there was no significant difference between the intensity of pain 15 minutes after the withdrawal of the tubes in the case and control groups (P=0.21). Conclusion: Respiratory relaxation is an effective technique for the pain intensity of postoperative chest tube after open heart surgery. It is recommended to use this method before tubing, due to lack of cost, ease of use and effectiveness.

Background Stress reactivity can be different in women compared to men, which might consequently influence disease risk.Stress in women may also generate adverse physiological effects on their offspring during pregnancy or lactation. The objective of this study was to compare the effects of different relaxation interventions on physiological outcomes and perceived relaxation in healthy young women, to assist in identifying the most appropriate intervention(s) for use in a subsequent trial for mothers who deliver prematurely. Methods A within-subject study was conducted in 17 women of reproductive age comparing five different relaxation interventions (guided-imagery meditation audio (GIM), music listening (ML), relaxation lighting (RL), GIM+RL, ML+RL), with control (silence/sitting), assigned in random order over a 3–6 week period. Subjective feelings of relaxation (10-point scale), heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), and fingertip temperature (FT) were measured before and after each technique Results All interventions significantly increased perceived relaxation and FT, while music also significantly reduced SBP (p

Relaxation therapy (RT) is considered to be helpful in the management of symptoms of premenstrual syndrome (PMS). This systematic review (SR) was conducted to find the impact of RT on PMS management, which could be utilized in clinical and community populations. Five major databases like Google Scholar, PubMed, ResearchGate, Scopus, and Web of Science were used as search engines. The Joanna Briggs Institute checklist is used to analyze the quality of articles selected for this review. Only 35 different studies among 71 relevant articles which focused on the topic were selected for this SR. All of the 35 different trials reported that the selected RTs, namely Laura Mitchell, Jacobson, Benson, relaxation unnamed, yoga, aerobic exercise, and massage, significantly decreased PMS. The outcome of this SR suggests that the selected seven RTs effectively relieve PMS and ensure a productive life for all reproductive women.

Abstract Background Cancer patients often suffer from emotional distress as a result of the oncological process. The purpose of our study was to determine whether practice of Jacobson’s relaxation technique reduced consumption of psychotropic and analgesic drugs in a sample of cancer patients. Methods This was a multicenter pre–post intervention design. Participants were 272 patients aged over 18 years attending 10 Spanish public hospitals with oncological pathologies and anxiety symptoms. The intervention consisted of a protocol of abbreviated progressive muscle relaxation training developed by Bernstein and Borkovec. This was followed up by telephone calls over a 1-month period. The intervention was performed between November 2014 and October 2015. Sociodemographic variables related to the oncological process, mental health variables, and intervention characteristics were measured. Results A reduction in the consumption of psychotropic and analgesic drugs was observed throughout the follow-up period. Improvement was observed throughout the 4-week follow-up for all the parameters assessed: anxiety, relaxation, concentration, and mastery of the relaxation technique. Conclusions The practice of abbreviated Jacobson’s relaxation technique can help to decrease the consumption of psychotropic and analgesic drugs. Patients experienced positive changes in all the evaluated parameters, at least during the 1-month follow-up. To confirm these findings, additional long-term studies are needed that include control groups. Trial registration ISRCTN 81335752, DOI 10.1186/ISRCTN81335752 17. Date of registration: 22/11/2016 (retrospectively registered).

Abstract Background The physiological and psychological signalling between mother and infant during lactation is one of the prominent mother-infant factors that may influence breastfeeding outcomes. The infant can ‘signal’ his needs through vocalisation, and the mother can respond by allowing or restricting nipple access, which might alter the breast milk composition or volume. This may lead to parent-offspring conflict during the lactation period. Challenging infant behaviour has also been associated with maternal psychological distress, which might affect breastfeeding performance. Most attempts to improve breastfeeding rates focus on providing additional support, yet many aspects of the breastfeeding process are poorly understood. Thus, our objective is to investigate mother-infant signalling during breastfeeding by manipulating maternal psychological state using a relaxation therapy intervention. The study will test the hypothesis that mothers who listen to the therapy will be more relaxed/less stressed and this will favourably alter breast milk composition and/or affect milk volume and hence influence infant outcomes. Methods A randomised controlled trial will be conducted in first-time breastfeeding mothers and their new-born infants. Pregnant mothers will be recruited at antenatal clinics in Selangor, Malaysia, and four home visits will be carried out at 2, 6, 12 and 14 weeks postnatally. Participants will be randomised into a control and an intervention group in the early post-partum period. Mothers from the intervention group will be asked to listen daily to an audio recording with relaxation therapy during breastfeeding. Maternal psychological state, breastfeeding practices and infant behaviour will be assessed using validated questionnaires. Milk volume will be measured using stable isotopes. Breast milk samples will be collected to measure macronutrient content and hormone levels. Anthropometric measurements (weight, length and head circumference) will be performed during all home visits, including body composition at week 14. Discussion The main outcomes will be the effect of the intervention on maternal psychological state, milk production, cortisol levels, and infant behaviour and growth. Secondary outcomes will be associations between breast milk composition and infant appetite and growth. This study aims to provide a greater understanding of maternal-infant factors which influence breastfeeding outcomes and which may be useful targets for future interventions. Trial registration ClinicalTrials.gov identifier: NCT01971216 .

The article deals with the psychological treatment of patients with voice disorders using the latest computer technology psychotherapy. The paper describes a method of psychological treatment based on biofeedback relaxation. The data on the dynamics of changes in physiological parameters, psycho-emotional background, as well as the state of the voice functions, taking into account the treatment. It describes the techniques and methods of work on the unit. On the basis of the data evaluated the effectiveness of this method in rehabilitation of voice function in patients with voice disorders. Substantiates the proposition that biofeedback relaxation is highly effective and non-invasive method of treatment and health effects in the treatment and rehabilitation of diseases of the vocal apparatus, helping to reduce the level of anxiety, psychosocial stress, as well as increase the level of vitality. Using biorelaxation technology can increase stress levels and ensures the production of constructive behavior strategies in stress situations. Relaxing biofeedback helps to reduce muscle tension and raising the level of skin temperature as autonomic response of the patients at the beginning and end of the training differed significantly, and the vegetative balance towards the end of the course was shifted toward parasympathetic reactions.

One of the most frequent health problems is stress. It has been linked to negative effects on employee well-being in many occupations, and it is considered responsible for many physical and psychological problems. Traditional in-person relaxation therapy has proven to be effective in reducing stress. However, it has some drawbacks such as high cost, required infrastructure and the need for qualified trainers. Relaxation therapy in Virtual Reality (VR) tries to solve these problems. However, one aspect has received little attention, that is personalised therapy. Indeed, while many studies show the need for patient-tailored relaxation exercises, little existing work focuses on personalised VR content. One reason for this is the complexity of recognising emotions, which is required for emotion-based adaptive VR. In this work, a method for adapting VR content to the emotional state of the user is presented. This model has been applied in a VR relaxation therapy application, which adapts to the user’s emotional state utilising a heuristic optimiser. Simulations have proven the performance and usability of the emotion model. Additionally, this paper explores the impact of the order in which adaptations are performed on the effectiveness of the relaxation experience.

Background: Menopause increases stress level among females and this may be a contributing factor in developing metabolic syndrome. Objectives: The objective of this study is to study the effects of progressive muscle relaxation on cardiorespiratory efficiency and autonomic functions in over weight and obese working stressed postmenopausal females. Materials and Methods: A total of 30 postmenopausal overweight or obese (body mass index [BMI]: 24.97 ± 1.28) females belonging to the age group 50-55 years were included. Stress level in the subjects was assessed according to the presumptive life event stress scale. The perceived stress scale (PSS) of Sheldon Cohen was used for measuring the perception of stress. Fasting blood samples were collected to exclude diabetic subjects and analyze lipid profile. BMI and waist/hip ratio were calculated. Resting pulse rate and blood pressure, respiratory rate were measured. VO 2 max, physical fitness index, breath holding time and 40 mm endurance test time were calculated for estimation of cardiopulmonary efficiency. Autonomic function tests were carried. Subjects were given progressive muscle relaxation training for 3 months and all parameters were reevaluated. Data was analyzed using SPSS version 16 (SPSS Inc., Chicago, USA). Results: PSS in pre-training session was 26.16 ± 1.7 and in post-training session was 14.33 ± 2.01 and the difference was statistically significant. There was a significant decrease in pulse rate, blood pressure, BMI, waist/hip ratio, cholesterol, low-density lipoprotein following preventive medicine residency training. Results of autonomic function tests and cardiopulmonary efficiency test improved significantly following relaxation training. Conclusions: Increased stress levels may increase BMI and waist/hip ratio, dyslipidemia and lead to autonomic dysfunctions and increase incidence of cardiovascular disease in postmenopausal females. Lifestyle modification with relaxation exercises decreases stress levels and improves autonomic functions, cardiopulmonary efficiency, and lipid profile.

Background: Preoperative anxiety is a challenge in most surgical interventions that needs to be taken into consideration. This trial assessed the effect of relation technique on the anxiety and hemodynamic response in patients undergoing surgical procedures. Methods: This single blind, randomized clinical trial was conducted on patients who were candidates for coronary artery bypass graft, coronary angiography, percutaneous intervention, or general surgery at Ekbatan and Besat Hospitals, Hamadan University of Medical Sciences, from March to August 2014. Patients were randomly assigned to intervention and control groups. The intervention group received Benson’s relaxation technique, a half an hour before surgical procedures. The preoperative anxiety and hemodynamic status (systolic and diastolic blood pressure, pulse pressure, heart rate, and respiratory rate) were evaluated before and after intervention. Results: Of 166 patients identified, 144 patients enrolled into the study. No patient declined follow-up. The baseline clinical characteristics of the patients in the intervention and control groups were nearly the same. The mean systolic and diastolic blood pressure, pulse pressure, the average number of heart rates and respiratory rates declined significantly in the intervention group compared to the control group (P < 0.001). The mean score of hospital anxiety was significantly lower in the intervention group than in the control group (P < 0.001). The intervention was effective in both males and female patients. Conclusion: This trial indicated that Benson’s relaxation technique is a safe method with no adverse effects with significant beneficial effect on preoperative anxiety and hemodynamic responses in patients who were candidates for surgical procedures. Trial registration: Iranian Registry of Clinical Trials registration number: IRCT201312249014N19. http://www.irct.ir/searchresult.php?id=9014&number=19.

Purpose: This study investigated evidence for the use of relaxation therapies as interventions to decrease irritable bowel syndrome (IBS) symptoms and severity as well as reduce anxiety and improve quality of life in IBS patients. Methods: A search of electronic bibliographic databases (e.g., Medline Ovid, Embase, KoreaMed, and National Discovery for Science Leaders) was conducted to identify randomized controlled trials that included relaxation exercise programs for adults (>18 years old) with IBS. Of the 486 publications identified, 8 studies met inclusion and exclusion criteria, and all studies were used in the meta-analysis. We used Cochrane's risk of bias to assess study quality. Results: The results showed that IBS symptoms decreased significantly, 6.19 (95% confidence interval [2.74, 14.02]) and there was no heterogeneity. Symptom severity and anxiety decreased by 0.38 (95% confidence interval [−1.41, 0.65]) and −0.08 (95% confidence interval [−0.38, 0.23]) due to relaxation therapies, but theses scores were not statistically significant. Conclusion: This review revealed positive effects of relaxation therapy on IBS symptoms in adult patients with IBS. However, these results should be interpreted with caution due to the small number of studies examined and the associated methodological problems. Further studies are needed to ascertain the long-term effects of relaxation therapy and the underlying psychosocial mechanisms leading to anxiety reduction and improved quality of life.

Background and objectives: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children and adolescents. Mind−body therapies (MBTs) seem to be effective for improving health in different populations; however, whether a positive effect occurs in children and adolescents with ADHD is still controversial. The main aim of this systematic review was to analyse the interventions based on MBT aimed to improve the main ADHD symptoms in children and adolescents. Materials and Methods: A systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to identify MBT studies on children and adolescents (4−18 years) with a clinical diagnosis of ADHD. Study quality was evaluated by the NIH quality tool (U.S. National Institute of Health). Results: There were positive results in eleven out of twelve included studies regarding the effect of the MBT interventions on ADHD symptoms. With respect to ADHD symptoms, we observed differences across studies. In relation to the studies’ quality, eleven studies were rated “poor” and one was rated as “fair”. Conclusions: MBTs, such as yoga or mindfulness, could be positive strategies to mitigate ADHD symptoms in children and adolescents. However, further research with high-quality designs, with randomization, greater sample sizes, and more intensive supervised practice programs are needed.

BACKGROUND: Pregnancy is associated with negative psychological symptoms (NPS) and multidimensional pain. Therefore, the present study was conducted to determine the effect of the combination of Benson's relaxation technique (BRT) and brief psychoeducational intervention (BPI) on multidimensional pain and NPS of pregnant women. MATERIALS AND METHODS: The present randomized clinical trial was conducted on pregnant women referred to Imam Reza and Motazedi Hospitals in Kermanshah, Iran. In this regard, 60 pregnant women were randomly allocated to intervention (n = 30) and control (n = 30) groups. The groups attended BRT and BPI educational sessions for 4 weeks, but the control group received no intervention. Subsequently, both groups completed Depression Anxiety Stress Scale-21 and multidimensional pain inventory. RESULTS: The mean NPS (stress, anxiety, and depression) was significantly decreased in the intervention group (P < 0.001), while no statistically significant differences were observed in the control group (P > 0.05). The independent t-test revealed a significant difference between the mean scores of intervention and control groups (P < 0.001). The mean multidimensional pain was significantly decreased in mothers after the completion of educational sessions (P < 0.001), and the independent t-test results indicated a significant difference between the scores of the intervention and control groups (P < 0.001). CONCLUSION: The results of this study suggested that the combination of BRT and BPI can lead to a reduction in the NPS and multidimensional pain in the pregnant women. This intervention is recommended to be considered as part of a healthcare program in pregnant mothers.

Objective: Multiple Sclerosis (MS) is a demyelinating autoimmune disease that imposes a significant emotional burden with heavy psychosocial consequences. Several studies have investigated the association between MS and mental disorders such as depression and anxiety, and recently researchers have focused also on Post-traumatic Stress Disorder (PTSD). This is the first study that investigates the usefulness of proposing a treatment for PTSD to patients with MS. Methods: A randomized controlled trial with patients with MS diagnosed with PTSD comparing Eye Movement Desensitization and Reprocessing (EMDR; n = 20) and Relaxation Therapy (RT; n = 22). The primary outcome measure was the proportion of participants that no longer meet PTSD diagnosis as measured with Clinician Administered PTSD Scale six-months after the treatment.Results: The majority of patients were able to overcome their PTSD diagnosis after only 10 therapy sessions. EMDR treatment appears to be more effective than RT in reducing the proportion of patients with MS suffering from PTSD. Both treatments are effective in reducing PTSD severity, anxiety symptoms and to improve Quality of Life (QoL). Conclusions: Although our results can only be considered preliminary, this study suggests that it is essential that PTSD symptoms are detected and that brief and cost-effective interventions to reduce PTSD and associated psychological symptoms are offered to patients, in order to help them to reduce the psychological burden associated with their neurological condition.Trail registration: NCT01743664, https://clinicaltrials.gov/ct2/show/NCT01743664

Background: If anxiety and depression do not detect in pregnant women, they may cause complications for the mother, child, and family, including postpartum depression. With regard to the administrative capability of relaxation in health centers, this study was conducted to determine the effect of progressive muscle relaxation and guided imagery on stress, anxiety, and depression in pregnant women. Materials and Methods: This randomized clinical trial was conducted on pregnant women in the city of Kashan at 28–36 weeks. At the onset of the study, demographic questionnaire, Edinburgh Depression Scale, and Depression, Anxiety, and Stress Scale-21 (DASS-21) were completed. Providing obtaining score of mild-to-moderate in the stress, anxiety, and depression scale and score of 10 or higher in Edinburgh Depression Scale, individuals were divided randomized to the intervention group (n = 33) and control group (n = 33). DASS-21 was again completed in the 4th–7th weeks of beginning of the study by all women. Results: Analysis of variance with repeated measures indicated significant differences in mean of scores of stress, anxiety, and depression at three different times in relaxation group (P < 0.05) whereas found no significant differences in the mean of scores of stress, anxiety, and depression in the control group. Conclusions: In this study, relaxation could reduce stress, anxiety, and depression in pregnant women during six sessions. Due to the simplicity and low cost of this technique, it can be used to reduce stress and anxiety in pregnant women and improve pregnancy outcomes.

The prognosis and methods of coping with headaches were studied by telephone interview in 98 children followed for 10 years after diagnosis at the Department of Pediatrics, Dalhousie University and Children’s Hospital, Halifax, Canada.